“What we’ve got here is failure to communicate.”
In that classic line from the 1967 movie “Cool Hand Luke” starring Paul Newman, the warden (played by Strother Martin) points out that much better communication would keep things moving smoothly — or at least the way he wants them going. For all of us in healthcare, communication is key, yet we’ve let clunky systems get built up around us, systems that seem to get in the way more than we’d like.
As I’ve written about multiple times (including as recently as last week’s column), failing to efficiently communicate often leads to suboptimal care. What we really need is a streamlined process that gets the right information to the right people at the right time.
I’ve seen this first hand. Our on-call service at night has had several communication issues, and we’re trying to find out where these rules and processes came from, who decided on them, and how we can make them better. In fact, we only recently discovered that apparently the hospital operators are still trying to page us, although none of us carry pagers any more. If we’ve stopped using pagers, why has the hospital system continued to try and page us?
I still have my old hospital pager. It’s sitting on my desk at home, with a nice coating of dust, and I mostly think of it as a medical antique. We replaced our on-call system with two people on, both of whom have their cell phones registered with the on-call operator. It’s supposed to be a relatively simple system: call the first person, and if they’re not available, call the backup. We’ve never heard there had been a concern of no one being reachable overnight, so we’re not really clear why someone decided to keep this old antiquated system turned on.
Previously, the paging system in our hospital always had its own backup, which is that the paged messages were translated into a fax and an email. And this week we discovered that the administrative team at our practice has continued retrieving these faxes and emails in the morning, and going through them all to ensure that the calls had all been answered from the night before. The incredible volume of human work hours that have been wasted on our administrative staff going through these paper pages, opening up all the charts and double checking that the messages were dealt with, could probably have been better served doing the work that needed doing today.
In addition, we’ve discovered that the on-call service is reaching out to the on-call physician once, then a second time, but they are automatically telling patients that if they don’t hear from the doctor after certain amount of time that they should call the practice back. For the on-call operators, how was it decided that the message they would give to our patients was that if they don’t hear from someone after “a while” that they should just call back? Neither of these systems seem ideal, neither seem foolproof, neither seem designed to get the job done.
The technology available to us, either in the electronic medical record or through our cell phones, has allowed a lot of really important information to travel smoothly in multiple directions, often helping to expedite patient care. But when a message gets sent to an answering service that types it into an email and then faxes it to the practice, and then that fax gets put into a queue that gets dealt with at the end of the next business day, then surely we can see that this isn’t the right workflow to handle critical information.
On the other hand, I love that critical lab results of my patients come through the electronic medical record and pop up right on my Apple watch. Sure, there are times when it’s a pain, and we should probably figure out a way to automatically sign us in and out of these electronic work queues, and have the results sent to someone else when we’re not on call. But why isn’t there a way for a radiologist trying to report a critical finding on an imaging test, or a lab trying to report life-threatening blood test results, to reach us directly?
On the hospital inpatient side, this information is quickly reported to the floor where the patient is currently admitted, and that phone call is transferred from the desk clerk to the nurse taking care of that patient. The nurse then must report the results to the on-call physician who is in the hospital, assigned to take care of that patient at that moment. All of this is documented: “Critical result reported to Nurse A, who communicated the result to Resident B; results read back and verified. MD aware.”
When something similarly critically important arrives in the outpatient world, how have we allowed this to enter this cluttered clunky chain of telephone calls, emails, faxes, cut-and-pasted data, routing and rerouting, getting us absolutely nowhere? Perhaps we need some serious systems experts to come in and take a look at all the things we have going on, all the things that are pain points for our practice, including those layered on by bureaucracy and regulations, as well as limitations from shortages of personnel all the way through the good and the bad of the electronic medical record.
We should have the final say in how things work at our practice, so that nothing falls through the cracks, so that no result gets left unattended to, so that no call goes unanswered, so that no patient is not heard from or taken care of.
Answer me this.
Please enable JavaScript to view the