If you want to gauge the effectiveness of a healthcare system’s communication and collaboration technology, enter a health system as a patient or a family member of a patient. Hospitals and health systems have spent billions of dollars on healthcare technology implementations and I must confess, the results on the ground can be disheartening.
In this post, I’ll break down my firsthand experiences of the successes (few) and challenges (many) of clinical communication during my mother’s recent elective hip replacement surgery. My training and practice in many different hospital settings, as well as years of experience in healthcare IT spanning all areas of the care continuum, has given me a unique perspective of the importance of care collaboration and communication not only for clinicians, but for patients as well.
1. Broken communication in laboratory results
My mother chose a highly recommended orthopedic surgeon who performs his surgeries at a hospital associated with one of the nation’s largest physician-owned private for-profit health care networks. The care team required several medical clearances in advance, including preoperative (preop) bloodwork, which my mother coordinated herself at her local freestanding lab as she had routinely done in the past.
So far, so good. Right?
On the positive side, the preop clearance consults went smoothly, and the clinical notes reached the surgeon without problems. However, upon accessing her lab results via the lab portal, my mother noted an abnormal coagulation value which had also been present 12 years ago prior to a previous surgery. Despite being obsessive about maintaining her own personal medical history (on paper, naturally), she couldn’t find anything related to the negative workup from 2009. She immediately faxed (!) the results to the orthopedist’s office, called, left messages, and then called the 2009 surgeon’s office to obtain the relevant historical documentation. Three weeks later, she hadn’t heard back.
Then, when she went for her preop appointment on the day before surgery, she was told they never received her labs because she had them done “at the wrong place.” Fortunately, she’d brought copies with her and the physician’s assistant said this abnormal lab would “not be a problem.” She was told to be at the hospital at 5 a.m. the next day for surgery.
2. Broken communication the morning of surgery
We arrived at 5 a.m. to a completely locked down hospital with only one open entrance through the emergency department (ED) ambulance bay – not surprising to me, but I was a night shift doc for many years. After finding someone in the ED to make a couple of calls, we were directed to the operating room (OR) family waiting room and instructed to pick up the phone to learn where to go next.
Unfortunately, the phone wasn’t in service, so we had to hike back to the ED. ED staff made more phone calls and then directed us to the opposite side of the hospital to outpatient registration.
We signed in at the kiosk and registration went smoothly. But, after waiting over two hours with no further communication, the time of scheduled surgery came and went. I asked a volunteer staff member for a status check and she informed us that the surgery had been moved back by four hours and someone should have told us already. We were given no reason for the delay.
A different staff member came for my mother an hour later, two hours earlier than we expected, and we discovered that the delay in surgery was ordered by the anesthesiologists based on the (you guessed it!) abnormal coagulation test results. They were considering canceling the surgery. Multiple providers, several conversations, and additional lab studies later, the surgery was back on.
3. Broken communication in the postoperative waiting room
The anonymous patient tracker in the family waiting room meant to provide status updates wasn’t functioning. I was later told no one uses it anymore since they switched EHRs because “it never works.”
Ninety minutes after speaking with the surgeon to learn everything had gone well, I finally called the post-anesthesia care unit (PACU) nursing station using a nearby phone and was told everyone had been too busy to come get me.
My good deed for the day was revealing the existence of the PACU phone to another family who had been waiting five hours for a status update. When they called, a nurse told them their mother had been taken upstairs “several hours ago” but no one had informed them. They had been sitting there all morning, worried there were complications with their loved one.
4. Broken communication in alarms and alerts
My mother’s transition to the floor was unremarkable and after several hours I left for the night. When I returned the next morning, I learned that my mother had been awakened all night by a constantly beeping infusion pump and a nurse call device that was out of reach. The white board on the wall displayed extension numbers for her to call via a Spectralink device, but unfortunately it was safely ensconced in its holster on the back wall and unreachable by my mother.
Fortunately, one night in the hospital was enough and we were discharged home late on postop day No. 1.
5. Broken communication in postoperative care
Once we were home, we received multiple calls from several different home health and home physical therapy (PT) agencies, all claiming the hospital designated them to provide postop care. Unfortunately, in this day of pervasive phone scams, my mother never answers calls from unknown numbers. It was a Friday evening and coordinating care over a weekend is a challenge. Ideally, this coordination would have taken place during the eight hours we were sitting in the hospital room, waiting to be discharged.
When clinical care is exceptional, but clinical communication is lacking
The surgical procedure itself was a rousing success. Two weeks after surgery my mother is home alone, walking with a cane, and is self-sufficient. As a healthcare professional, I understand that at the end of the day, the patient outcome is by far the most important aspect of the healthcare encounter.
Yet, many of our patients and their families might not appreciate outcome over experience. Disconnects and unpleasant communication can lead to patients and their families assuming the worst about the care and skill of their providers – even though we know they are usually completely unrelated.
So, while this may seem like a rant of an overly-knowledgeable patient family member, I think it’s illustrative of the fact that we, as an industry, have a long way to go to realize the benefits of healthcare technology. The health system where we experienced these significant clinical communication disconnects has spent millions of dollars on technology. Yet, in many ways, the communication between providers, patients, and family was the worst I have ever experienced.
Healthcare viewed with the lens of consumerism is not going away and we owe it to our patients and their families to ensure communication between all participants in patient care works seamlessly, reliably, and securely. Learn more about how Spok Go® can help with several of these communication breakdowns by contacting us today.