Care Triad

What about the patient?

My 85-year-old mother was recently hospitalized and the experience was a great example of how far our healthcare system has come and how far it still needs to go.

The good news is that she only required 2 days in the hospital, had no complications, felt dramatically better at discharge and felt “cared for” during her hospitalization.

Here are a few things that were great: everyone we encountered was very nice, she received a printed record of her hospitalization when she was discharged (it didn’t contain much useful information but that’s a separate issue) and she was helped to sign up for access to the hospital portal so she could review her records online.

In short, the customer service was excellent. However, there were 2 important failures to see things through her eyes – one on admission and one on discharge.

First, the admission process. My mother had arrived by ambulance with chest pain. She was evaluated by an emergency room doctor who ordered an EKG, blood tests and a chest x-ray. Over the next few hours, my mother’s pain resolved and she was pretty sure that it had been caused by vomiting and irritation of her esophagus she had experienced the day before. She intended to discuss this with the emergency room doctor but the next person to enter her room introduced herself as the admitting physician. My mother had been admitted to the hospital but no one had told her. I asked the admitting physician what the diagnosis was and she said pneumonia. That was the first we had heard about pneumonia. In short, the emergency room team had decided my mother needed to be admitted and had neglected to tell her that she was being admitted or why she was being admitted.

Now for the discharge process. After 2 nights in the hospital my mother was told she could go home the next morning after her dose of antibiotics. I adjusted my schedule to pick her up at the appointed time. When the covering doctor came by to discharge her, he noted that her white blood cell count had been elevated on admission and that it was still a little high when her blood was tested the day before. He said my mother needed to stay and have her blood drawn (and wait for the results) to make sure her white blood cell count was continuing to get better. Although she looked great and felt great, he didn’t want to discharge her unless her lab tests were normal. He seemed not to realize that this would be very inconvenient for my mother and me and that it wouldn’t change the fact that she was clearly better. I asked a few questions about how the lab test results would change his decision about sending her home and he ultimately agreed that the blood test was unnecessary.

In short, the hospital did very well with customer service but completely failed to think about the patient at 2 of the most critical points of the hospitalization – admission and discharge.

Improving the patient experience is much more than just improving customer service – it requires putting the patient at the center of all decisions about the care.