The Patient Who Was Nowhere
Study the Case and then answer the questionsat the end. The spaces will expand as you type.
Jane Brown, RN has been a nurse at Community Hospital for 15 years.A competent and caring nurse,she receives excellent reviews and always has positive comments from her patients in patient satisfaction questionnaires.
Despite her reputation, Jane has just finished yelling at the Admissions clerk that she cannot provide care to her patients if she can't enter orders for them in the electronic order entry system.Then she storms into the Nursing Supervisor's office to complain about the "incompetent idiots" in the Admissions office.She has not been able to enter orders for a new patient transferred to her Medical floor, Room 225, from the Critical Care unit for over three hours because "those Admissions people" have not transferred the patient in the ADT system (Admission, Discharge, Transfer) and the patients are still "located" in the system in CCU.
The Admission Clerk, who has been busy all morning entering patients newly admitted to the hospital, hangs up the phone from Jane Brown's call and tells her supervisor that she "can't transfer a patient in the system if no one tells her the patients have been transferred from one room to another!"Her supervisor goes over to the report printer where a long pile of paper has printed from the hospital network communication system and folded into the printer bin. The Supervisor begins separating the individual sheets and reviewing them.Near the bottom of the stack is the transfer sheet on the patient. The supervisor gives the three sheets to the clerk, who keys in the patient's name, types in 2-2-5, in the new location field and presses [enter].
The patient is now "officially" transferred and Jane Brown can carry out the physician orders for the patient in Room 225.
The Software System that Community Hospital has had for the last year is very advanced and allows for order entry to be tied to the patient geographic location. All departments are then able to electronically access the patient location to send paper reports and carry out tests at bedside when needed. On the financial side, when transferring the patient in this system, room rates are automatically adjusted, which results in a more accurate billing process.For example, the room rate for CCU is much higher than a medical floor, so the patient now in Room 225 will be billed at the correct rate for the time in each unit. Prior to the new system, the Nursing Units entered the transfers when they occurred.Becausethey were always busy, this never happened in an appropriate timeframe, resulting in a nightmare of problems, including inaccurate daily census, lost reports, andtime consuming manual adjustments to the patient bill.
After the new Software System was implemented, Admitting was given the responsibility to make all changes in patient location in the system.Throughout the day, the admitting clerk takes the messages off of the ADT system and enters the changes, thereby ensuring that the patient location is correct.
Adapted from Shaw, S, Elliot, C., Isaacson, P., & Murphy, E.(2010).Quality and performance improvement in healthcare. Chicago, IL: AHIMA.
Case Study Questions
1. Indicate theopportunities for improvement in this system. Write a full paragraph, citing details from the case and providing explanations to support your conclusions.
2. Is a PI team appropriate as an improvement tool in this context?
3. Explain with supporting details from the case and from your own study.
a. If you do feel that a PI team is appropriate, who do you think should be a member of the PI team?What is your reason for including each member?What role would each member have on the team: leader, member, advisory? Be sure to apply your comments to the case.
b. If you do not feel that a PI team in appropriate, what performance improvement tools would you use to solve this problem?