My son John was recently admitted to UCLA hospital as an outpatient for an epidural injection for what the doctor described would be a way to decrease his back pain from a bulding disc due to a basball injury - and what John hoped would be a way to eliminate it. As it turned out, the results were much closer to John's hope than the physician's promise - but in retrospect, she was doing a great job of what all "good" consultants would call managing patient expectations. It also turns out that this was only part of the patient-centered care approach that we experienced at UCLA.
Here are a few others:
First, everyone - and I mean everyone - smiled alot. And, we arrived at 5:30 in the morning. The general feeling of the unit was pleasant and upbeat - which, to be honest isn't all that hard in Santa Monica, California during February.
Second, John was cared for by one nurse from the time he arrived until his discharge. She coordinated all of his care. And, we knew exactly who to go to with questions.
Third, patient education was rampant. From the anesthesiologist who came in to the room prior to the procedure to explan exactly what a "translaminar" injection was to the lab tech who inserted the IV line, information was plentiful. After inserting the IV line, she asked, "Would you like me to explain what I just did and why I did it?" After John shook his head yes, she went on to describe the purpose of the line and the fact that because it was plastic and not metal, there would be no hematoma or pain. She also explaiined the fact that because a foreign body had been inserted all of the cells around the IV line were "clumping around it trying to fight it", so he might have some slight pain. But, she went on to explain that within a few minutes when the cells realized there was no harm, they would calm down and any pain would disappear.
Fourth, the procedure was lickety-split quick. From the time John was rolled into the radiology where the injection was performed under x-ray visualization to the time he returned to the room next door, was all of about 8 minutes.
The bad news......this five minute procedure took 3 hours out of our day. Although John's pain began improving almost immediately, we found ourselves talking more about why this simple procedure took so many people and so much time from the patient. First, there was the admissions representative, who we spent about 15 minutes with. Then, 20 to 30 minutes in the waiting room. Another hour in the room next to the xray room waiting for the pain management team to be ready and encounters with the nurse, lab technician and anesthesiologist. And, another 40 minutes after the injection taking vitals, and giving John apple juice. Although the outcome from a quality perspective was superb, I found myself asking the question - did we need this amount of oversight and safefy for an epidural injection? Many patients receive injections in their physician's office with no adverse events. The question for us on follow up with the physicians at UCLA is to ask them to explain the pros and cons of having the injection performed in the hospital versus a physician office.
Now, the clinical documentation component of this story....During the two or so hours we spent in the room, John's medical record (hard copy) was on his bed stand. So, of course, we read it. There was surprisingly little information documented from any of the current clinicians. We found no progress notes, either blank or filled in. My guess was that the notes were at the nursing station and would be completed after the procedure. However, there was a four page, transcribed note from the physician's office that had made it's way to the hospital from a visit to the office 10 days prior. The note was superb! It contained lavish details of his history, the physical - that took a resident and an attending physician about 40 minutes to perform - as well as the review of John's prior documentation that we had brought with us to the visit. So, our grading on a scale of 1 to 10 for patient-centered care was a 9 and for documentation, a 9.5!
