Sunday, 9 November 2014

6429 - Follow up on the medical assembly line

More observations, experience and impressions – We walk into the day surgery unit at the local, regional, medical center at 5:30 AM Monday morning and are given a card with our number on it, #6429.  There are codes below the number that can give an update on the patient’s status, provided somewhere on a screen so that any family member can know where the patient is and what is happening. 
We are there for a rather straightforward procedure, a minor repair that is supposed to take an hour beginning at 7:30 AM with an hour or so recovery time and then home.  Why it takes two hours to sign in and get ready remains a mystery as it seems at least an hour was mere wait time, no registration, no preparation, just wait.  We will call it insurance time, in case it’s needed. 
A man comes out from behind some doors and calls our number “6429” and in we go, off with the clothes, on with the gown, vital signs, etc. you probably know the drill.  There will be seven people attending this procedure, the pre-op nurse, an OR nurse, the nurse anesthetist, the main surgeon, his PA, a surgical resident doc and a surgical technician.  There is a 8th wandering around,  an orderly for help with transport from gurney to OR table.  The last thing I remember was someone putting a pillow under my head and looking up at all the lights and wires.  After an hour of invasive surgery, I am transported, unconscious, to recovery, 6429 changing status for another hour, and then awake and preparing to leave.  My wife’s face is most welcome waking up and she helps me get dressed and chauffeurs me home, still woozy from the anesthesia and in a rather weakened condition.
By 11:30 AM I am in my own bed, resting quietly.   About 2 PM we notice blood oozing out from the wound above my belly button and I felt miserable.  A call to the doc and we are told to come back to his office and he would see what was going on.  There by 3PM on the table, sprawled uncomfortably with my feet on a stool because the table was too short.  Or am I too tall?  He said he would call the hospital, see if they could get a bed and I could be readmitted.  An hour and a half later, we shuffle across the road via wheel chairs and car to the emergency entrance for a “direct admit” foregoing all the emergency room registration, admission procedures.
I am ushered into the CDU, “Critical Decision Unit” just off the ER where there at least 10 cubicles, one for each patient being observed and evaluated. I spend the next 18 hours there and here is an abbreviated account of that piece.
CDU, at least not ICU.   It is about 5 PM and the usual intake procedures are initiated, more vital signs for the record, the weight, recorded by the bed itself, temperature, pulse, blood pressure, oxygen, all within normal ranges.  An IV is started for some hydration and nourishment since I have not eaten anything in over 24 hours, perhaps contributing to a sense of weakness, no fuel.  I ask if it’s still possible to order dinner and yes, it is.  Good news as I am very hungry.  Looking at several choices, I opt for pot roast, mashed potatoes, sliced peaches and some chicken noodle soup for starters.
Some medications are prescribed and the nurse comes to flash the laser on my bracelet to see what they are so they can be ordered from the pharmacy.  When she goes to put the information into the computer, the screen gives her a message that will not allow any further progress.  She mumbles something about the system not working and I agree wholeheartedly.  She blames the pharmacy.   I suggest that perhaps since I was discharged from the day surgery outpatient unit, I have not been re-entered into the hospital admission system.  She says, no, your name and information are right here, pointing to the bracelet and the computer.
Three hours later, they discover that since my bracelet wasn’t changed on readmission, their system would not recognize the new me.  Meanwhile, pain and discomfort have increased although I am still hungry. The nurse and patient traffic outside my CDU # 10 continues all night long with a variety of blood tests on me and changing of IV by my own bedside.  Sleep is next to impossible.  By morning, I want simply to get out of there ASAP.  I order a large breakfast of scrambled eggs, fresh fruit and toast, consume it probably too fast and it all erupts twenty minutes later.  Several doctors stop by, make some observations and comments, and the surgeon says if I feel like it, I can go home by noon.
It is now Tuesday afternoon, I am home and recovery is much slower than expected.  By Friday morning, I am on the mend, feeling better but still a ways to go to get back to being fully operational, no pun intended.  My conclusion is that the insurance companies are holding the medical system hostage to lousy patient care and I will be hard to convince otherwise.  The “critical decision” should be whether or not the patient is better, not whether time and the UCR has expired.  In case you did not know, UCR is “usual, customary and reasonable” and has to do with fees.  What the insurance company apparently does not take into account is that there are situations that are unusual, unreasonable and not customary.  It seems there might be a case made for getting it right the first time rather than taking the additional time, extra trouble and serious inconvenience to do it over again.

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