Source(s) of inefficiency and reduced quality of care

QUESTION

For the following case studies, identify the source(s) of inefficiency and reduced quality of care. Then discuss what changes to the health care system could be made to have improved the patient’s outcome.

• Case # 1:  Raymond

Raymond, a 78-year-old man living in a motel, is found lying on the floor of his room, semi-conscious, by the housekeeper.  The motel manager calls 9-1-1, and Raymond is taken to the closest emergency room, where he lies on a gurney in the hallway for 6 hours before being examined by a physician. Because it is unclear what is wrong with him and he cannot speak coherently, the physician admits him to the hospital for observation.  Later, when it is determined he has suffered a stroke; he is discharged to an inpatient rehabilitation facility that has no knowledge of his medical history, including his current medications for hypertension and high-cholesterol. He dies there several weeks later.

Case Study adapted from:  Kovner, A.R., and Knickman, J.R. (Eds.). (2011). Jonas and Kovner’s Health care delivery in the United States. (3rd ed., p. 201-2). New York: Springer Publishing Company.

• Case # 2:  Tanya

Tanya, a 7-year-old girl who suffers from chronic asthma, is hospitalized when her asthma exacerbates a case of pneumonia.  Although her pediatrician and pediatric asthma specialist are members of the same medical group, they recommend conflicting medications and treatments.  Decisions about how to treat Tanya are made by the pediatric unit nurses, shift-by-shift.  Her parents cannot understand why her treatment in the hospital is so confusing and uncertain.  After a week as an inpatient, Tanya is discharged and returns to school where she is kept indoors at recess and the lunch period due to the fragile state of her lungs.  Months later, her parents find out from the pediatrician that, in addition to the pneumonia, Tanya had a collapsed lung, and the pediatrician and asthma specialist disagreed about how to treat it.

Case Study adapted from:  Kovner, A.R., and Knickman, J.R. (Eds.). (2011). Jonas and Kovner’s Health care delivery in the United States. (3rd ed., p. 201-2). New York: Springer Publishing Company.

ANSWER

Case #1: Raymond

The source of inefficiency and reduced quality of care in Raymond’s case is the lack of timely evaluation and communication of vital information. Raymond experienced a significant delay in receiving medical attention while lying on a gurney in the hallway for 6 hours. This delay in assessment and diagnosis hindered prompt treatment for his stroke. Additionally, the lack of access to his medical history and medications during his transfer to the rehabilitation facility further compromised the quality of care he received.

To improve Raymond’s outcome, changes can be made to the health care system. Firstly, emergency departments need to address overcrowding and implement strategies to ensure timely evaluation of patients. This can include improved triage systems, efficient patient flow management, and adequate staffing. By reducing wait times, patients like Raymond can receive timely interventions, leading to better outcomes.

Furthermore, enhancing communication and coordination of care during transitions between care settings is crucial. Implementing electronic health records (EHRs) that allow for secure and real-time exchange of patient information can prevent situations where crucial medical history and medication information is missing. Healthcare systems should prioritize interoperability and ensure seamless sharing of patient data between hospitals, rehabilitation facilities, and other care providers.

Case #2: Tanya

The inefficiency and reduced quality of care in Tanya’s case stem from conflicting treatment recommendations and a lack of care coordination. The pediatrician and pediatric asthma specialist within the same medical group provide conflicting medication and treatment plans, leading to confusion for Tanya’s parents and uncertainty in her care. The decision-making process being left to different nurses during shifts further contributes to the lack of consistency and clarity in her treatment.

To improve Tanya’s outcome, changes are needed in the health care system to enhance care coordination and standardize treatment protocols. Establishing interdisciplinary care teams that include both the pediatrician and asthma specialist can ensure consistent and collaborative decision-making based on best practices. These teams can develop evidence-based treatment protocols for common conditions like asthma and pneumonia, ensuring that all healthcare providers are aligned in their approach.

Additionally, implementing care coordination mechanisms such as care plans and regular interdisciplinary meetings can help streamline communication and facilitate consistent care across shifts. Clear documentation of treatment plans, medication instructions, and follow-up recommendations is essential to ensure that all involved parties, including the parents, are well-informed and actively engaged in Tanya’s care.

Conclusion

In both case studies, the sources of inefficiency and reduced quality of care revolve around delays in evaluation, lack of communication, and inconsistent decision-making. Improving patient outcomes requires changes at the system level, including addressing overcrowding in emergency departments, implementing electronic health records for seamless information exchange, establishing interdisciplinary care teams, and standardizing treatment protocols. By enhancing efficiency and care coordination, healthcare systems can provide more timely and consistent care, ultimately improving patient outcomes and experiences.