I totally blew up at a nurse, a nurse practitioner and a "patient advocate" today.I'd just been held up at Roswell Park for hours past what I had expected. Again. One time too many.
There is a systemic problem with the outpatient infusion clinic at Roswell. They can't keep an appointment. Not your usual problem with not keeping appointments, mind you, but a gross, irresponsible inability to keep appointments. One can plan, on any given day, that if one's appointment is set for any time after about 9 AM, one can expect a minimum of a two-hour wait just to get seated in the clinic. Once seated, expect another hour to see a nurse practitioner. After that, perhaps 45 minutes more to get one's chemo. The wait gets worse as the day goes on.
These delays are hurting patients, the staff and the hospital's reputation:
Patient attiude: It is the talk of the waiting rooms that appointments are so egregiously not kept. Usually one will hear about the hour and a half wait, the two hour wait, the three hour wait, etc. No one bothers to apologize for the problem, either. The wait is so bad and so long that the hospital has put a band-aid on the problem. They use pagers, the kind of light-and-vibrate things they give you at Outback Steakhouse or Olive Garden when there is a long wait. In the case of Roswell, the reservations have been made weeks or months in advance. Is this situation really right?
Patient Care The long delay means, even if a patient lives in Buffalo, he is tired and annoyed by the time he finally gets his chemo. If the patient is from afar, it may be the wait is on top of a long drive in starting with the wee hours. This frustration is taken out on the nurses, who are just doing their best within the system. Still, mistakes are inevitable. Two weeks in a row, I had to demand a chemo drug that was odmitted. For several weeks, an order was written requiring observation after this Erwinia. Today, for some reason, someone noticed and the order was enforced. Not a problem if prompt attention had been paid. But it was the end of a long series of disappointments, more waiting, and more disappointments. My appointment was at 10:00. I was seated at 10:45, which is actually pretty early. I didn't get my chemo, a stupid, simple shot of Erwinia( which, granted is not a routine drug, but I AM the only person in the hospital who gets it, so it shouldn't have been hard to find.) until 12:30. As the patient advocate (basically a customer liason) said to me, "You just seem like you've had it." And she was about right. What would have happened who didn't know everything he needed to get that day, before he showed up?
Follow the money: Hospitals don't seem to like to talk about money. But I wonder if Roswell Park knows how much money they are losing with their inefficiency, especially considering the chemo clinic.
It seems to me a basic flaw exists in the attention paid to certain periods of time. More effort is spent focusing on the time chemotherapy takes. But the time chemotherapy takes is not up for change. There's only so much stuff one can get into his body in an hour. Some drugs require observation, for a specific period of time. It is not appropriate to fight the time medical procedures take, and I think medical procedures are not the reason things are delayed. I think the delays boil down to 1) a lack of a manager or expediter to move things along when they need to be moved along, and b) a belief that once a patient is seated, the pressure is off.
My contention is that once a patient is seated, the pressure is on! It oughta be showtime. Fifteen minutes shouldn't go by between the time a person is seated and the time chemo starts flowing through their viens. A half hour would be great. But what I don't think they realize is the time people wait in chairs, inside the chemo clinic, is the time the WHOLE clinic is delayed.
One thing the patient advocate, who I spoke with at length while I was cooling my heels in the clinic for two hours today, requested I make some sugesstions. Here they are:
A. Treat chair time like gold. This time in the chair is the ONLY hope the clinic has of reaching a more on-time treatment rate, or increasing its throughput. We can't change chemo time, so everyone's got to figure a way to hustle. Patients should spend as little time in the chair when not getting chemo as possible.
2 Find alternatives to the chair. In other clinics, patients are returned to the lobby after an evaluation until a dr./ NP/ exam room is ready. Appointments are rarely late in other clinics, just chemo. So send us out of the chemo if things aren't ready! If observation or post counts are needed, don't keep us in the chair if another patient is waiting. There is very comfortable Stickley furniture in the lobby, and I am sure we could wait the proper amount of time then. The hours people would normally wait in the clinc chair would be spent in the less-scarce lobby seating, freeing up more space for more patients and enabling everyone to do the job accurately and efficiently.
3.Invest in any technology that will decrease labor and increase accuracy and speed of care. Wilson Hospital in Johnson City, a small generalist hospital, has these neat scanner guns. The nurse scans the order, scans the drug, scans the patients' wristband. Any drug, chemo or otherwise, is a 1-minute affair to confirm.
In the chemo clinic, one's nurse gets all the chemo, sets it down. Then the nurse has to go find another nurse. An odd ritual ensues, requiring basic ID information from me and having both nurses sign off on the orders and chemo confirming both are correct. So now we have two nurses, two clocks ticking, two sets of labor hours charged for a procedure that allready takes two or three times what it might take if a modern scanner system were in place. I don't know, but this seems like it could save a lot of time over 50 or 100 patients in a day.
That is about all, but realize why I am frustrated mostly is I entered this whole thing with only the best things to say about Roswell. And frankly, my care has turned out just great. But after so many days like today, there is just so much you can take. I had my fill today, and hence the problem that has probably earned me quite the reputation.
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PS: Becky: I'd like to email you back but the silly blogger program doesn't show your email. GRR.
Dustin: I miss Dustinland. And thanks for spreading the word about my blog.
