Experiences in the Emergency Room

I have worked as a customer support specialist in the emergency department for five years and have witnessed many outpatient procedures. Most people might think that an emergency department mainly deals with ambulances bringing patients in, but most of the time, we treat patients who have driven themselves to the hospital. Patients who experience outpatient care have come in to the hospital for minor check ups, headaches, fevers, cuts, etc. There have been times where the waiting room is packed full, and they have to wait because we are understaffed. I feel this is the biggest problem with our health care system today. In the hospital that I work at, there are a total of 12 rooms in the emergency department but only one doctor working. The number of patients coming into the emergency department can be very unpredictable, and when we are understaffed is when we run into the most problems. I have seen people wait for hours just to be checked in, and I feel that if more people were working, this wouldn't be such a problem. Having more workers would provide a shorter waiting time, as well as more patient interaction with healthcare providers. Also, patients wouldn't feel as though they are being hurried out and may feel more comfortable opening up to the nurses/doctors about their concerns.

Health Care Experience

I am posting this on behalf of my dad, who wrote this as a patient...

I've been a businessman for more than 20 years in manufacturing environment. In my opinion, the single most examine important element to maintaining a successful businesses is the ability to minimize waste and maximize efficiency in every operation of the business. To varying degrees, the health care industry has been very slow to adapt "lean manufacturing" principles in the products and services they offer. The textbook definition of "lean" simply means the elimination of waste in the execution of a process, where waste represents any action / time that is not directly conducted in the process of delivering the product or service.

As I use the healthcare system, I immediately notice the inefficiency of the process. Starting at patient check-in and carry it through to patient discharge, it seems very few of the services performed have any efficiency built in. Why? Possibly because our system does not have a natural competitive marketplace. If you are fortunate enough to have health care, probably you are limited to a specific plan (provider, location, etc) and cannot "shop" for a better deal. So the costs for services have little emphasis placed on them, as the provider can set their price for services high enough to cover the waste. Secondly, particularly in the case of urgent care, most people (with health coverage) do not care about costs; they simply want treatment. In summary, it is mostly an unmanaged system of inefficiency, with little incentive to change. 

Reform #3

Being a future health education promoter, it is our responsibility to ensure access to health care and knowledge to enhance the health of individuals. One barrier to accessing care is the cost of receiving care. Stated by Shi & Singh, there are 46 million Americans who are uninsured (Shi, Singh). One reason as to why health care is so expensive is because of the growth of technology in the medical field, and although it makes things pricier, our group believes that better technology leads to a better quality of care received.

            One are of technology that can be improved is health information technology (HIT). Stated by the Department of Health and Human Services, HIT reduces health care costs, increases administrative efficiencies, decreases paperwork, and expands access to affordable care. “Health information technology can help to improve public health one individual at a time by building partnerships between health care consumers and providers across the country” (Dept. of Health & Human Services). So although refining health information technology may cost more initially, the benefits that come from an advanced system outweigh the cost.

            Technology has also taken a role in the medical world. Medical technology defined by the Kaiser Family Foundation as “ procedures, equipment, and processes by which medical care is delivered” (Kaiser Foundation). Technology is also expanding by providing information to people all across the nation about their health issues. An example of expanding health care technology is the access of medical information on the Internet. It is understood that the Internet doesn’t necessarily treat a problem, but it can help prevent illness and aid populations in recognizing symptoms. Those who rely on the Internet for information about their health do have to be careful, however, because the web isn’t regulated and has little oversight, so the information might be incorrect. Therefore, our role as health care providers and educators would emphasize teaching patients how to recognize credible Internet sources.  The Internet is a great resource, “it can’t completely replace face-to-face contact with a health professional” (PHAC).  Our group believes that e-health can empower and encourage an individual to become more aware of their body and health, which ultimately could reduce the cost of visiting doctors for easily treated and preventable health problems.

            Technology can greatly impact the quality of care a patient receives. Growth of technology has been associated with rising health care costs, but according to the New England Journal of Medicine, countries such as Britain and Australia have adopted a cost-effectiveness system. This system evaluates the cost of new technology per quality-adjusted life. (NEJM).  Some technologies, differing from the norm, actually decrease costs for health care. An example of this is the use of antiretroviral therapies being credited with the reduction in hospitalization of AIDS patients (Shi & Singh). Better technology allows new procedures to provide a better diagnosis, faster and more complete cures, risk-reduction in a cost-effective manner, and new treatments that are more effective, less invasive, or safer. Also according to Shi & Singh some examples of technology enhancing care is the use of laser technology, which is available for performing surgery without as much trauma as a normal surgery and also allows for a shorter recovery time (Shi & Singh).

            According to the Kaiser Family Foundation, many factors should go into a new technology increasing or decreasing the cost, such as the cost of treating an individual patient and changes resulting in lower or high health spending.  Another factor is can much the new technology is used by a broader population, or is it only available for specialized care? (Kaiser Foundation). Health care professionals also strive to improve ways to treat their patients by providing the “latest and greatest” service. Having state-of-the-art technology practices drives competition with different providers and may even serve as motivation for practitioners to improve their own practice.  Either way, creating new technology to be used as treatment is a desire to increase human understanding (Kaiser Foundation).

            Overall, technology is an asset to health care improvement. The question of whether we are getting value for the money spent will always be pressed upon those involved in care. Providing patients with the best care possible is what providers strive for, and if resources for professionals aren’t available, the overall quality of life and health of a population suffers. Putting a price on one’s health is difficult to do, and our group thinks that if spending money on advancing technology improves the well being of patients, then it is money well spent.  

 

References:

Shi,L., & Singh D. A.(2008). Delivering Health Care in America: A Systems Approach. Sudbury, Massachusetts: Jones and Bartlett

Health Information Technology. (n.d.). Department of Health and Human Services. Retrieved March 27,2009, from http://www.hhs.gov/healthit/

 

How Changes in Medical Technology Affect Health Care Costs. (2007, March 8). Kaiser Family Foundation. Retrieved March 26, 2009, from http://www.kff.org/insurance/snapshot/chcm030807oth.cfm

 

Davis, K., Ph. D. (2008, October 23). Slowing the Growth of Health Care Costs — Learning from International Experience. New England Journal of Medicine, Volume 359(Number 17), 1751-1755. Retrieved March 26, 2009, from http://content.nejm.org/cgi/content/full/359/17/1751

 

For the Good of Your Health: Technology and Health Care. (2008, June 4). Aging and Seniors. Retrieved March 27, 2009, from http://www.phac-aspc.gc.ca/seniors-aines/pubs/tech_fact_sheets/ no05_e.htm

My view from a different university

My name is Adam and I was asked by Rachel to comment on this blog concerning outpatient and primary care. I am currently a student at Argosy University in Eagan, MN, working toward a degree in Vascular Ultrasound.

Health care reform is a major topic in today's society. With the rise of insurance premiums and the loss of jobs across the country, outpatient clinics are being utilized more often than ever. A major reform that needs to happen in my opinion is reduction of costs. We all know that health care is not cheap, and it is getting more expensive. As people lose employment and subsequently lose their insurance, the cost of any care that is required is often passed onto those who have health insurance in the form of higher premiums. Both the hospital setting and the outpatient clinics need to be able to offer affordable care to those who need it.

As I have been learning in my studies at Argosy, insurance companies are reimbursing less and less to the hospitals for exams performed, such as ultrasounds or stress tests. In order to earn enough money, more and more exams are being crammed into normal work days. I have learned that an ultrasound technician in a busy hospital can perform twenty or more exams in a given day! What does this mean for patients and for health care workers? Health care providers are having to having to work faster and harder, while patients are getting less time with the providers or technicians.

Reimbursing is also becoming less for primary doctors. Doctors are spending much less time with their patients then ever before because they cannot afford to spend too long with one person. The doctors get the same amount of money per visit, regardless if it is then minutes or an hour. It is unfortunate that our health care system has become more about the money than it is about how well we care for our friends, family, any who put their trust in us.

Another major reform that needs to be made in my mind is the elimination of referrals. In my studies, we have learned that many health care clinics require a written referral from a primary doctor in order to have specific exams completed. This forces people to have to make multiple appointments and pay multiple co-pays in order to get the test they want or to see a specialist. Many people need to see specialists multiple times, and in doing so they have to see their regular doctors time and time again when it really isn't necessary. Outpatient clinics help with the increased speed of some exams, but more change is necessary.

Finally, with the increased in computer technology, computerized charts are a must. Many health care facilities are switching from the paper chart to an electronic one, but this needs to happen on a national level. Electronic charts make the transfer of information from one provider to another so much quicker and more efficient. Providers, doctors, technicians, anyone who is involved with the care of a patient has instant access to all the patients information, allowing them to make better decisions concerning the patients plan of care. Outpatient clinics and hospitals can all be linked together and create a great environment for care giving.

Health care reform is no small task. It requires not only changes from the administrations, but also from those of us who are physically working with the patients. We need to be efficient with our time so we can care for as many people as possible, but we also need to take the time to make sure people are happy with our care giving. I have learned that patient interaction is so important to the success of care giving, and we as health care providers need to focus on making each patients visit as pleasant and efficient as possible.

Improving health care

I am a Nuclear Medicine Technologist at a hospital in the Twin Cities. I work daily with outpatients, performing tests to diagnose various types of disease. One of the biggest problems I see with heathcare is cost. The most common test we perform in our department costs upwards of $5000. If a patient doesn't have insurance, they will either end up not having an exam that would be beneficial to them, or they will complete the exam but not pay their bill. In this latter case, the hospital ends up eating the cost of the test. At most hospitals around the area, this is a growing problem. The current economy is partly to blame, since as people lose jobs, they lose insurnace coverage. Even those who have insurance are increasingly not paying their portion of the copay, and the hospital loses money. This loss ends up getting spread around, since exams end up costing more for everyone in order to make up the difference.

One step toward improving this downward spiral is to reform the insurance that patients have. A universal health coverage would be a good start. If patients had better access to insurance, it would in turn provide them better access to healthcare since the costs involved would be less of a barrier for them. It would also help insure that the hospitals were reimbursed for the tests they provide the patients. By being paid consistantly, providers would be able to lower the costs for everyone. Patients would be able to get the tests they need instead of putting them off because of an inability to pay. By getting these tests, doctors will be better able to diagnose disease in the early stages instead of waiting until a problem becomes chronic or needs costly emergency treatment.

Reform Proposal #2

As medical professionals in the making, our group is looking out the the patient, who one day could be ourselves. We want to make sure that everyone has access to the best quality health care possible. Primary care is defined as the first contact with the health care system, in which a health care provider provides basic and routine care including all the patients health care needs (Shi and Singh). As discussed in Delivering Health Care in America by Shi and Singh, secondary and tertiary care are other levels of care. Both of these levels of care come after diagnosis of a disease. Secondary care includes specialist consultations or procedures that primary care doctors cannot provide. Tertiary care is the care of a patient with a rare or uncommon disease. This usually involves hospitalization, highly specialized care, and the latest technology.

Our group believes that if health care providers of primary care put more emphasis on prevention, we could decrease costs of secondary and tertiary care. In a recent news article, Dr. Rick Baxley stated "If [the patients] kept their blood pressure down, if they kept their blood sugar down, if they kept their cholesterol down, if they quit smoking, then the cost of health care in the United States would drop dramatically" (Mort). As seen in the video Sick Around the World, Britain was running a huge preventative campaign. Britain believed that prevention was a key component of health care (Frontline). This is something our group would like to see in the U.S. health care system. According to The National Commission on Prevention Priorities if preventive care was expanded "millions of Americans could live longer, healthier, and more fulfilling lives" (National Commission on Prevention Priorities). This same article also stated that if we increased the use of just 5 preventive services in the United States, 100,000 lives could be saved a year.

Robert Jecklin pointed out in the Cost, Quality, and Access lecture that the cost of health care is different for its many players; individuals, employers, insurers, health care providers (Jecklin). The cost incurred by medical providers may increase with the increase of preventative care. The cost incurred by individuals and employers would depend on how the insurance companies would react and how much they would cover. Although costs may rise initially, costs incurred from treatment of preventable diseases would decrease. In the long run costs would be decreased. Say a patient was developing type II diabetes. The progression of the disease could be prevented with diet and exercise. If the patient was not given proper preventative care, the diabetes would progress and could cause many other complications. One such example is kidney failure. The cost of the treatment for kidney failure would be much higher than providing preventative care to the patient.

Our group has a strong believe in quality health care for all. The quality of health care would be improved with this reform. The implementation of increased preventative care would increase patient education and patient health. Diseases could be avoided with the proper prevention education. If the health care system is keeping patients healthy, this is a measurement that proves the good quality of the health care given. Avoiding diseases would increase the patients quality of life. They would not have to live their life being controlled by a preventable disease.

Access to health care can be measured in the numbers of people who can get health care services (Jecklin). If more time is spent on preventative care, our group's theory is that less people will develop preventable diseases. If less people are needing treatment of these diseases, the providers would have more time to see patients and provide proper preventative care. Thus, since more patients are able to be seen, access to health care would be increased.

A previous reform suggested to increase the number of primary care facilities. This would definitely increase access to health care facilities due to an increase in providers. Increasing the number of primary care centers is like increasing your ability to had out medication for an illness. On the other hand, increasing preventative care would be like teaching proper hand washing to prevent the spread of the illness. Increasing facilities would help with treating symptoms of disease but increasing preventative care would allow people to avoid the disease. People would not have to live by treating symptoms; they could stop them before they happen.

References

Frontline. (2008). Sick around the world [Video]. Retrieved from: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Jecklin, R. (2009). Cost, access, and quality [PowerPoint Slides]. Retrieved from: http://uwlax.courses.wisconsin.edu/d2l/orgTools/ouHome/ouHome.asp

Mort, S. (2009). Some US doctors are practicing preventive care. Retrieved March 10, 2009 from: http://www.voanews.com/english/2009-03-09-voa44.cfm

National Commission on Preventative Priorities. (2008). Preventive care: a national profile on use, disparities, and health benefits. Retrieved March 10, 2009 from: http://www.prevent.org/content/view/129/72/

Shi, L. & Singh, D.A. (2008). Delivering health care in America: a systems approach. Sudbury, Massachusetts: Jones and Bartlett.

Reform Proposal #1

As we have learned in class, cost, quality, and access are three important aspects of healthcare to consider when making any changes (Jecklin). The changes our group wants to propose relate to our main values and beliefs. Our main values are a concern for the underprivileged in society, nationwide access to healthcare, and equally good services in poor/rural communities compared to affluent/urban areas. Our main beliefs are the importance of technology in healthcare, the necessary role of social and spiritual elements of health, and the use of clinical interventions instead of alternative therapies.

By having the government/private providers increase the number of outpatient facilities, this will provide better access for elderly and other underprivileged patients as they may not be able to travel far to receive medical care. Also, by healthcare providers spending more time on patient (and family) education, this should increase the number of patients who understand what is expected of them for following medication directions and comprehending the details of their medical care, resulting in better quality care.

Some may argue that nationwide access to quality healthcare through a government universal healthcare system will increase costs initially, but it would result in better access, which our group values. Better access would result in better quality care over a person’s lifetime and increase the likelihood that they would see the same primary physician consistently. Dr. Bruce Auerbach of the Massachusetts Medical Society explained, when patients have “a relationship with” a primary care physician, “those individuals…have the best outcomes” (Bowler). According the Shi & Singh, “A health services delivery system that lacks universal access is ill-equipped” to provide continuity of care.

In order to overcome racial/ethnic and geographic barriers and increase access and quality while maintaining affordable, the government/private providers must concentrate on the placement of and access to outpatient clinics. We also need to pay attention to the costs and affordability of the healthcare and not let them increase too much.

Initially, incorporating the use of better technology in outpatient services may result in higher costs, but it will improve the quality of care. Also, increases in technology allow for the formation of more outpatient clinics and also procedures to be performed at lower costs in less time, increasing the quality. This in turn leads to greater availability and access because more patients can be treated in one facility in the same amount of time (Emory Healthcare).

Dr. Thomas Hines of Boston University Medical Center states, “The most essential skill for a good family doctor is knowing what [the patient] know[s], knowing what [the patient] do[es]n't know, and being able to distinguish the difference between those two things” (Bowser). As important as noting that difference is educating the patient on what they need to do. Being aware of each individual’s needs based on their condition, age, culture will improve the quality of healthcare (Adler). Different patients need different levels of social/spiritual involvement and healthcare providers must be aware of this and act appropriately.

Studies have proven the use of clinical interventions in the treatment of patients as being beneficial. To greater promote this, healthcare institutions should place an emphasis on reaching the populations around them and informing them of the benefits of healthcare. Also, caution must be exercised to maintain respect for others and their beliefs. However, they should be informed of the healthcare options that are available.

Improving outpatient and primary care is of great importance because our healthcare system is continually shifting from hospitals and inpatient services to outpatient and primary care services. Insurance companies have also begun to prefer outpatient services more than inpatient services (Shi and Singh). Our society will probably continue the trend of increasing demand for outpatient and primary care services. “Industrialized countries with strong primary care networks -- the Netherlands, Germany, Switzerland -- have some of the world's best medical outcomes: longer life expectancy and lower infant mortality rates” (Bowler).

By Sabrina Klein

References:

Adler, A. M., & Carlton, R. R. (2007). Introduction to radiologic sciences and patient
care. St. Louis, Missouri: Saunders Elsevier.

Bowler, B. A. (2009). States face shortages of primary care doctors. PBS News. Retrieved February 27, 2009, from: http://www.pbs.org/newshour/bb/health/jan-june09/doctors_01-06.html.

Emory Healthcare.(n.d.) Improvement report: Outpatient-centered care: Quality, access, efficiency, and patient satisfaction. Retrieved February 27, 2009, from: http://www.ihi.org/IHI/Topics/OfficePractices/ Access/ImprovementStories/ OutpatientCenteredCareQualityAccess EfficiencySatisfaction.htm.

Jecklin, R. (2009). Cost, access, and quality [PowerPoint slides]. Retrieved February 18, 2009, from: https://uwlax.courses.wisconsin.edu/d2l/orgTools/ouHome/ouHome.asp.

Shi, L., & Singh, D. A. (2008). Delivering health care in America: a systems approach. Sudbury,
Massachusetts: Jones and Bartlett.