This week’s discussion focuses on Chapter 10 “Transitions of Care”. For this week’s assignment, you will need to read Chapter 10 and then answer the discussion question listed below. Your initial response needs to be at least 250 words and is due by midnight Thursday night. You will also need to post a response to a classmate’s post by midnight Saturday night. APA citation and formatting rules apply.
After reading Chapter 10, I realized that I could provide a very real-life scenario for us to discuss in terms of patient care quality and safety. The scenario described below happened to my grandmother. I have changed the names of all facilities and persons involved for confidentiality purposes. Please read the scenario and answer the discussion question listed at the end.
Connie, age 84, was home alone when she found herself waking up in the hallway. Connie couldn’t remember falling and had severe pain in her head and left arm. She was wearing a “Life Alert” bracelet that allowed her to call for help immediately. When the ambulance arrived she was told that although she has always doctored at Happy Hills Medical Center (HHMC), she would have to be transported to Valley View Medical Center (VVMC) because it was closer. Upon arriving at VVMC, a CT-scan was performed on her head and an X-Ray of her left arm. The CT-scan showed an active brain bleed (subdural hematoma) and the X-Ray showed that her left arm was fractured. Since the brain bleed was beyond VVMC’s scope of care, Connie was transported by a mobile ICU unit to a major medical center, Big City Medical Center (BCMC). Once Connie arrived at BCMC, multiple doctors were on her case trying to formulate a care plan. Additional testing was ordered. During this time, Connie’s family arrived. After the additional testing was completed, the doctors began holding discussions with the family. When the doctors learned of Connie’s past medical history of severe heart disease, severe emphysema, an inoperable cerebral aneurysm, and an inoperable abdominal aneursym, it was determined that nothing in terms of surgery could be done for the brain bleed or even the broken arm. The doctors at BCMC were surprised when the family stated that they were fully aware of the aneursyms. They were also surprised at her extensive medical history.
Connie remained in ICU at BCMC for a 5 days. After it was determined that her brain was no longer actively bleeding and her arm had been placed in a special splint, Connie was transferred to a skilled nursing facility, Knotty Pines, for rehabilitation. On her fourth day at Knotty Pines, Connie had to use the bathroom. Connie was not allowed out of bed without assistance. Connie rang for help and was set on a bedside commode. The staff member then left the room, giving her instructions to ring the buzzer when she was finished. After going to the bathroom, Connie fell forward off of the commode. Her roommate called for help. Connie was in pain again and was rushed to the nearest ER, which happened to be HHMC.
Once arriving at HHMC, another CT-scan was performed. It was determined that her brain was bleeding and she was to be transported again. At this time, her granddaughter (me, lol) questioned the nurse if the radiologist was aware that she had just been treated for a brain bleed? Was it truly a new bleed or was it residual? The granddaughter was assured that the radiologist was aware of the recent history of subdural hematoma. After the radiologist read the CAT-scan as an active bleed, the ER doctor made arrangements for Connie to be transferred again. At this time the family spoke up and asked if it was truly necessary since she was NOT a surgical candidate. Doctors will not sedate her at all. Couldn’t HHMC provide the same type of care if surgery was out of the question? The family was assured that she needed to be transferred.
This time Connie was transported to a different major medical center, State Medical Center (SMC) because the ER at HHMC dealt with this facility more than BCMC. Once Connie arrived at SMC, another CT-scan was performed, as well as another X-Ray of her left arm. The CT-scan was read as NOT being a newly active bleed, but chronic from the initial fall. The X-Ray was performed and showed the same result as the initial X-Ray. SMC participates in a teleradiology service that allows their doctors to view radiologic images performed at other participating hospitals. Another wave of doctors assessed Connie and determined that there was nothing that could be done other than comfort care. Connie was kept at SMC for 5 days and was transported back to Knotty Pines to continue her rehabilitation.
Discussion Question: Please identify the quality and safety issues in this scenario and explain what Components of Quality are affected. How could the issues have been prevented? How could better continuity of care affected this scenario?