You might think it odd that I return to this topic on Christmas evening, but there's only so much reading/TV/Angry Birds that a person can do and still be entertained.
When I left off last week, I was discussing how hospitals place great store in customer service, and in fact they tie quality of care to customer service. I for one disagree; I have worked in the healthcare industry for 25+ years and it seems to me that the more they focus on customer service, the worse the quality of care.
Anyway, I left off with my recovery room experience. I was in recover 2 hours longer than necessary because a bed was not yet available on the orthopedic floor. By the time I left recovery, I was pretzeled up from the uncomfortable gurney and sick of being blind. Remember, no glasses. When I got to the ortho floor, I saw sign after sign saying that discharge time was 11 AM. Good, I thought. Having worked for the director of case management, I was glad to see that the discharge process was receiving such attention. If I hadn't been full of narcotics, I might have remembered that I sat in recovery because I didn't have a bed....
And the bed. As bad as the gurney was, the bed was almost worse. It was merely an air mattress on top of a bed frame. No regular mattress. No trapeze (a device that hangs above your head and allows you to pull yourself up in bed; a must for any ortho floor). At least 3 different people noted that I had the "wrong bed" but nothing was done to change it. The bed caused so much back pain that I required pain meds FOR MY BACK, NOT MY ANKLE.
A bright spot in customer service was the swift action of the Acute Pain Service, who responded quickly when my nerve block catheter became kinked or blocked. And I have to say that the nurses were pretty decent. The last time I was on the ortho floor the nurses complained constantly about any and everything. I was spared that this time.
You know, it's the little things that matter, because they add up over time. I had to use a bedpan pretty frequently and that was most difficult without the trapeze. The 3-11 nurse ordered a bedside commode for me at 3:30 PM. It didn't show up until well into the night shift, and the only reason I even got it is because I asked if it had come up yet- turns out it had been sitting in the hall for awhile but no one knew where it was supposed to go. It would have been nice to be spared 4 bed changes that resulted from trying to use a bedpan on an air mattress, without a trapeze.
The discharge process was...words fail me. The ortho chief resident popped in at 6 AM (turned on bright lights and asked me to wiggle my toes) and said that my discharge orders were written and prescriptions were in my chart. I had to go to PT to prove that I could manage a walker, but other than that and some paperwork, I could have been discharged by the golden hour of 11 AM. Instead, because no one talked to each other and because the discharge nurse (whose sole job is to prepare discharges) was having a "bad day," I was not discharged until 2 PM. AND....they sent Ken down to bring the car around but didn't manage to call escort and get me to the front door until 2:35. I am assuming some other poor patient was hanging out in recovery waiting for my bed, while I was sitting there waiting for the process to let me go!
If I were to grade hospital stays based on customer service, this admission overall gets a C. The acute pain service gets an A, the discharge process gets an F, and the nursing staff get a B. The focus on treating pain is one that I vigorously applaud, but some of my pain was due to their crappy beds. In fact, except for when the nerve block hiccuped, I had no pain in my ankle at all. I had lots of back pain from the beds and muscle pain from having to haul myself around the bed without a trapeze.
The nurses at AGH are unionized and no one had more than six patients for their assignment. The discharge nurse should walk onto the floor and start filling out discharge paperwork ASAP. My nurses were mostly very kind, very nice people but my day nurse was 2 hours behind with meds and with facilitating my discharge.
I was very pleased to receive my Press-Ganey survey in the mail....
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