Adventures in Discharge (Mis)management

The following story concerns a small slip in discharge planning — really, a tiny issue in the grand scheme of things. But since I’m the patient affected by the slip, you won’t be surprised to learn that it feels pretty important to me. Also, given the extent to which niggling IT issues played a role, perhaps there’s something to learn here for readers of this site.

The incident took place after a recent hospitalization at Johns Hopkins Bayview, a sister facility to the Johns Hopkins mothership in central Baltimore. I generally don’t name the hospitals involved when I write about bad experiences, but in this case, the hospital involved is well, branded “Hopkins,” and I hold a facility with its reputation to a higher standard.

During the last week of December 2019, I was an inpatient at Bayview for just under a week to address a flare-up of a chronic illness. Nearly everyone I encountered during my stay was prompt, thorough, warm and upbeat.

I was particularly impressed with the way one nurse on my unit handled things when I complained about the long delay I faced in getting discharged. Not only did he immediately leave the unit to deal directly with my concern, but he also took an exemplary customer service approach to following up on his efforts.

“We didn’t do our best this time,” he said with what seemed like full sincerity. “I’m sorry. We’ll learn from this.” If most hospital employees responded the way this nurse did when patients had complaints, it would have a huge impact on patient satisfaction across the board. (Someone at Hopkins should give this man some love!)

However, when I got home and began going over the medications with which I was discharged, I noticed a problem. Though I was told by a physician to keep gradually increasing doses of my medication upward steadily at timed intervals, the medication label didn’t include instructions for doing so. Because titrating up this med is important to my treatment, I was a little concerned by the oversight.

To address the issue, I spoke with a pharmacist working at the Bayview pharmacy. She was as pleasant as could be but couldn’t help. In fact, when she logged into the pharmacy system she found she didn’t have the permissions to even access my records.

Because the pharmacist suggested it, my next step was to call the unit’s nursing desk and see if someone there could determine what was going on. After running me through security questions, one of the nursing team members looked at my record, but the steady increase in dosing recommended by the inpatient physician wasn’t documented in Epic either.

Given how sure I was about my dosage instructions, I’m not going to let this drop. I’m hoping my outpatient physician will write a new script to address the problem, or at least help me better understand the situation. However, if she wants to check in with Hopkins to verify my existing instructions, I’m guessing she won’t get anywhere.

Again, I realize that this is far from the most egregious care coordination problem I’ve ever tackled across the course of my care. However, after a couple of hours attempting to solve the problem, it’s not the most minor one either. And as of this writing, more than a week after my discharge, it still hasn’t been solved.

I do hope that if someone at Hopkins Bayview ever reads this, they take note of the disconnect I encountered and do something about it. If I ever need a concrete reminder that small care coordination issues can blossom into threats, this was it.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

2 Comments

  • The benefits of guided care coordination across the continuum has been proven time and time again but too many hospital execs are deaf to the value. In addition, there is a built in resistance to transition from legacy hospital case management models and adapt value based care coordination principles. Many execs will claim that they are not reimbursed for providing care coordination post discharge, but they fail to consider the long term financial benefits that are accrued by reducing avoidable visits to the ED, reducing admissions, improving clinical outcomes, and reducing payer denials. Successful post acute care coordination is based on patient risk and can be as short as 7 – 10 days post discharge or as long as it takes for patient to assume self care. The new marketplace is today’s guide.

  • Stefani,

    What you say about execs not seeing the benefit/value of better care coordination makes sense.

    That being said, on the hospital operations level, aren’t health leaders constantly being reminded of the massive cost of poor medication compliance? I was trying hard to follow physician instructions and no one I reached at Hopkins Bayview had the power to help. I was surprised that this didn’t seem to be something they were prepared to address.

    Also, couldn’t they at least make it possible for the pharmacist to access my records? I’d assume that hospital execs take data silo problems seriously, but they seem to have dropped the ball here somehow.

    None of this takes away from your original points, which were very helpful. Just making a few additional observations.

    -Anne

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