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.