Curbside Consult with Dr. Jayne 2/1/21

I mentioned in last week’s EPtalk my ongoing healthcare adventures with Big Health System. As a patient, the organization unfortunately continues to provide plenty of material for HIStalk.

It’s an interesting setup there, with the academic medical center and the non-academic hospitals not fully aligned. That leads to somewhat of a “let’s do it separately together” approach to not only the EHR, but operational and workflow elements, too.

The academic side of the house continued to have their act together. I had specifically requested that my skin biopsy be sent to the flagship hospital’s pathology department after hearing about a friend’s disastrous experience at one of the community hospitals. They didn’t disappoint. Pathology was turned around in less than 48 hours and I received a phone call from the dermatology office bright and early on Saturday morning. When I went to look at the report via the patient portal, not only was it there, but also present was a full copy of my visit note and not just the post-visit summary.

The community hospital where I was scheduled for my MRI continued to underwhelm. I showed up at 6:45 a.m. as requested. There was a backup of people waiting to enter the hospital at the COVID screening checkpoint. Based on the predominance of running shoes and scrub pants peeking out from long winter coats, I assumed that many of them were employees arriving for a 7 a.m. shift change.

It would have been useful for the facility to have separate lines for employees and patients to get people more quickly to where they needed to go. No one was standing six feet apart, but everyone was masked, so I guess that’s something. After finally making my way into the building. I noted that at least the line at the coffee kiosk was well spaced, so that was good.

I quickly found my way to the “imaging pavilion,” the name of which made me laugh since it looks like just another hallway branching off in the bowels of the mammoth complex. I’m sure the naming had something to do with fundraising, but a decade after its addition, it just seems silly. The hospital has grown up around it, and once you’re in that part, you still have to snake around to get to the particular area where your study will occur.

Despite my compliance with the pre-registration team’s phone call, they had no record that my file had been updated. I had to answer all the questions again, this time while yelling through Plexiglas to someone who acted like they couldn’t hear me despite the fact that my patient-facing work has made me very good at speaking clearly while wearing a mask. I had to sit for a full 15 minutes, which was annoying since I was the first patient of the day and had arrived at the time they specified. There was no explanation of the delay, and I was somewhat tortured by the overly-loud TV blaring a local morning show.

When I finally made it back to the MRI suite, I noted that they had turned the two curtained changing areas into a single larger one, presumably for distancing. They had rearranged a credenza and chair in the changing area, but unfortunately had not rearranged the herd of dust bunnies and leftover hair on the floor, which kind of grossed me out. I know that hospitals are running on razor-thin margins, but skimping on housekeeping services isn’t the answer.

As I finished changing, they brought in a second patient. That person was using the changing area while I was in the adjacent IV chair, so they got to listen to all kinds of personal questions that I was asked. Starting my IV was challenging, resulting in multiple attempts in which the second patient was the audience for the latter two.

I’ve had this study done numerous times and have never had someone right behind me like that. As a patient, it was unnerving. I don’t expect total privacy, but I do expect that they pace appropriately so that staff doesn’t feel rushed while they’re trying to complete satisfactory IV access.

I was greeted in the MRI room by the team member who was going to do my actual study. Turns out I recently cared for her daughter at the urgent care, so we had a bonding moment. Since this particular MRI study is face-down, they don’t make patients wear masks. We had a laugh when I handed my mask to her at the last minute — the MRI magnet was attracting the metal nose piece, and I felt for a brief second like I was in some weightless space movie as it floated upwards.

The rest of the procedure was uneventful, and I slept through it as planned. Any day the IV works right and you don’t get an arm full of contrast material is a good one. I headed home to await my results.

I usually get a call from the nurse coordinator who manages my program, but this time I got a call from the physician because they’re changing my follow-up protocol. She explained the situation and the next steps and promised to send the information through MyChart. The results arrived more than 24 hours later with this header:  

Result Letter: Not Sent
Error: The exam failed to generate a default result letter. Please review the exam information and select the correct result letter or contact your helpdesk for assistance.

Just what every patient wants to read, right? I don’t know if the issue was on the part of the radiologist or the physician who called me, but either way it’s a poor user experience and one that patients should not have to deal with. Fortunately, I’m a physician informaticist who understands what this means, but for other patients, it might have generated anxiety and phone calls.

I wonder if the institution explains to physicians how to prevent this, or what things need to look like on their side to make sure the patient gets the right letter. I have the notes I took during my phone call, but that’s it as far as commentary on the results. I also wonder what kind of user acceptance testing is done from the patient perspective, if any. I know of too many hospitals and health systems that never test the patient-side views.

I would be interested to hear how other organizations manage testing for scenarios like this, and whether they’re doing any post-visit quality checks to ensure it’s not a common occurrence. Have you seen this at your institution? Leave a comment or email me.

Email Dr. Jayne.