Mar 19, 2012

Following standard process has healing results

Nine days ago, my 86-year old mother had a stroke. Today she is fine. In large part because we had a good process set up, and everyone followed it.

Two years ago, she had two strokes. Both were mild, and left no damage that anyone could find. But it was a wake up call for my four siblings and me. Mom lives in Delaware and we are scattered from Maryland to Sydney Australia. She is too independent to want to live in an assisted living facility. So making sure she can get help in an emergency became a huge priority.

We got her Life Alert -- you have seen the commercials. When the person using the service needs help, she presses a button on a device she wears around her neck, and it communicates to a radio unit in the house. Someone immediately responds, "Are you all right?" Most of the time, the answer is that she's just fine, but set it off accidentally. (Should this not be true -- let's say she is being coerced by someone, the process is to ask a question just like you do with an online account. Give the wrong answer and help is on the way.) If there is no answer from the Life Alert customer, police and ambulances are dispatched immediately.

This time she said no, she was not all right. Her left arm and leg were numb -- she couldn't feel them at all -- and she had fallen when she tried to get out of bed.  Everything worked as it should. Her door was locked, but the service has on file where a key is hidden outside. The ambulance and paramedics came from just a few miles away and were there immediately. They had her on an IV, and EKG, and in the ambulance in minutes.

Christiana Hospital-Newark is not far away. When they arrived, a room was ready in the ER, a neurologist was waiting along with the ER team, and they were CAT-scanning her before she knew it. A small artery in her brain was narrowed and blocked.

Life Alert had already called my sister who lives nearest, and she arrived at the hospital not long afterward. All this is following a standard procedure set up when we started it. 

Because of the speed and smoothness with which the process was executed, the ER staff could perform a procedure that her doctor has since said is rarely even possible, because it must be done within a very short time of when the stroke occurred. They gave her t-PA (tissue plasminogen activator), the "clot-buster." Within an hour, feeling came back to her left side. She spent the next two days in bed, being awakened every two hours to make sure she hadn't stroked again, getting the carotid ultrasound, etc. One of my sisters spent three nights with her. Mike and I spent three more.

I took her to see her primary care doctor six days after the stroke, and he was exclaiming in amazement at how good she looked. Well, she didn't really look good. The t-PA, plus her fall from the bed, left her with two black eyes, bruises on her arm and hip, and a bruise on her head. (It can cause serious bleeding - a risk the patient must be informed about and decide whether to accept.) Because he is a member of the Christiana Care network, her entire story was in her electronic medical record, which he read from the laptop in the examining room.

I had seen on Twitter a few days earlier that a speaker from Christiana was presenting at the upcoming ASQ conference (which I retweeted), so I knew this hospital is serious about quality. They had obviously instituted many processes we would call lean. (In fact, I had seen signs of visual controls the two years before when Mom had her first stroke.)

The Christiana Care Quality and Safety Report does not contain a lot of details about their quality programs, but the excerpt below shows the emphasis on people and respect for them.
From the Christiana Care 2011 Quality and Patient Safety Report

Here's more about Christiana Care and its quest for quality: 

Changes on Transitional Surgical Unit...
Highlights: Patients' families included in daily rounds, shift change meetings, whiteboards, fewer patient moves to ICU, fewer falls.

Leveraging Multidisciplinary Teams to Improve Quality: Q&A With Christiana Care CMO Dr. Janice Nevin

Defining Value in the Surgical Environment 

Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Innovation Profile: Hospital-Wide Inpatient Screening for Alcohol Withdrawal and Algorithm-Driven Treatment Improve Care and Reduce Acute Delirium Episodes

We are grateful to the doctors and nurses at Christiana Care and the Christiana Hospital in Newark for the excellent treatment our mother received there. (And to the dieticians, and cooks - Mom kept remarking at how good the food was.) I'm sure all the cleaners, porters, administrators, and aides played their parts well. We also thank the Millcreek Fire Department's emergency service personnel for the fast response to the call from Life Alert. The operators, planners, and communications staff at Life Alert performed perfectly. 

Mom's taking a couple of weeks off, then getting back to her life. She drives, takes five classes a week at the University Academy, is writing a book about her homesteader great grandmother, does gardening, volunteers at her church, and takes meals to her former boss who is now homebound. She'll be doing all these things rather than going through a long recovery because of PDCA, standard processes, elimination of the waste of time, planning, and people.


Matt Wrye said...

Karen -

First of all, I am really glad to hear your mother is doing well. What a trying time to begin with. It has to be reassuring the health system she is a part of has high standards for quality and has standard work down. Same with Life Alert.

It is a great and personal story of how important standardized work is. There is nothing more frustrating then to see someone get hurt or in pain when there is a way to prevent it.

Thanks for sharing.

Unknown said...

Thanks for your comment, Matt. We have shared this story with Christiana Care, and the social media representative, Shane, will share it with the staff. Thanks go to Ken for getting the story to his friend Shane after I had also sent it to the hospital media contact.

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