May 22, 2012

More healthcare experience: a timed visit to urgent care


Sometimes you test the healthcare industry by mishap. On Friday I came home with a trunk full of flowers to plant. I went through the garage into the house to enlist Mike's aid in unloading them, walked back into the garage and found myself falling.

As I looked back at the dangerously placed step, I thought about putting "fluorescent tape" on my shopping list when we bought this house, and thought about how I never  had followed through. I wasn't looking at my feet, however, and I'm still pondering how to render the hazard safe.

I hobbled into the house, took off my sock, and found a big blue goose egg blooming below my ankle. Sprained? I could move all my toes, so I decided it wasn’t broken and I didn’t need a trip to Urgent Care -- which is many times less expensive than Emergency, I’ve learned. I figured the first sunny weekend in May would mean a crowded waiting room, not an attractive prospect. Mike made me an ice bag, and Ace bandage, and got me some naproxen, while I made a bid for sympathy on Facebook. (I was kinda proud of remembering from Girl Scouts how to properly bandage a sprained ankle. I did get that First Aid badge.)

I spent Saturday on the couch with a book, and went to a play we had tickets for, limping. It didn't hurt much, just swollen. By Sunday morning, Facebook comments were in favor of getting my foot checked out. It was even fatter than it had been before -- not a good sign.

St. Joseph Mercy Hospital has an Urgent Care unit not far from us, so Mike drove me there.

Here’s a rundown of their performance:

12:09 I arrive.
Go through doorway marked urgent care.
Stand around near the lone clerk signing a patient in.
Eventually she looks up and tells me I should have stopped in the lobby to sign in.
Mike goes back out to sign me in.
He goes home to start planting.

1:09    I’m called to triage room.
           Problem assessed, course of action determined: X-rays
           I’m sent out to waiting room

1:15    I’m called in to wait in hallway for X-ray.

1:25     Lisa, the X-ray tech, checks with me, gets room ready
            Xrays taken
            Back to waiting room -- all the exam rooms full.

1:40     Called to the exam room by the nurse
            Nurse leaves.
            Nurse comes back for more assessing.
  Doctor comes in, looks at the foot, goes out to look at the X-rays, back in, there’s no obvious fracture, but she wants to immobilize with a splint until I can see the orthopedist.

2:09      Getting ready for splint. It involves wrapping the foot with gauze, adding cotton, molding a quick-cure fiberglass slab to the foot and wrapping with elastic bandage, while I lie on my stomach with my knee bent and foot in the air. My foot shakes because I’m pressing my knee on a reflex nerve. Lisa comes in to hold my foot still. Finally the job is complete, but it feels like I’m wearing a wrinkled sock, and I know that will drive me crazy. Nope, not gonna do it.

Rework: the nurse is not pleased about taking the whole assembly apart to get at the gauze. She starts over. I continue to complain about wrinkles, she leaves and comes back with the doctor. (The doctor implies this means she’ll take responsibility for any future flak.) The first fiberglass mold is not going to work. They have to stand there holding another one through the cure time.

I decide to accept the work this time.  Doctor tells me to follow up with the orthopedist. Lisa comes in to say that she can’t burn my X-rays onto a disk because the computer isn’t working right. I can pick them up in the morning, however.

I get exit papers from the nurse. I get crutches. Nurse gets more frustrated when I fail to catch on to how to use them. She gets wheelchair, loads me on with my crutches, and takes me out to wait by the front door, giving the receptionist the responsibility for me.

 3:09             Call Mike to come get me.

Three hours from in to out.

Monday morning: I call an orthopedic surgeon’s office, finding one at the same facility so the X-rays wouldn’t have to be picked up and taken anywhere. Woman tells me the doctor will read the X-rays and decide what’s next. She’ll call back.

Tuesday morning: Nothing from the orthopedist. I call back. Woman said she called yesterday and left a message -- someone must be wondering why somebody called them about foot fractures. The conclusion is that there is no fracture. I should baby my foot. But what do I do about my splint? The woman and  I decide I should just take it off myself, and not go to get entangled with another medical intervention.

Bought a Futuro ankle stabilizer at CVS. It, combined with a trusty hiking boot, is about as much support as the splint. Good thing too, because I did a poor job of protecting the splint in the shower this morning. 

I’d give the whole healthcare service  I received from St. Joe’s a “B.” Some courteous and caring people, some quick flow in parts of the process.

So what do you think? How could it have been improved?

2 comments:

mbaudin said...

You should not have had to wait 1 hour at the emergency room for triage. You should have been able to sign-in online from home, go through a self-triage questionnaire, and received a number, with a dynamically updated estimate of when that number will be up. This would have allowed you to go to the clinic just in time to be seen. You would still have waited, but at home.

Once at the clinic, eliminating the time between medical acts for patients in process is more difficult but should be pursued at least for common cases. This may involve replacing "monument" x-ray machines with smaller ones or using alternative technologies to see fractures, like sonograms. You should not have had to wait 1 hour at the emergency room for triage. You should have been able to sign-in online from home, go through a self-triage questionnaire, and received a number, with a dynamically updated estimate of when that number will be up. This would have allowed you to go to the clinic just in time to be seen. You would still have waited, but at home.

Once at the clinic, eliminating the time between medical acts for patients in process is more difficult but should be pursued at least for common cases. This may involve replacing "monument" x-ray machines with smaller ones or using alternative technologies to see fractures, like sonograms.

Karen Wilhelm said...

Thanks for the input, Michel. I never thought about the sign in from home. In fact, I called and asked how busy the facility was and the receptionist guessed a 45-minute wait. I could have looked for a different facility, but you never know how good a physician is in one of the private clinics. It's surprising that all hospitals don't have urgent care facilities to take the burden of treating minor injuries and illnesses off the emergency room. ERs are beginning to advertise short waits and online availability of waiting time estimates. If 30 minutes is a short time, that is. As you say, a short wait for triage is no guarantee of fast cycle time.

The strangest thing is how they kept sending me walking from pillar to post when I obviously had an injury that was going to be made worse by walking. They could have had a well-signed bank of wheelchairs at the entrance, or a roving receptionist with a telephone headset to offer aid.

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