September 3rd, 2008

harpsichord

Improvements need in hospital discharge methodology

Last week when we were in Philadelphia (actually Haverford) seeing Robert's father in the hospital and then back home I got another taste of how things work in hospitals. He was in the Bryn Mawr hospital; I'd say all the staff were exceptionally nice and seemed competent - the attending physician in particular.

After everyone agreed it time for him to be discharged and they did their bookkeeping they brought in a pile of prescriptions and instructions. They were all handwritten and the writing, particularly on the what to do next instructions was hard to read. The nurse came into explain everything but had little information about why the various drugs were chosen (mostly heart/bp many of which I recognized) but there were some others. His father was quite surprised to see an acid reflux drug since he hadn't complained of this - perhaps it was given because one of the symptoms that caused him to be hospitalized was nausea.

He brought the prescriptions to the clinic at his retirement community and when checking on the status they said that the pharmacy had trouble reading the faxes and they had to be resent. They used trade names for some of the drugs and not the generic names even though they are available in generic; hopefully the filling was done with generics at the lower cost.

At the other end of the spectrum they had several WiFi networks (including one public one) and most of the machines and other devices that they brought into the room used it to get their info into their system.

I've been reading about how poor discharge instructions often contribute to re-hospitalization; probably that won't happen in his case partly because he has access to the clinic; his regular doctor and cardiologist and he is alert and smart - some of these conditions are not present for many patients.

Also I just read an article about the problems caused by unclear prescriptions and the situation where drugs with very different characteristics have similar names. This is a situation where better technology universally applied would be very helpful. When I go to Harvard-Vanguard, my HMO, the doctor deals with prescriptions on the computer mostly by just checking off renewals and the results are available downstairs at the pharmacy. When I request refills online I do have to type in the prescription number and drug name. I can request renewals from another part of the website which does list my prescriptions. A few years ago with United Health Care their online system only required checking a box on the list of my active prescriptions to get refills.