Point of view

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 - Claudette Lew
Claudette Lew, Associate Editor

Over the last several weeks, I’ve spent a lot of time with a family member in the hospital—waiting, watching and listening. It reminded me of something John Irving said: “We often need to lose sight of our priorities in order to see them.” While my priorities were temporarily rearranged, I suddenly observed healthcare from a different vantage point. Suddenly issues of clinical workflows and processes were far more real. My appreciation and respect of nurses and techs grew as I got a new education on the importance of prioritization in radiology reporting, accuracy and user friendliness (or lack thereof) with EHRs, coding, billing and the potential reimbursement ramifications of even minor errors or omissions.

That health crisis that necessitates a hospitalization is frightening for both patients and family members. In this case, EMTs and then ER physicians and nurses triaged the patient. ER physicians watched, asked questions and provided patient information to the intake staff. They awaited the results of blood work. They again waited for imaging test results. ER workflow focused clearly on the patient’s urgent medical needs. Radiology played a critical role in quickly offering an initial evaluation. A neurologist was next, looking, asking, evaluating. He ruled out several major clinical problems based on the initial tests, but the patient was admitted for further testing and treatment of some injuries.

Once admitted and settled into a room, a nurse pulled up the health record and went through a list of intake questions about current medications and health conditions. She noticed the patient’s name was misspelled in the ER. It was a simple correction to be made, but everything stopped. Imaging and blood work had already been completed under the incorrect spelling. More blood work had been ordered, and further testing was scheduled. All these things—testing, reporting, coding, billing, and reimbursement could be affected by the error. Nearly a half dozen phone calls went back and forth before the situation was rectified. Tests resumed and doctors and nurses began a new series of evaluations.

Fast forward to release day. The neurologist arrived during rounds, pulling up the patient’s MRI from PACS on the bedside monitor, pointing here and there and offering the patient and family an explanation of what had brought on the ER visit. She also pulled up blood work results and summarized the current picture of the patient’s health. She showed us with pictures, numbers and careful explanation. Her words demonstrated why she felt the patient could be released and what the next steps should be in his continued care.

The business solutions that support seemingly seamless workflow and billing in a hospital system or healthcare practice are far from overtly visible to patients and their families. But when the operation runs smoothly and accurately, they clearly benefit from clinicians and staff who can spend more time treating patients and less time worrying about back-end operations.