Mini Med School Brief #2

Hospital to Home - A Winding Road




Dr. Michael McCloud opens the class

Week 2 of UCD’s Mini-Medical School focused on a topic that most of us would rather ignore until necessity bares its teeth and makes us pay attention. Deborah Bakerjian,PhD, RN concisely outlined the continuum of care that we - or a loved one - may experience during and after a hospital stay. Lacking knowledge of the health care system, any one of us can be drawn into a labyrinth that rivals the London Underground overlaid with a street map of the infamously complicated city. In the case of health care, it’s not only easy to get lost, it’s also dangerous. So, like my fellow undergrads, I Iistened up!

Bakerjian, an assistant adjunct professor at the Betty Irene Moore School of Nursing at UC Davis, advised us: “You are a member of the health care team and you are the center. The more empowered you are, the better the outcomes.” The time to assume that role is now, when we’re well and determined to stay that way!

 
Some Smart Moves

Step one, she says, is to designate a personal advocate - someone familiar with your medical history and your intentions regarding the level of life saving care you expect. After all, when we are admitted to a hospital we may not be in the best mental and physical condition - think stroke, heart attack, unconsciousness. The advocate will have access to your health records, know your wishes and be able to help guide your care when you are not at the top of your game.

 

The California Patients Bill of Rights has an online form that makes it easy to designate an advocate in writing and prepare other documents such as a POLST (Physicians Orders for Life Sustaining Treatment) , a Durable Power of Attorney and an Advanced Directive that specifies the level of care you want and do not want. These documents, when signed by a Notary Public, are legal and enforceable. You can find out more about the benefits of this kind of planning ahead by reading an inspiring story about a Sacramento woman’s advanced planning, by by Sacramento Bee writer Anita Creamer.

 Follow the Roaming Records?

But, it’s not just emergency and end-of-life decisions that call for an advocate. That responsible friend can also help guide your journey back to health. As an expert in the process, Bakerjian admits that, as patients move through the system from hospitalization to after-care, there are ample opportunities for information to go astray.  Consider that a person may have seen more than one team in an ambulance, the emergency room, another in surgery, intensive care, and a hospital recovery room. Each will have sets of records as will an individual’s personal physician; it’s easy to grasp the concept of many moving parts that don’t necessarily fully mesh with each other. In addition, an emergency may have taken a patient to a hospital not in their insurance network - necessitating a transfer. Bakerjian pointed out that although electronic medical records are the ideal solution for such cases, they are not yet reality. Most often, your records and history cannot be immediately shared between all hospitals.

 
“Every time we move we are vulnerable,” Bakerjian  says.
 

Speeding Recovery

Upon release from a hospital, a patient may be sent to a skilled nursing facility (a SNF). The advocate can help select which facility would best suit the patient - and research the quality of facilities www.nuringhomecompare.gov before making that choice. Considerations include staffing level, the results of health inspections, complaints and deficiencies noted in inspections. It’s also important to know that SNF’s are not required to have a physician on site. Most skilled nursing facilities are not like a hospital with doctors, RNs and LVNs readily available. Bakerjian lauds the growing use of Nurse Practitioners in SNFs because their presence shows improved health outcomes for patients. An  advocate can monitor medical visits and intervene if necessary. That said, Bakerjian pointed out that SNFs are the nation’s second-most regulated industry, just behind nuclear power. Nonetheless, caution and research are advised.

 

Learning without Experience often Necessary

Health events requiring hospitalization, rehabilitation and skilled nursing care are, thankfully, not a commonly repeated experience for most people. However, this lack of experience can create ignorance that’s dangerous. Health records with allergies listed, medications taken, past health history and Advance Directives can help mitigate the chance of information getting lost or not communicated from one entity to the next.  Having those documents accessible and available to a health advocate is critical. Understanding these vulnerabilities in the system is important according to Bakerjian. She freely admits that records from hospitals are “often incomplete,” that emergency department treatment can be “missing,” lists of medications “may be inaccurate” and other balls in the healthcare court can go astray.

 The take-away from week 2 of Mini Med School, a free community service created by UCD Department of Internal Medicine geriatrician Dr. Michael McCloud? Just buckle down and take care of business! Complete legal paperwork that can protect you and guide your personal care according to your wishes, and make some trusted person your advocate. Then, relax and do something fun like bungee jumping or sky diving without worrying about those troublesome, what-if details!

 Next week we learn about skin. Stay tuned and perhaps I’ll be able to pass along some miracle cream, eye lift serum, age spot remover or, at least, a better attitude through understanding of the body’s biological concept of “face time”.