Just recently, I had a personal experience which highlighted a serious problem in how hospital staffers handle health IT workflow.
The backstory is as follows. I was dispatched to the emergency department of a local mid-sized community hospital after complaining of chest pain and shortness of breath. (Turned out it was an asthma attack, not a cardiovascular complication, but the on-call doc I spoke with wasn’t taking any chances.)
This hospital ED seems efficient and well-run. Moreover, the clinicians and techs are uniformly attentive, thorough and patient. In other words, I feel safe and well-cared-for there.
That being said, I had a few experiences during this ED visit which I suspect are endemic to the industry. No one of these issues seemed serious in and of themselves, but collectively they gave me the sense that my feedback on what I observed wasn’t welcome.
They included the following:
- When I called attention to the fact that my blood pressure reading was unusually low (80/60) they dismissed the data as a blip and discouraged further discussion.
- After the expected EKG to rule out cardiac concerns , staff left the leads attached to my skin to allow further testing if needed. Because the adhesive attaching the leads to my skin came loose now and then, you guessed it, alarms went off. When I suggested that the leads be either reattached or removed, the tech’s response translated to: “Honey, you have no business asking these questions.”
- When I tried to find the results of the tests they were running via the MyChart app on my phone (yes, they’re an Epic shop), none of them were available, even though the doctors already had them.
None of these issues represent a staggering problem. My blood pressure did normalize, we handled the EKG lead stickiness issue without incident, and I did get my test results as soon as the doctor had them. I got a nebulizer treatment and some feedback on my overall health, and went home feeling much better.
That being said, I still find it unsettling that I was discouraged from taking note of what I saw and heard, and had no access to test results on the spot that would have put many of my concerns to rest.
More broadly, I object strenuously to the “doctor knows best” scenario that played out in this setting, at least where IT workflow was concerned:
- While I understand completely that nurses and techs are besieged with needless noises and suffer from alarm fatigue, treating my response to those alarms as trivial doesn’t seem appropriate to me.
- Failing to share data on the spot with me via the portal deprived me of the chance to discuss the data with my ED doctor. Instead, I only got to go over the data very quickly and mechanically with the nurse at discharge.
What bugs me, ultimately, is the intangible sense that I was perceived as a force breaking the IT workflow rather than a participant in it. This incident has convinced me that we need to transform the way HIT systems are designed, in a manner which brings the patient into the process of care. You clinicians need my eyes and ears to be on the case too.