May 22, 2013 Proceedings of CCHHS Quality and Patient Safety Committee

During the public comment period, a pair of nurses complained that unlicensed Medical Assistants were doing nursing work without supervision.

The meeting was dominated by a long report comparing various measures of hospital quality. The data aren’t consistent even within measures; the CIO is working to reconcile them. There were no data about the supply of Spanish-speaking staff; this will be provided at the next meeting.

Between arrival at the Emergency Department (ED) and actual admission to the hospital, it takes a total of 638 minutes---nearly 11 hours. Many ED patients, lacking primary care, require time-consuming evaluation before the admission decision can be made, but more than 4 hours is spent simply waiting for a hospital bed. All patients with real emergencies are given priority and seen in less than 6 hours. Those ultimately discharged also wait an unacceptably long time (170 minutes).

ED wait times have been calculated based on when a doctor completes his/her notes. But because notes are often delayed, future wait times will be based on when a doctor "signs up" for a patient, unless this is prohibited by the Center for Medicare and Medicaid services.

Consultations with specialists and waiting for MRI results account for most delays. CCHHS will examine other hospitals’ procedures and may call on colleges for process-engineering support.

Patient satisfaction surveys: 72% of patients rate CCHHS "very good" overall, which sounds
great til you learn this means 99% of the nation’s hospitals do better. The biggest difficulties were getting through on the phone or having a call returned, followed by wait time and lack of information about delays. Though wait times at certain clinics are down to 90 minutes, patients don’t perceive the improvement. Wait times for tests and specialty care also need to be reduced. Patients get good care once they can get to doctors but barriers to access are huge.

Dr. Stabile, in charge of the Patient-Centered Medical Home initiative, cited improvements including "patient panels" (care teams to help doctors manage patients) and computerized records. An RN Care Manager coordinates care; this should improve phone response. They’ve also revamped scheduling and hope to offer some 12-14 hour clinic days by year-end. Chairman Michael said, "Overall we’re doing badly and seem to be getting worse." The key problem is lack of respect for patients. "We give the impression we think we’re doing them a favor." Training won’t be enough to create a customer service ethic; incentives would be necessary. Dissatisfied patients represent loss of market share; neighboring hospitals are already pulling in County Care patients. But CCHHS can never be successful if it’s short-staffed.

---Submitted by Kelly Kleiman