There is an enormous opportunity to improve the way healthcare is delivered. Our providers are run off their feet every day trying to deliver the best care they can with the limited resources they have. My passion for healthcare excellence comes from many sources but is most rooted in the experiences I have had with my mom over the years. Here is one of those stories.
My 84-year-old mom lives in the house our family built in Yorkton, Saskatchewan when I was 14 years old. My two brothers and I were quite a handful to raise mom kept us on the straight and narrow. She loved playing practical jokes on the three of us and April Fool’s Day was always a day to be nervous about what she was cooking up. She also has five grandchildren and one great grandchild, whom she talks with quite regularly. Mom is a ‘good old farm girl’, as she puts it, and is the definition of a go-getter! Despite complex health issues, she still enjoys every moment of every day. You will find her in the yard working on her countless flowers and large garden that supplies her with enough vegetables to go through the winter. She is a die-hard Saskatchewan Roughrider fan and can crochet just about anything! Since her 80th birthday she has been on oxygen and drags a long hose all through the yard as a constant companion.
Mom loves it when we are all home in Saskatchewan, a home full of laughter, teasing, and kids running around as she cooks for us. In December, while hosting a big family dinner, we could see her labouring away and resting on the counter to catch her breath. We tried to get her to sit down as we attempted to take over, but she would have none of it. The next day, she was feeling weak, nauseous, and could barely get up from her crocheting chair.
I could tell it was deeper than just exhaustion from all the excitement of the previous day. It became obvious something was very wrong when she did not argue as I said, “I’m taking you to the emergency department”. Once we got there, because she was labouring to breathe, we were moved to the front of the line. The initial assessment by the triage nurse put her at a CTAS 1, the most severe rating level. Mom was put into an emergency room bed and her O² was increased from 5 Lph to 15 Lph in an effort to get her saturation level above 80. A portable X-ray was brought in and showed significant fluid in her right lung. Blood work showed an infection, possibly pneumonia. She was going to be admitted and put on antibiotics and high flow O². Upon the decision to admit her the nurse came in to complete the admission documentation, it was 28 pages of paper. When I asked why they would not be using something like an I-pad to direct input the information the nurse indicated that they have two different systems that do not talk to each other, so they needed to write it down and then input it into two separate systems. I could not help but think how much time this was taking away from the nurse being able to help other patients.
Later that night mom was moved into an inpatient room, in the pediatric unit, as beds were scarce in the hospital. I arrived back in the morning to support her through the different tests and scans. The CT scan discovered she had a pneumothorax in her right lung, which was fully collapsed and full of fluid. She needed a Thoracostomy, a tube inserted to drain the fluid and reinflate the lung. Given it was during Christmas break we learned the doctor wasn’t available to do this procedure until the 10th of January, which would leave Mom in this condition for another 11 days! The hospitalist knew she could not wait that long, and although he had only completed the procedure once before, asked mom if she would be ok with him performing it. Mom is from a generation that explicitly trusts physicians and agreed to him completing the procedure. The Dr did an amazing job, but the suction wasn’t actually removing the fluid, but mom never gives up. Over the next 10 hours, my mom worked diligently on moving about, doing lung exercises, and focusing on “keeping the bubbles flowing” in the suction machine, to try to get all the fluid drained out of her right lung. This was exhausting for her but her will is quite amazing. By the next day, her CT scan confirmed the fluid was almost all out and the lung had reinflated. This was great news and we were told she just needed to stay a couple more days to let the wound heal and for observation.
At this point she’s been in the hospital for 7 days. During this stay she was now on her third bed move within the unit for three different reasons unrelated to her admission diagnosis. On the eighth day, within an afternoon, she went from feeling better to laboured breathing again. Tests showed her lungs were fully inflated, but her heart rate was erratic, ranging from 50 – 180 beats per minute and blood pressure all over the map. Further tests showed she now had atrial fibrillation. The next two days were a series of tests and trials to try and find the best level of anticoagulant to use, and due to medications she was on she needed to use the less desirable Warfarin.
Her weight was now down to 80 pounds and her arms and veins were so hard to draw blood that they were both purple from bruises. Just as they figured out the right dose her breathing got worse again. This time she had caught hospital acquired influenza and COVID. This was significant due to her COPD and the first night the nurses were barely able to keep her oxygenated. But, somehow, my super mom made it through the night and was feeling better by the next evening. The problem was, she needed to stay longer in the hospital. When she was finally released, after almost three weeks, she still had a high white blood cell count. She was in good spirits but not the best of health. I will leave the continuing story and readmissions for a next time.
Mom’s story is not an isolated one. What should have been a 7 day stay with appropriate timely treatment turned into 20 days and additional life-threatening illnesses to battle. From excess manual documentation for healthcare staff, to lack of specialized healthcare resources to perform the care required, to the increased length of stay due to hospital acquired infections, and the significant work created for all hospital departments each time a patient is moved – the list of opportunities to improve healthcare is widely evident.
Fortunately, I was there to advocate for mom, but I worry about those patients that do not have an advocate or the support to quickly move through the system. I also worry about the staff having to work in an environment where there are fires popping up everywhere.
The system does not have to be this way, we have proven that in other health systems transformations.
At The Poirier Group, our significant experience and business consulting services span many industries – not just healthcare consulting. Our proven track record of delivering tangible and pragmatic sustainable results comes from a blend of analytical rigour and creative problem-solving, empowering our clients to unlock their full potential to remain competitive.
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