THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: June 15, 2006 09:04 PM Thursday;
Millie letter to Kaiser feedback on hospital care improvement.
2...Hospital Care Improvement Feedback on Why Patient Checked Out
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Resperatory Department Emergency Room Quality Care Feedback Lessons
1103 - ..
1104 - Summary/Objective
110501 - Follow up ref SDS 93 0000. ref SDS 92 0000.
110507 - ..
1108 - Progress
110901 - Hospital Care Improvement Feedback on Why Patient Checked Out
110903 - Follow up ref SDS 93 PR5R, ref SDS 92 PR5R.
110905 - Millie prepared ref DIT 1 0001 to commend Kaiser's good work in the
110906 - ER, ref SDS 0 TB5U, Kaiser's team care practice, ref SDS 0 TB9X, and
110907 - Doctor Sunitha Rao Annamaneni, MD in Resperatory Department.
110908 - ref SDS 0 TB5R She also provides feedback that may aid the Respeatory
110909 - Department in developing quality care protocols.
110911 - 1. I was treated in the Emergency Room at Kaiser, Walnut Creek
110912 - beginning on June 7, ref SDS 91 044G, and then by you in
110913 - Resperatory Department on June 8th, ref SDS 92 PR5R, and 9th,
110914 - and then checked out at that time. ref DIT 1 0001
110916 - [On 060801 Millie received letter from Joel in Member
110917 - Services at Kaiser Walnut Creek, ref SDS 97 PR5R,
110918 - responding to Millie's letter today.
110920 - ..
110921 - 2. I am very pleased to commend your excellent care in the
110922 - Resperatory Department, and that by the ER team. ref DIT 1 FU5L
110924 - [On 060817 commendation to backup doctor and Oncology team
110925 - for dramatic reversal of rising cancer marker, and breakup
110926 - of IBC disease, indicating patient on the mend. ref SDS 98
110927 - L29J
110929 - ..
110930 - 3. On recommendation of the Oncology Advice Nurse, I went to
110931 - Emergency on Wednesday, June 7th at about 2pm, with a
110932 - temperature of 104+, I was shaking with chills, and wobbly on
110933 - my feet. The screening doctor commented that I looked fit,
110934 - and, despite elevated temperature, standard practice releases
110935 - patients with no evident symptoms of disease or injury to go
110936 - home. ref SDS 91 4G5N After further discussion the doctor
110937 - checked patient history on the computer. The doctor followed
110938 - Kaiser guidance for treating cancer patients with elevated
110939 - temperature, and with cancer marker indicating possible rising
110940 - metastatic disease for the past five (5) months.
110941 - ref DIT 1 FU5Y
110943 - [On 060711 diagnosed IBC recurrence, ref SDS 95 025H,
110944 - chemotherapy treatment begins 060721. ref SDS 96 0001
110946 - ..
110947 - 4. Christy and Cellia were timely and professional preparing
110948 - admitting documents, taking vitals, ref SDS 91 PS6Q, and
110949 - drawing blood for initial assessment. Blood draws with needles
110950 - have become problematic for me. ref DIT 1 8N7J I appreciated
110951 - very much Cellia's careful work minimizing trauma to the arm.
110952 - ref SDS 91 YS6O
110954 - ..
110955 - 5. About half an hour later, I was admitted to an emergency room.
110956 - Andrea assisted me, being attentive to privacy, and comfort,
110957 - posting the initial work plan on a marking board, and
110958 - monitoring my condition while waiting for a doctor. ref SDS 91
110959 - K64F James set up another blood draw and IV using the port
110960 - catheter. This is specialized work, which he performed
110961 - perfectly. ref SDS 91 K645 James was informative and helpful
110962 - conveying messages. In sum, nursing staff and procedures in
110963 - the ER reflect Kaiser's high standards. I was treated with
110964 - competence, compassion, and dignity. ref DIT 1 4R8G
110966 - ..
110967 - 6. The attending physician, Doctor Natchak, explained findings of
110968 - pneuumonia in the lower left lung, shown by xrays, and
110969 - consistent with blood work showing elevated WBC fighting
110970 - infection. ref SDS 91 PT7S This was treated with fluids to
110971 - bring the temperature down, and with antiobotics. By about 6
110972 - pm my temperature had lowered. The doctor advised that blood
110973 - count rose slightly. ref DIT 1 8N9S
110975 - ..
110976 - 7. I was suprised when the doctor asked, ref DIT 1 8N41, how long
110977 - I have had esophagitis. ref SDS 91 LN6M
110979 - ..
110980 - 8. We briefly reviewed the record showing esophagitis was reported
110981 - in a PET scan test on January 20, 2006. I received this report
110982 - in a meeting with the primary care physician on February 17th.
110983 - (as shown in a record on January 26, 2006, ref SDS 71 DH4O)
110984 - There was no time during the meeting to read the report. After
110985 - the meeting, I read the report and saw the analyst's comment
110986 - about esophagatis. ref SDS 72 DH4O My letter to the primary
110987 - chare physician on March 20th reported occasional symptoms of
110988 - esophagatis. ref SDS 75 XE3M Could this be a target for cancer
110989 - relapse driving up the CA 15-3 marker? What treatment is
110990 - needed? A follow up PET scan test on April 14, 2006 was
110991 - presented by the doctor during a meeting on April 28. This
110992 - next test made no comparison with the prior findings of
110993 - esophagatis. No diagnosis and no treatment was prescribed at
110994 - that time on April 28th. Therefore, on June 7th I asked Doctor
110995 - Natchak the basis for asking about esophagitis.
110997 - ..
110998 - 9. The doctor advised that Kaiser's computer says I have
110999 - esophagatis. ref SDS 91 YT9J
111001 - ..
111002 - 10. Subsequent research seems to show correlations between
111003 - radiation treatment for cancer, and esophagitis, and further
111004 - with pneumonia, ref DIT 1 8N5T, which all fit my patient
111005 - history. ref SDS 91 I24L
111007 - ..
111008 - 11. I was very pleased that Doctor Natchak consulted with an
111009 - admitting team, who recommended hospitalization for treatment
111010 - and observation, based on patient history. I am grateful for
111011 - Kaiser's Team Care process that supports busy doctors with
111012 - multiple views of experts. ref SDS 91 A58H At approximately, 7
111013 - pm Doctor Natchak said that I would be moved from the ER into a
111014 - hospital room in a few hours. About an hour later, I was taken
111015 - to a holding room for transfer to the main hospital.
111016 - ref DIT 1 8N5Y
111018 - ..
111019 - 12. The next morning on June 8th at 6:30 am I was moved from ER
111020 - into room 303B in the Respiratory/Medical/Alzheimer Ward of the
111021 - main hospital. ref DIT 1 8N93 This 12 hour delay presaged
111022 - issues that may need attention. ref SDS 92 PR5R
111024 - ..
111025 - 13. Your [Sunitha Rao Annamaneni MD] work was thorough, careful,
111026 - and competent treating pneumonia, ref SDS 92 V944, including
111027 - analysis of possible correlations with esophagitis, cited by
111028 - Doctor Natchak the day before, ref SDS 91 K66E, and further
111029 - complicated with rising signals of cancer relapsing the past
111030 - few months. ref SDS 91 D45K I was greatly encouraged by Doctor
111031 - Johnson's visit, even though this added to his busy day.
111032 - ref SDS 92 KS4F Team care oversight and collaboration by the
111033 - primary care physician provides experience that lends
111034 - confidence in treatment decisions, which cannot be drawn from
111035 - computers and medical charts. ref DIT 1 8N5Q
111037 - ..
111038 - 14. Later that day on June 8th, switches on the bed that enable
111039 - patients to control bed elevations, lights, and television
111040 - suddenly failed. ref SDS 93 CH4F I panicked when the nurse
111041 - call button did not work, because there was no way to report a
111042 - problem. Eventually, a nurse came by to attend another
111043 - patient. I called out for assistance. The nurse said this
111044 - happens all the time. She made adjustments that fixed the
111045 - controls. What a relief. A few hours later, however,
111046 - everything failed again. A nurse came by and said she would
111047 - call the Engineering Department for repairs. We discussed
111048 - getting another bed, but the nurse said we should wait for the
111049 - engineer. Several hours later, the nurse came by and asked if
111050 - the engineer had fixed the control system. I asked again about
111051 - getting another bed, because being in one position made
111052 - sleeping difficult; loss of the television was inconvenient,
111053 - failure of the lights at night, and failure of the nurse call
111054 - button presented risks. The nurse said I could not be moved to
111055 - another bed due a shortage of beds in the department. She
111056 - indicated that getting a bed from another department would take
111057 - too much time and paperwork, because the staff was busy caring
111058 - for special needs of alzheimer patients. She planned to ask
111059 - someone to call the Engineering Department again and remind
111060 - them to fix the problem. She showed me a light switch on the
111061 - wall out near the doorway that I could use by getting out of
111062 - bed and walking through the other patient's area. At this
111063 - time, she offered to turn on the lights so I could read, and
111064 - she explained how I could use the telephone to call the
111065 - hospital and ask for the Respiratory Department to get a nurse,
111066 - until the Engineers come by and fix the emergency call button.
111067 - ref DIT 1 8N49
111069 - ..
111070 - This record aligns with reports of quality care challenges facing
111071 - hospitals reported on 990912. ref SDS 5 0001
111073 - ..
111074 - Letter to Kaiser continues...
111076 - 15. An hour or so later I needed assistance, and so tried the
111077 - telephone to call the Respiratory Department. The phone rang
111078 - about 10 times. I wasn't sure if I mis-dialed and so tried
111079 - again, but no answer. Thinking everyone was busy, I waited for
111080 - about 15 minutes, and called again. This time someone answered
111081 - and asked me to hold while he located the nurse. After about
111082 - 10 minutes I hung up in order to avoid tying up the line and
111083 - blocking others trying to call the Respiratory Department.
111084 - ref DIT 1 8O69
111086 - ..
111087 - 16. I got out of bed and walked out to the nursing station. A
111088 - nurse walked me back to my cubicle, saying I shouldn't be
111089 - walking around the hallways at night. She apologized for no
111090 - one answering the telephone, and explained that everyone was
111091 - busy helping alzheimer patients. She planned to ask someone to
111092 - call Engineering again. The nurse adjusted the bed manually
111093 - and fixed the covers so that I could sleep. She also brought
111094 - some water, which was very helpful. ref DIT 1 8O78
111096 - ..
111097 - 17. I asked about screaming coming from the ward, and shouting by
111098 - nurses to the patient next to me. This was unnerving and
111099 - stressful, and made reading, and sleeping difficult. The nurse
111100 - apologized and said that nurses and doctors have to talk loudly
111101 - to patients suffering alzheimer disease, and that these
111102 - patients are disoriented, causing them to scream about
111103 - imaginary things. It's just part of the job. Eventually,
111104 - things quieted down and I fell asleep, but was awakened about 2
111105 - am by more screaming. Since I could not call the nurse, I
111106 - walked out to the nurses station and requested a sleeping pill.
111107 - The pill was not effective. I was awake most of the night
111108 - listening to wailings, and moaning of other patients, and to
111109 - staff attempting to communicate with very troubled patients.
111110 - ref DIT 1 8O8S
111112 - ..
111113 - 18. In the morning, I asked the day-shift nurse about getting the
111114 - bed fixed. Aida was very helpful. Her approach to patient
111115 - care was attentive and highly professional, reflecting Kaiser's
111116 - strong reputation. I got the impression that she is new in the
111117 - Department. ref DIT 1 8O97
111119 - ..
111120 - 19. I was grateful, when at last you arrived and reported favorable
111121 - test results. My temperature and blood counts were both
111122 - satisfactory, validating your treatment plan. As you may
111123 - recall, I was ecstatic at the prospect of going home. I am
111124 - afraid though that I may have left an incorrect impression when
111125 - you suggested that I stay another day to treat diarrhea, which
111126 - had begun during a stressful night. I did not disagree with
111127 - your analysis, and only decided to check out of the hospital,
111128 - when you indicated that self-treatment at home was feasible.
111129 - Under the circumstances, the level of care in Respiratory
111130 - Department justified self-treatment at home to reduce the
111131 - burden on overworked nursing and engineering staff. Being
111132 - removed from unsettling conditions treating alzheimer patients,
111133 - made peace and quiet of home an attractive prescription.
111134 - ref DIT 1 7W4M
111136 - [On 060711 follow up xray shows pneumonia resolved, lungs
111137 - clear. ref SDS 95 FF3K
111139 - ..
111140 - 20. While I was getting ready to leave, which took an hour or so,
111141 - two engineers came by to examine the bed. They said the bed
111142 - was broken and I should be moved to another bed, a solution
111143 - rejected the night before. Some time later another engineer
111144 - came by. He determined that the electrical "cord" was
111145 - defective. He went and got another cord. Then everything was
111146 - working again, ready for the next patient. ref DIT 1 8O51
111148 - ..
111149 - 21. Again, thanks very much for excellent care. Since leaving the
111150 - hospital my condition has further improved. I am back at work
111151 - today and everything seems fine. Please forward my letter to
111152 - the ER department, so they are notified that hard work and
111153 - excellence at Kaiser are recognized and appreciated by
111154 - customers. Doctor Johnson has done a good job the past few
111155 - years upgrading the Oncology Department. This kind of
111156 - leadership is greatly needed in the Respiratory Department,
111157 - including a separate unit for alzheimer patients. In the
111158 - meantime, patients admitted to the Respiratory Department
111159 - should be warned about conditions, so they can participate more
111160 - fully in the doctor/patient partnership model at Kaiser.
111161 - ref DIT 1 8O6S
111163 - [On 060711 follow up xray shows pneumonia resolved, lungs
111164 - clear. ref SDS 95 FF3K
111166 - ..
111167 - 22. Good luck in your career.
111169 - ..
111170 - 23. Post Script
111172 - You sent me a letter advising that a blood test was available
111173 - on Kaiser's website. However, the website only has results of
111174 - one (1) test, which was on the pancreas. I would like to get
111175 - results of all the tests performed in the ER, and for your work
111176 - in the Respiratory Department. The Oncology Department
111177 - routinely makes this distribution to support the doctor/patient
111178 - partnership. Thanks. ref DIT 1 00W2
111180 - [On 060623 Kaiser has not submitted test reports,
111181 - ref SDS 94 W67M; blood test report may be listed in medical
111182 - chart. ref SDS 94 SZ9L