CONTACTS 

SUBJECTS
White Blood Cell Condition Blood Test Shows Too Low Doctor Johnson A

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 61 0000. ref SDS 60 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 -    1.  On 081229 had to coordinate getting CT test at Kaiser in Walnut
040902 -        Creek. ref SDS 12 T55G
040904 -         ..
040905 -    2.  On 081230 Millie had the last CT test. ref SDS 14 3G5I
040907 -         ..
040908 -    3.  On 090107 Millie received report for CT test on 081230,
040909 -        ref SDS 17 J85F, to prepare for meeting with UCSF on 090108,
040910 -        and discovered that Kaiser published 2 separate reports for the
040911 -        test again, ref SDS 17 RU6R, contrary to request on 081219 for
040912 -        a consolidated report. ref SDS 10 587G
040914 -         ..
040915 -    4.  On 090108 UCSF had difficulty applying results for the CT test
040916 -        on 081230 becasue the several reports presented conflicting
040917 -        findings. ref SDS 18 UE6X
040919 -         ..
040920 -    5.  On 090325 0830 Doctor Johnson ordered CT test on 090413 to be a
040921 -        consolidated report. ref SDS 57 TE4O
040923 -         ..
040924 -    6.  On 090407 1421 Loretta reports Kaiser CT Department changed the
040925 -        time of the test from 090413 1520 to 1500 requested by the the
040926 -        IS Department to avoid overtime expenses that start at 1530.
040927 -        ref SDS 60 JZ87
040929 -         ..
040930 -    7.  On 090407 1421 Loretta reports Kaiser CT Department changed
040931 -        Doctor Johnson's referral order issued on 090325 to consolidate
040932 -        findings in a single report; Loretta advised that Kaiser's
040933 -        computer does not call for a consolidated report. ref SDS 60
040934 -        1163
040936 -         ..
040937 -    8.  On 090407 1421 Katie called back and advised that Loretta made
040938 -        a mistake in the Kaiser CT Department by accidentally changing
040939 -        the date of the test from 090413 to 090414, when she changed
040940 -        the time from 1520 to 1500. ref SDS 60 YK64
040942 -         ..
040943 -    9.  On 090407 1421 Katie confirmed Loretta's earlier report that
040944 -        somebody changed Doctor Johnson's order on 090325 to
040945 -        consolidate findings in a single report. ref SDS 60 YK5O
040947 -         ..
040948 -   10.  On 090407 1421 Katie advised that the doctor's order was
040949 -        changed because government regulations require issuing multiple
040950 -        reports for CT tests for each pass of CT scanning equipment.
040951 -        ref SDS 60 L86F
040953 -         ..
040954 -   11.  On 090407 1421 Katie discussed multiple and conflicting
040955 -        explanations Kaiser has presented for changing Doctor Johnson's
040956 -        order for Millie's CT test. ref SDS 60 L44K
040958 -         ..
040959 -   12.  On 090407 1421 Katie decided to ask Doctor Davidson, Director
040960 -        of Radiology for Kaiser Mt Diablo to support Millie's doctor
040961 -        prescribing a consolidated report for the CT test on 090413,
040962 -        and will ask Doctor Davidson to send an email to Millie
040963 -        explaining procedures on consolidating test findings into a
040964 -        single report. ref SDS 60 YZ95
040966 -         ..
040967 -   13.  On 090409 2018 Doctor Davidson, Chief Radiology Imaging
040968 -        Services Diablo Service Area, letter reports CT Department made
040969 -        mistake publishing findings in multiple reports for multiple
040970 -        passes of CT test scanning equipment performing a single test;
040971 -        advises each CT test should consolidate findings into a single
040972 -        report. ref SDS 61 WB6G
040974 -         ..
040975 -   14.  On 090409 2018 Doctor Davidson, Chief Radiology Imaging
040976 -        Services Diablo Service Area, letter advises Kaiser personnel
040977 -        will be counseled that for future CT tests Kaiser will
040978 -        consolidate findings into a single report for each test.
040979 -        ref SDS 61 XZ6U
040980 -
040981 -
040982 -
040983 -
040985 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Submitted letter to Doctor Davidson, Director of Radiology for the
041302 - Kaiser Diablo Service Area, and responding to the doctor's letter
041303 - received earlier this evening 090409 2012, ref SDS 61 WB6G, and
041304 - following up telecon with Katie on 090407 1442. ref SDS 60 L44L
041305 -
041306 -    1.  Subject: Consolidate Report for CT Tests Problem Solved - Thanks
041307 -        Date: Thu, 09 Apr 2009 23:57:07 -0700
041318 -         ..
041319 -    2.  Thanks for timely response in your letter today [received
041320 -        090409 2012, ref SDS 61 WB6G] on "consolidating" findings into
041321 -        a single report for each CT test, rather than publish a report
041322 -        for the neck and a second report for below the neck.
041323 -        ref SDS 61 XZ6U  I draw from your letter that the CT Department
041324 -        cannot correct the record having issued multiple reports for
041325 -        prior tests, ref SDS 61 OK5F; but, for future tests Kaiser will
041326 -        issue a single consolidated set of findings for each radiology
041327 -        test, as standard practice. ref SDS 61 XZ6U
041329 -         ..
041330 -    3.  Thanks as well to Katie for facilitating review of this issue.
041331 -        [shown in Katie's letter to Doctor Davidson on 090407, and
041332 -        cited in the record receiving Doctor Davidson's letter this
041333 -        evening 090409 2012, ref SDS 61 MO9I]
041335 -         ..
041336 -    4.  Consolidated reporting simplifies use of CT test work product
041337 -        for quality care.  Medical practice is inherently complex;
041338 -        radiology technology produces huge amounts of data.
041339 -        Comprehending complexity quickly and accurately requires a well
041340 -        ordered record to prevent mistakes and discover opportunities.
041341 -        Your letter today clarifying Kaiser policy and procedure
041342 -        supports this requirement (see, for example, a few para on
041343 -        "Command and Control of the Record". ref OF 7 1113
041345 -         ..
041346 -    5.  Millie has a CT test next Monday on 090413.  Her doctor ordered
041347 -        the test for the neck, chest, abdomen, and pelvis, noted in
041348 -        Katie's letter to you earlier today. ref SDS 61 MO9I, and
041349 -        ordered by Doctor Johnson on 090325, ref SDS 57 LX5J].  The
041350 -        past two tests with the same scope, on 081107 and 081230, were
041351 -        both published for the first time in patient history as
041352 -        multiple reports [reported 081113, ref SDS 8 HV4H].
041354 -         ..
041355 -    6.  Results for the test on 081107 were received in separate
041356 -        reports days apart [reported 081113, ref SDS 8 DA6Q, This
041357 -        caused confusion and error applying findings [reported on
041358 -        081113, ref SDS 7 DP8J].  The next report on 081230 described
041359 -        the same supraclavicular and axillary region with different
041360 -        language in separate reports, evidently because the scans
041361 -        overlap [reported 090107, ref SDS 17 5O6N].  Care providers at
041362 -        UCSF who read the reports on 090108 could not determine results
041363 -        for this supraclavicular/axillary region [which was reported in
041364 -        Millie's letter to the medical team on 090109, ref SDS 18
041365 -        UE6X], which in this case directly relates to cancer relapse.
041366 -        Millie came through thanks to skill and experience of her
041367 -        medical team, but at great cost in time and stress for
041368 -        everyone.
041370 -         ..
041371 -    7.  Your letter today indicates this was a mistake, ref SDS 61
041372 -        WB6G, and that Kaiser will publish a single report for the test
041373 -        on Monday, and for future tests. ref SDS 61 XZ6U
041374 -
041375 -           [On 090415 1642 CT test report consolidates findings for
041376 -           scans above neck and below the neck in single report, as
041377 -           ordered by the doctor today. ref SDS 63 RU6R
041379 -            ..
041380 -           [On 090617 0842 radiology report on Millie's CT test on
041381 -           090612 was again issued in multiple, separate, and
041382 -           overlapping reports, ref SDS 64 6V4S, contrary to Doctor
041383 -           Davidson's instructions today, per above, ref SDS 61 XZ6U;
041384 -           Al Hutchins, Manager of Reporting for Radiology, apologized
041385 -           for continuing difficulty implementing policy to use good
041386 -           management that avoids mistakes. ref SDS 64 6V5I
041388 -         ..
041389 -    8.  By copy, notifying Doctor Rugo at UCSF, and her colleague Tara
041390 -        Lacey, NP, that the problem they cited on 081218 has been
041391 -        solved by Kaiser in Walnut Creek. ref SDS 9 LM4I
041393 -         ..
041394 -    9.  Thanks again for taking time to research patient history on
041395 -        this matter to provide a clear solution.  Very pleased to
041396 -        commend the Radiology Department, including the CT people, who
041397 -        have provided excellent care for Millie the past 8 years.
041399 -         ..
041400 -   10.  Large organizations provide economies of scale, essential to
041401 -        meet growing demand for health care while holding the line on
041402 -        costs.  Doing things correctly prevents mistakes.  However,
041403 -        success avoiding mistakes, eventually makes good management
041404 -        begin to look like unnecessary overkill with potential for
041405 -        "cost savings." It's a knowledge management dilemma, that can
041406 -        only be solved through diligence and good will, shown in your
041407 -        letter today.
041408 -
041409 -           [On 090415 1642 CT test report consolidates findings for
041410 -           scans above neck and below the neck in single report, as
041411 -           ordered by the doctor today. ref SDS 63 RU6R
041413 -         ..
041414 -   11.  By copy to Doctor Rugo at UCSF and Doctor Johnson at Kaiser
041415 -        Oncology, I pass along your offer to republish results of CT
041416 -        tests on 081107 and 081230.  My sense is this in not needed;
041417 -        however, they can respond separately to your offer.
041426 -         ..
041427 -   14.  PS.  Doctor Johnson mentioned in a telecon today that you
041428 -        facilitated transformation performing CT tests using Mil's
041429 -        power port for injecting contrast medium.  It took a few tries,
041430 -        but the last test went well. ref SDS 14 3G5I
041432 -         ..
041433 -   15.  Notice at line 071057 that Barium Sulfate suspension required
041434 -        for the CT test caused problems for Millie. ref SDS 14 I84N
041436 -         ..
041437 -   16.  This delayed the work, which disrupted the schedule for the CT
041438 -        Department, and caused Millie a lot of discomfort.  During the
041439 -        meeting at Kaiser with the primary care physician on 090325,
041440 -        Millie asked about going back to the previous contrast medium,
041441 -        which did not have bad side effects. ref SDS 57 G58N  Doctor
041442 -        Johnson indicated this is a matter for the CT Department.
041443 -        ref SDS 57 RR6G  Can you comment please.
041444 -
041445 -            [On 090413 1500 Kaiser did not provide a solution; Millie
041446 -            suffered recurrent multiple health problems using Barium
041447 -            Sulfate Suspension contrast medium. ref SDS 62 QO9M
041449 -         ..
041450 -   17.  Thanks.
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