TELECOM Digest Editor wrote:
> now appears I had pneumonia when I was admitted to Jane Phillips;
That's not uncommon.
> I get over to Dr. Dykstra (cardiologist) and Dr. Higknight (his
> associate here) and although Dykstra thought that plan of action would
> be acceptable, Dr. Higknight flipped his lid -- literally -- was quite
> angry and said Bartlesville should have held me over and 'done the
> entire job right'. My personal doctor, Dr. Walker, was sort of neutral
> on the matter, but considering he is the 'low man on the totem pole'
> here in Independence (the new guy in town as I mentioned here a week
> or two ago) he went along with Dr. Higknight's beliefs.
Sadly this "intramural squabbling" is common among doctors and the
patient is caught in the middle. The poor patient has no idea what to
do.
A friend of mine had a "bubble" in a key intestinal artery and
required surgery. He didn't know he also had pneumonia as well. The
post op treatment plan for him was frustrating as different doctors
told him to take or not take various drugs. Also, they weren't
passing on their test results to other doctors in the chain. Then
they were giving other drugs to counteract the side effects from the
earlier drug which in turn caused other side effects. It was a mess
getting it all straightened out. Not helping was that he was upset
and confused by the whole thing and it was hard for him to follow
along with everything.
> He left the room, went and found the two of them, brought them over
> to his examination area to have them look at me and prod me; they
> then all came to the consensus that yes, I should be immediatly back
> in the hospital; they called across the street to the hospital
> proper and told them to plan to admit me as an inpatient. ...
You were fortunate that the doctors and the hospital were all in one
place. His doctors were all over the county. Of course, not helping
was that he wasn't allowed to drive so it was hard getting to see all
these people, plus make appointments that wouldn't conflict with each
other. He was able to round up some people to take him to various
visits, but not everybody has that luxury, esp when your friends are
working and would have to lose time from work*.
I'm glad it worked out for you. Best wishes for continued good health!
> OB-TELECOM and MERCY HOSPITAL DATACOM: _Everything_ at Mercy Hospital
> is computerized. ...
With the advent of inexpensive scanning devices and micro computers,
this is practical.
Having worked in a hospital I do think it's a good idea. All of that
stuff used to be done by hand by either the nurse or a clerk and was
subject to error.
Upon admission, each patient got an Addressograph plate, similar to a
credit card. (For some reason they still do to this day). For every
patient action the plate would be used to stamp a form (remember the
old heavy charge stamp machines cashiers had to post a credit card?),
and the details filled out on the form. In the old days, chargeable
actions, such as prescription or supply orders, would be keypunched and
processed for billing. IBM had a sophistical patient accounting system
to do that that ran on its 1401 using only 16K, indeed, many hospitals
kept that system going years after conversion to more modern computers,
running the 1401 under emulation.
Several times a day the patient's vital signs are taken. This may be
automated now with the beep monitors attached to people, but they are
important as a steep change could indicate something wrong and allows
them to nip serious problems early.
Presumably now an order for say pharmacy is electronically transmitted
so an orderly doesn't have to carry the slip down as in the old days.
There was considerable traffic in such slips and forms.
> He said the main reason for having all the medications
> audited and tracked by the computer was because "The Sisters of Mercy
> out of St. Louis (hospital administrators) 'have had some problems
> in the past with missing medications, patient complaints, etc". He
> quite agreed the system was not fool-proof, but when it booted up in
> each patient's room it did present some sort of message from Microsoft
> about what it was doing, and he said among other things, it did remove
> the possibility of 'human error' in noting the administration of
> drugs to the patients, etc.
That hospital was by no means unique in missing meds or errors. The
computer system can improve accuracy, but human error is still
possible. The volume of medicines dispensed is incredible, and many
have special conditions. It gets messy.
Years ago when I was a patient after surgey I was entitled to a pain
killer. I could choose between 30 mg or 60 mg every 4 hours. The
problem was that 30 mg was not enough but 60 mg was too much and made
me sick. So I asked for the obvious, such as 45 mg or to take the 30
mg more frequently. (Wouldn't 30 every two hours equate to 60 every
four hours)? They said NO, one or the other. I also preferred an
injection rather than a pill due to naseua which was approved, but
sometimes the nurse insisted on a pill.
I don't know if modern systems would alleviate the above problem. It
depends on a large part to the people making the entries in the first
place and the subsequent people interpreting the entries and THE RULES.
More recently, with my mother in the nursing home, she got a sedative
that knocked her out. I asked and was approved for her to get a
half-dose but often the nurses wouldn't bother cutting the tablet for
a half dose and still gave the full pill. That used to annoy me but I
had other bigger issues to deal with.
IMHO, I think it is imperative for anyone getting major health care
treatment to have a "manager" look out for their interests. That
manager should understand all drugs and treatments, what they are for,
what they are supposed to accomplish, and what side effects there will
be. Sometimes there are treatments that are routinely done but not
always necessarily in a particular case. My friend above had a friend
help him much of the time with this mgmt to clear up some of the
confusion.
Usually the manager is a spouse, parent, or child, but that person
needs a cool head and good common sense. If the closest relative
isn't too well skilled (and not everyone is), it could be a problem.
Another problem is when two relatives disagree on treatment.
> Apparently even small town hospitals like ours have some 'big city'
> problems like drug abuse and 'evil-nurse' syndromes from time to
> time.
IMHO, many health care workers in direct patient care are overloaded;
there are simply not enough qualified staff to do a proper thorough
job. People are either stretched too thin, work double shifts, or
inadequately trained helpers are used. In the old days only an RN
could dispense meds, then it became an LPN, now it is aides under an
LPN's "supervision". I think they're giving these aides, who are not
that skilled or trained, too much responsibility. I don't like it when
professional staff like RNs or LPNs work double shifts.
> THE PHONE SYSTEM: Mercy Hospital's main switchboard is 620-331-2200.
When I was in the hospital it was a classic Bell System dial PBX.
Patient rooms had beige phones, all others were black. In semi-pvt
rooms (with 2 beds), each patient had their own set, but were on a
common extension line for the room.
The PBX operators would screen patient calls if requested and make
blanket screenings. Calls to the maternity ward were rejected during
certain hours at feeding time. No calls after 9pm went through.
Individual requests were accomodated by placing a colored dummy plug
in the switchboard jack for that patient extension. The operator
would either reject all calls for that room ("the phone is
disconnected") or restrict to "calls by immediate family only"). I
don't think any of this screening is possible today with centrex,
except to shut off rooms after bedtime. At another hospital with a
centrex, the operators manually threw a toggle switch to shut off the
rooms at bedtime and reopen them in the morning.
Patients could only dial 9+local number or the hospital operator, they
could not dial any hospital extension. Patients could only be reached
through the operator.
The hospital switchboard was 12 positions and very busy. There were
700 beds and 900-1000 extensions plus tie lines. There were also many
lamps on of outside (trunk) and attendant calls coming in. Operators
"overlapped", taking a second call while ringing on the first. This
was a classic style operation with terse standard phasing and high
volume. The operators made up a toll ticket and got time and charges
from Bell for outside toll calls.
Two operators handled paging for doctors. Paging was done through the
headset and a key on the keyshelf. I believe Western Electric
provided the PA system.
When there was a stat call, an operator would call the elevator man to
position it as needed. Bell made a phone for elevators oddly shaped
to fit into the phone box.
When the Chief Operator retired, she returned shortly afterward as a
volunteer and worked taking calls.
One change from then to now is back then family were forbidden to call
the nursing station desks, only doctors were allowed; the operators
screened such calls. But today the operators put family right through
the nurses' station to answer questions on treatment and condition.
That does make it easier for family.
When I visited my above friend during his stay, I was surprised that
his hospital still extensively used loudspeaker paging. Even 25 years
ago the above hospital was moving to beepers; I figured by now all
doctors would use beepers.
Anyway, Pat stay well!
[TELECOM Digest Editor's Note: One thing I noticed about Mercy was the
place was generally _very quiet_. Of course I kept the door of my room
mostly closed, but there were no 'beepers' or 'pagers'; just the
occassional incoming 'cell phone' call to a staff person. No loudspeakers,
no blue or red codes while I was there. Lisa, I _hope_ I can stay
well, I would like to at least get through 25 years of it here; which
is not to say I would quit then, but it would be a logical place if it
was to happen. PAT]
hancock4@bbs.cpcn.com