Yesterday TedMed officially began – It’s been great to see and talk crazy tech ideas with Dave Clifford and Rebecca Coelius; learn that Kaiser is so far past faxing orders that they’re into sustainable apples from Ted Eytan; and just hug on Amy Berman and Maggi Cary. Special love to Mark Silverberg for running my interference, Konstantin Karmazin for being completely unflappable, and Ms. Whitney Bowman-Zatzkin – the woman who, despite being Ms. Great Challenges, took the time to run to my side and hug me. Because she’s amazing like that. People of TedMed, you remind me that the heart of life is good and I applaud you for it.

Intravenous Lecture

When you look at the images from last year, the one that stands out is Stephen Petronio’s Intravenous Lecture. Today I had to leave TedMed so I could make it to, literally, my Intravenous Lecture. Yesterday I had a Peripherally Inserted Central Cathater (PICC) line put in so I stop falling over and, today, I had to go learn how to take care of it.

The wires in my chest- you can see the catheter going into my SVC and my loop recorder.

What has not been easy is the administrative side of things, which brings us back to TedMed and three Great Challenges:

Challenge 1: Patient Communication

I had to email or call the cardiology department 15 times to find out about treatment plans or make sure faxes went through.  From here we had insurance authorizations (that got lost), bloodwork (that got lost), infusion referrals (that got lost), PICC line orders (that got lost.) Why did these things get lost? Because they have to be FAXED from location to location.

While I’ve listed out the whole boring process here, don’t read all the stuff in italics, it’s just a long list of interactions. But I think seeing that there is a long list of crazy administrative headaches shows how very broken the communication process is for every single step of getting healthcare.

Ted Med in the Children's Hospital!

TedMed in the Hospital Hallways!

Step One: Get Cardiac Appointment

  • 2/11: Get referred to cardiology by head of cardiology department. AWESOME! 
  • 2/11: Email Nurse
  • 2/18: Have amazing Nurse call you and let you know you can be a patient. 
  • 2/18: Make Appointment for a month out

Step Two: Get Blood Work

  • 3/25: Go to hospital with paper blood work orders.
  • 3/26: Email nurse and say blood work is done
  • 4/2: Call hospital to make sure blood work was done. Find out it was done and entered 3/25.
  • 4/2: Email nurse and ask about results
  • 4/3: Have nurse email you saying you're getting a PICC line. 

Step Three: Get PICC line

  • 4/2: Get told by nurse you’re getting one. Ask if you’re taking Vitamin B12 and if you’re allergic to anything.
  • 4/4: Call hospital about paperwork
  • 4/5: Call insurance about paperwork
  • 4/6: Call hospital about paperwork
  • 4/6: Call insurance about paperwork
  • 4/10: Call nurse about paperwork. Be told to take Vitamin B-12 Supplements as an afterthought (since you called anyway).
  • 4/10: Nurse emails you that paperwork’s been approved and radiology will be calling. Asks about medication allergies for the third time.
  • 4/10: Call radiology and hear paperwork hasn’t been submitted from cardiology
  • 4/11: Call cardiology and ask to resubmit to radiology
  • 4/11: Call radiology and have them say they need insurance approval, despite cardiology having already done it.
  • 4/11: Have radiology call you and schedule PICC insertion
  • 4/16: Get PICC line. They admit you with a diagnosis having to do with your Gallbladder and have lost your insurance information.

Step Four: Get Home Care

  • 4/11: Be told by cardiac nurse that Infusion Company will be contacting you with your infusion information
  • 4/12: Call Infusion Company and be told they haven’t heard of you
  • 4/12: Call cardiology and be told papers have been faxed
  • 4/14: Call Infusion Company and have them say they haven’t heard of you
  • 4/15: Call Nurse and have them say they did fax it, she even talked to the infusion company and the infusion company should be calling you. 
  • 4/15: Call Infusion company. They still say they haven't heard of you. 
  • 4/16: Go to cardiology in person after getting PICC line, have front desk refuse to look up your information since that's what the nurses do
  • 4/16: Call Cardiology nurse have her refax information. Ask if you can have copies of the faxes, be told it’s easier if she handles it. Ask her if you should make a follow up appointment. Have her apologize for not already setting that up.
  • 4/16: Call Infusion Company, get told they have to verify insurance benefits
  • 4/16: Call insurance company
  • 4/16: Infusion Company calls you and tells you have to have an appointment within the next day, even though you have TedMed. Their nurse will call you and come by in the morning, sometime before 2.
  • 4/17: Call Infusion Company and ask when nurse will be coming. Hear that nurse is sick and they don’t know. Say you have doctor friends who can flush the PICC line and they can call you when they have their stuff together. Get told they have their stuff together. Don't yell at the poor lady on the other end of the phone because you know it isn't really her fault. 
  • 4/17: Get called by a nurse. She agrees to give you a 30 minutes heads up. You leave your conference for a couple hours so you can infuse, write this blog, life is good.
IV Process

Today I Learned: Swipe | Saline Push | Swipe | Attach Bag | Swipe | Saline Push | Swipe | Heparin

 

Great Challenge 2: Error Prevention

Even when people did get faxes, their information was wrong: yesterday I was admitted for a PICC line, without insurance for 575.2:  Gallbladder obstruction. The infusion company is dispensing heparin to someone with a 10/30 birthday instead of a 10/3. These are tiny, clerical, errors. Physically they gave the right treatment. So I should just overlook these, right? Wrong.  Say that instead of the wrong number being in my birthday it was in how much heparin they were giving me? A misplaced 3 there is a big issue.  To adventure into magical-what-if-land even further, had the home care people come yesterday maybe I wouldn’t have passed out last night. Maybe if these faxes had gone through I would have done this last week and not gotten another concussion Saturday. I know that’s a really big jump and I probably still would have fallen over, but still, a girl can dream!

Great Challenge 3: Role of the Patient

I asked if I could have copies of all the orders so I know 1. What is going on and 2. Who I need to contact and follow up with and they told me no.  That I shouldn’t have to worry about that and they would handle it because they have better relationships with those people.  Sure, I can request the information through medical records, but by then it’s days old. I want to be copied on communications so I can follow up on them in a timely manner and not end up with a PICC line but nothing to put in it, or, when I finally have something to put in it, waiting for a nurse like I would my cable repair guy - to come by in the morning before 2.

High Fives

High Fives for following up with the system.

So, dear people of TedMed, this is my week. This is my Great Challenge and my intravenous lecture – I can’t wait to hear what yours, metaphorical though it may be, has taught you or reminded you to discuss this week.

PS - Next year's Great Challenge? Medical Waste.

Trash

The trash from one PICC line dressing change/IV start.