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June 15, 2016 Central Massachusetts Health Column

Simple improvements count for healthcare innovation too

During these exciting days of medical innovation, with developments ranging from advanced robotic surgery to nanoparticle-based cancer treatments, it’s easy to forget that simple actions can also advance patient care in equally dramatic ways.

This became clear to me as the result of an experience with Gertrude, an elderly patient who was admitted to UMass Memorial Medical Center with severe abdominal pain. Her workup revealed my worst suspicions–metastatic cancer. After sharing this heartbreaking news, Gertrude made her wishes known–she wanted to die at home with minimal pain. So we connected her with a hospice agency, wrote her a prescription for pain medication, and said our goodbyes. And while it is never easy to accept a terminal diagnosis, I took comfort in the fact that Gertrude would most likely have a relatively peaceful passing.

Prescriptions stymied

Such was not the case. I had prescribed a medication dose  that was not in stock. As I later learned, it took Gail, Gertrude’s daughter, more than 20 hours and multiple trips to pharmacies to get the medication. During this time, her mother’s extremities turned blue, her breathing became ragged, and her pain skyrocketed. In Gail’s words, her mother would have preferred to leap from a ten-story building rather than endure another moment of misery.

 The good news is that Gertrude finally did receive her pain medication. The bad news? The first dose came an hour before her death. No one should suffer like this especially at the end of life. No family member should experience such trauma when helping a loved one. 

I began researching the issue and, to my distress, discovered that Gertrude’s case was not unique. In fact, 17 percent of patients discharged from a 28-bed medical unit at UMass Memorial Medical Center encountered significant barriers to filling their prescriptions. There are many reasons for this failure, from monetary and insurance issues to lack of transportation. But whatever the cause, the outcome is the same: too many patients are either unable to fill their medications or cannot do so in a timely manner.

These sobering statistics gave wings to the promise I had given Gertrude’s daughter. Within a few months of this heartbreaking experience, we developed and launched Simple Scripts, a program that makes it possible for patients to leave the hospital with medications in hand. And while not an entirely novel concept—other hospitals employ similar on-site prescription programs—our approach was unique to UMass Memorial Medical Center.

Better bedside manner

 Another example of a simple innovation for a common problem grew out of a desire to improve physician and patient bedside communication. Both anecdotally and from research, I knew bed-ridden patients often feel diminished when their doctors speak to them while standing. To remedy this situation, I attached a collapsible stool to my computer workstation on wheels. This stool made it possible to have eye-to-eye conversations with patients at all times. I am happy to learn that physicians at the Hospital of the University of Pennsylvania are set to launch their own similar initiative.

Of course, this is not to minimize the massive challenges facing our healthcare system —challenges that will require significant investment and years of committed work to solve. But in the meantime, there is much we caregivers can do to improve the physical and emotional wellbeing of our patients.

Dr. Tzvi Jonas is an academic hospitalist specializing in Internal Medicine at Worcester’s UMass Memorial

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