Visiting a physician for a planned appointment is a fairly controlled event, conducive to both information gathering and sharing. The patient describes what is going on with their body, the doctor gathers data through medical history and examination, a hypothesis is developed regarding what is going on, and an action plan, if necessary, is put into motion.
All of this establishes a “baseline” — a snapshot in time — from which future health status and interventions can be measured.
When an individual is hospitalized, whether for an elective surgery or an emergency admission, this dynamic becomes more fluid. In this environment, an individual’s status is continually changing, the result of numerous transitions to different levels of care and among multiple healthcare teams. The baseline information about a patient may get overlooked and that can become problematic.
A recent experience with a hospitalized client reminded me of just how important it is for someone, other than the patient, to represent their baseline. Let’s consider the recent experience of our client, “Mr. Thomas” (not his real name).
Pre-Op
I had accompanied Mr. Thomas to all his pre-operative appointments as he prepared for an elective joint replacement with his orthopedic surgeon. With the medical record and his home-based tracking tools that included his unconventional medication schedule to manage a chronic medical condition, he accurately relayed his baseline. He also demonstrated his ability to physically function, independently, in his home environment.
Pre-Operative Holding Experience
On the day of surgery, Mr. Thomas was admitted to the Pre-Operative Holding Area. Here, he went through an extensive preparation process, during which he was visited by the professionals who would be involved in his procedure.
They included the surgeon (and their “assistants”), the anesthesiologists (and their “assistants”), nurses, technicians, and others. There is redundancy deliberately built into the process, to verify information and be sure everyone, including the patient, agrees about what is supposed to happen.
I often accompany clients into this setting and marvel at the efficiency and safety protocols that are always in place.
From the Post-Anesthesia Care Unit (PACU) and Beyond
Because Mr. Thomas had such a complicated medical history, it became apparent to all the healthcare professionals involved that I was the keeper of baseline information about how his non-orthopedic conditions were being managed. By telling everyone of my nursing background and 17-year history with Mr. Thomas, I was fortunate to be invited into the Post Anesthesia Transition Unit (PACU), the Surgical Intensive Care Unit (SICU), the Step Down Unit (SDU) and, eventually, to the general surgical unit — not as a visitor, but as a critical member of my client’s team.
Despite the fact that Mr. Thomas’s transitions were all within the same hospital and on the same online medical record system, the numerous transitions between units, teams, professionals, and shifts led to some important information about his baseline not always being shared. So, I was constantly updating whoever was caring for him on a given shift.
After seven days, Mr. Thomas was transitioned to a skilled nursing facility (SNF) for short-term rehabilitation (STR). This was with a new team and a new medical record system. Despite the comprehensive discharge summary shared by the hospital, it felt like we were starting all over again.
What You Can Do
As you can see, when seeking surgery in a hospital setting, preparation and persistence are necessary for streamlining information and representing a baseline. Action is critical; here are ways you can help.
When planning with a surgeon…
Ask them to proactively communicate with other healthcare team members so they all know what to expect. For Mr. Thomas, we needed one if his specialists to be present at both the beginning and end of his surgery. A lot of energy went into making sure this would occur (i.e., phone calls, emails, patient portal messages).
Likewise, share your plans for surgery with all the other members of your healthcare team. Ask them to proactively communicate with your surgeon about any concerns they may have about the conditions they are managing and how these could be impacted by and mitigated before surgery.
For Mr. Thomas, we made sure pre-operative diagnostic testing was reviewed by all his specialists. As a result, two specialists suggested pre-op medication changes to prevent potential complications.
Make sure you have access to your patient portals; these are instrumental for sharing information. Review test results and carefully read every note your physicians write to be sure your understanding is congruent with what has been written. If discrepancies exist, contact your physician to clarify.
Upon admission to each unit…
At this point, it becomes difficult to advocate on your own behalf; we highly recommend relying on a Care Partner. As the Care Partner, introduce yourself to the nurse caring for your loved one and relay any information about which you are concerned.
Request to review your loved one’s medication list with every transition in care. If there are differences from the baseline, be sure you understand why medications may have been added, deleted, or changed. For Mr. Thomas, with his complicated list of medications treating several chronic medical conditions, this required constant repetition.
For example, one of Mr. Thomas’s medications was not available in the hospital pharmacy. We had to bring it from home, requiring the pharmacy to examine it and grant permission for the healthcare teams to administer it.
Create a means of communicating, at least every day, to fully understand your loved one’s status and the plan. Late morning and/or late afternoon is often best, as physicians have seen your loved one, reviewed diagnostic testing, assessed their status, and developed and/or updated a plan.
The patient portal will give you access to inpatient diagnostic testing, along with progress notes written by the physicians, nurses, and others. This can help reinforce what you heard and/or spark relevant questions about the plan of care.
If concerns arise, don’t hesitate to ask for a meeting with the physicians and nurses to review things. It’s always great if they can be in person, but a scheduled telephone or Zoom meeting works too.
Upon transition to every level of care…
Mr. Thomas’s experience transitioning to a skilled nursing facility that did not have access to his online medical records or hospital treatment is typical. Medical record systems are not universal.
So, here as well, be diligent about sharing information and representing your loved one’s baseline: their medical history, their recent hospitalization experience, and their pre-operative level of physical functioning.
For Mr. Thomas, and despite being transferred in a physically deconditioned state, it was important for everyone to know that pre-op, he lived alone and was able to perform all activities of daily living without assistance. His elective surgery was about being able to continueindependently managing his own life, but without the chronic pain that was limiting him.
Summary
When navigating the healthcare system, I strive for the ideal but fall back to what is realistic. For example, you may not be able to accompany a loved one during every phase of a hospitalization and/or during transitions in care. But you can coordinate in advance and share some of this responsibility with others.
Try as best you can, use the communication tools at your disposal, and strive to share baseline information and monitor changes in healthcare status every step of the way, especially as transitions in care occur.
All of these steps can prevent complications from incomplete or inaccurate information, helping you or your loved one achieve full recovery as quickly as possible.