Tuesday, February 22, 2005


Instawife Home Safe Albeit Several Hours Late

Glen Reynolds seems happy to have his wife home from the hospital. Glen does comment on the fact that his wife was scheduled to leave at 2pm but was not actually discharged until 8pm. He also appropriately points out that "This was a paperwork issue..." and quotes the blog at Technicalities with ""'So, paperwork takes time to fill out and you enter the world where everything seems to move like molasses (what happened to all that fast action you always see on ER? ... sue Hollywood).'" I will leave it up to Glen or Professor Bainbridge to tell us if there is a case to be made against hollywood, but I can directly comment on the paperwork issue.

Paperwork does indeed take time and can be completely overwhelming, especially with post-surgical hospital discharges and complicated patients. Wonderful new regulations such as HIPAA and those enforced by JCAHO, as well as documentary requirements by insurance companies before payouts, have lead to a gigantic paperwork nightmare. Paperwork has not been standardized and nearly every regulation has it's own form, despite the fact that it may have the same information that the last three forms you just filled out contained. The hospital bureaucracies have also required paperwork over and above that required by JCAHO (if your hospital fails a JCAHO inspection, you cant treat and get paid for Medicare patients). For example, there is a requirement that each patient who is to have surgery has a complete H&P (history and physical) which generally takes 30-60 minutes to perform and another at least 10-20 minutes to dictate. This document must have been produced within 30 days of surgery. If it has been greater than 30 days, a completely new H&P, or at least an update must be done which mentions all the critical areas and whether there has been any changes. Out of fear of JCAHO inspectors, my hospital requires all surgeons to fill out and sign an H&P update immediately before surgery - even when the patient was seen and the H&P completed the day before. As another example, the last hospital I worked at required that two forms and a dictation be done before each patient was discharged from the hospital. Both the forms and the dictation had essentially the same information. Since there was a problem with communication between hospital departments, a one-form discharge had been changed into the two-form plus dictation. Taken individually, one more form here or there does not take up a significant amount of time. Taken as a whole, paperwork is taking time away from patient care.

As a final note on the burden of paperwork to physicians, the American Academy of Orthopedic Surgery reported on a study performed by PricewaterhouseCoopers in 2001. They found that for each hour of patient care there is at least 30 minutes of paperwork and sometimes up to one hour.

...[an]hour of emergency department care resulted in one hour of paperwork; one hour of surgery and inpatient acute care, 36 minutes of paperwork; one hour of skilled nursing care, 30 minutes of paperwork; and one hour of home health care, 48 minutes of paperwork...

So I apologize in advance to all of my patients for being discharged late, I just hope you can wait for me to fill out the appropriate forms so that I may deliver that apology.

Speediest of recoveries to the instawife.

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