“The clinical microsystem is the place where patients, families, and caregivers meet. It is the lotus of value creation in healthcare.”(Nelson, Batalden, et.al, 2011) Lilly Walden describes herself as an active, athletic, and healthy woman. In her mid-forties she continues to run 2–3 miles 5 days per week. Lilly is married with three children and is employed by the local school district as a speech therapist. Lilly describes herself as health-conscious. Her diet is balanced, and she is a nonsmoker and drinks wine on rare social occasions. Lilly has a history of asthma, triggered by environmental changes, and it typically requires antibiotic therapy for bronchial infections 2–3 times per year. This presentation will review the following:
1. Priority care needs of the patient at the center of the case study 2.Priority care needs of the family care providers
3.The disruption that this acute illness has caused for the patient, family members, and clinical microsystem 4.The experiential features of acuity
5.The elements that the clinical microsystem
6.Potential barriers to providing care
7.The communication strategies that were used in the delivery of care 8.Well-defined (but flexible) roles within the clinical microsystem 9.Potential strategies for unexpected changes
10. The Deployment Flowchart
Priority care needs of the patient require the organization to take good care of the patient in a timely manner to find the cause of the pain being experienced. The patient’s pain has to be kept at minimum, have direct communication with the patient and their family and try to find the cause of the pain in a timely manner and provide follow up instructions for the patient. Priority care needs of the family. It is vital that they contact Lilly’s husband Tom because they need consent from him and have to keep him informed of the wife’s situation. The organization has to communicate the patient’s treatment plan to the spouse just in case Lilly is unable to give consent or is unconscious. Tom has to find someone to take care of their children while he is in the hospital with his wife and he calls his sister to take care of the situation. There has to be shared decision making between the family members and educate them about treatment of the patient since they will be helping take care of the patient.
Acute illnesses often disrupt the patient, family members and the clinical microsystem that has to take care of the patient because of the rapid onset in such a short time. What disruption has this acute illness caused for the patient and family members? Lilly has to miss work because all over a sudden she is not feeling well and decides she needs to go see her doctor for more clarification. Her children have to be taken care of and therefore Tom her husband calls her sister to help with the kids on short notice, Lilly has to stay in the hospital longer because she develops pneumonia postoperatively and thus her supervisor has to be notified. After she is discharged she prepares for a slow recovery back to health and follow up with different doctors. How has this illness disrupted the clinical microsystem?
Even if they always have to be prepared for an emergency happening anytime, there is disruption at the office. Dr. Woods has to be interrupted while she is with another patient, she has to call for an ambulance and the other patients have to wait on her for a while, while she deals with the emergency or reschedule for another day. The symptoms that Lilly is experiencing include the following: Pain in her right lower quadrant
Fever
Sweating
Rapid heartbeat
Poor physical appearance
Nonproductive cough/ no sputum
Fatigue
Crackles in lower left lung
In order to meet the needs of Lilly, the microsystem must possess effective communication and work in a timely manner. Because this is an emergency and anything can change anytime, communication to provide the best care and understand each other is vital. Timing is also very essential in acute care. “Careful role clarification and optimization based on education, licensure, formal training and practical experience give the work specificity.” (Nelson, Batalden, et.al, 2011). The microsystem has to be able to manage
disruptions and make structured decisions to be able to deal with emergencies proficiently. Much as we prepare for emergencies, there will be potential barriers. Poor communication, being unprepared for an emergency, unable to manage disruptions, ineffective handoffs, undefined roles within the microsystem. These barriers have to be managed in order to provide good care to the patient. Poor communication among the clinical microsystem might put the patient in more danger. If Proper procedures and algorithms are not followed this is a barrier to providing good care to the patient because instead of being able to deal with Lilly in a timely manner, they could make a misdiagnosis or not follow the proper measures. Being unprepared for an emergency is another barrier because microsystems always have to be ready and not to begin preparing when the emergency occurs. Everyone in the microsystem has to have a defined role and be prepared to do their job effectively. The communication strategies that were used in the delivery of care were: Office Manager – used practice-specific triage protocol Nurse Practitioner – Performed phone triage
Medical Receptionist – escorts Lilly directly into an examination room, and notifies the registered nurse that Lilly is in Exam Room 3 Nurse – took Lilly’s vital signs using office protocol Medical Assistant – called ambulance
Dr. Maureen Woods – Notified the emergency room of Lilly’s condition and her pending arrival. All these people in the microsystem were able to work together and realize an emergency because of proper training and everything went smoothly from one person to the other per proper protocol. Well-defined (but flexible) roles within the clinical microsystem. At Dr. Woods’s office, the staff was able to use clinical algorithms properly and identify and respond to the patients cares needs in a timely and efficient manner. Communication to family members was thorough and the other patients were notified of emergency situation and given other options. At the ER, the doctors tended to Lilly in a timely manner and were able to make the right diagnosis and perform surgery immediately. Proper recommendation for post-operative care was communicated to Lilly and her husband and follow up appointments given as well. Potential strategies to plan for unexpected
changes in care needs. Just like any illness unexpected changes can occur and a microsystem should always have strategies for theses unexpected changes in care needs. Lilly has to stay longer in the hospital because of pneumonia that she got post-operative, Recommendations are made for Lilly to receive nursing services at home to monitor her pneumonia and she has follow up visits with different doctors to monitor her after discharge. When Lilly goes to see Dr. Woods, she probably did not think she would end up being taken to the ER with an ambulance or stay away from work longer than one day. “Deployment charts are a type of process mapping tool that documents the process across roles or departments. This process mapping tool is very useful when redesigning process to optimize tools. It shows each person’s role and function during a patient’s initial visit to a primary care physician’s office.” (Nelson, Batalden, et.al, 2011). This particular deployment chart shows how Lilly Walden went from her physician Dr. Woods office and ended up in the ER in surgery, developing pneumonia post-operative and after an extended stay in the hospital is discharged with instructions to follow up with three different doctors and on her way back to recovery.
