Questions Submitted 3/28/08
Question:
How Many beds/patients are on this Gen/med unit?
Answer:
Thirty-Two
Question:
How many would the on-call intern be responsible for?
Answer:
35-45
Question:
How many attending MD's cover this unit?
Answer:
Three attending physicians, but they also cover SOE PTS on other units. Also there are some patients that are not general medicine that end up on the unit.
Question:
Is the unit care coordinator a nurse, and is that role only for discharge planning?
Answer:
No unit care coordinator, but there is a social worker
Question submitted 3/26/2008
Question:
What was the cost of the EMR system implementation? If this cannot be answered can we just make up a number? When we asked for cost estimates the response is it depends, so it is very difficult to obtain the information.
Answer:
You might want to find out the typical cost of an EMR implementation for the hospital size described in the case, and us that as your best estimate to make any other EMR calculations you deem are needed.
Questions submitted 3/17/2008
Question:
In this case, are the physicians employed directly by the hospital or outsourced?
Answer:
The hospital has a contract with a practice plan who employs the physicians. The hospital sill credentials each physician to work there.
Question:
Was the patient under any specific health insurance plan? Private? Or should we have no assumptions?
Answer:
No assumptions.
Questions Submitted 3/10/2008
Question:
Did the attending physician actually see Jane or did he rely on communication with the intern regarding Jane's Condition?
Answer:
Dr. Wells was not able to see Jane as she was discharged at 10 am.
Question:
Does the information presented in the case provide Jane's complete medication list?
Answer:
Yes
Question:
On the day of Jane's discharge, the intern reported her vital signs to the attending physician. What source did the intern rely on to report this information?
Answer:
The Intern pulled Jane's vital signs from the computer, but as noted in the case, he accidentally copied older vital signs onto his information sheet before rounds, and reported vital signs from the night prior rather than that morning.
Question:
Grant believed Jane looked better than the previous day. Did Grant T. actually do a real physical exam Day 2 am?
Answer:
He did a focused physical exam, as appropriate for a hospital followup. That means that he examined her heart, lungs, abdomen, skin, and performed a limited joint exam.
Question:
Do the nurses have access to data?
Answer:
Yes, they all have online access.
Question:
How are the records/information of previous visits within the healtcare network accessed, or can they be? (i.e. if the docs wanted to find Jane's lupus history in detail, would someone have to drive out to outpatient clinic and get them?) What's the process of getting paper charts from outpatient clinics?
Answer:
Outpatient Charts can be ordered to the floor during business hours. On an emergent basis they can be requested "stat" from medical records but this may take several hours.
Questions Submitted 2/27/08
Question:
If it is not specified in the case report that something has occurred, or an action has been taken by medical staff (i.e. let's say the
case states that Jane Doe ordered an IV drip of XXX, but it was not specifically stated that the patient received that IV) can we assume that
they did receive it? In general, if something is not written, is it safe to assume it did not occur?
Answer: It depends on the instance. See below.
Specifically, On Day 1:
The drug Plaquenil was ordered by Dr. Thomson, but we never hear past it getting to the Pharm. D. and him not filling it - was it ever filled or
given? Are we to assume it was not? And, for example, the Pharm. D. also "sent up prednisone," can we then assume she received it.
Answer: It was not filled at that time (for the reason below). Yes she received the prednisone.
Question:
We are wondering if the pharmacist, Joe Miller, acted in line with protocol when he withheld the Plaquenil for the patient as he wanted to check on her history of eye exam - a precaution as the drug can cause complications.
Answer:
He acted in line with professional protocol. It is his professional responsibility to STOP the process if he thinks that something major
should be performed first. Incidentally holding the Plaquenil for a couple days will not drastically affect the disease process.
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