The lonely path from hospital to home

Just as when we’d left Chicago, there seemed to be an assumption that we could manage the complexities of Eric’s care on our own. No one assessed our readiness or capacity to do so, no one offered us any support, and we received no follow-up calls in the subsequent days.

Arrghh!

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May 17 was a wonderful day: Eric was home at last. But it was also the day we entered the twilight zone. When we arrived home, we found a voice-mail message telling us that we were “being placed in collection” for not paying $23,312 owed to the community hospital in Chicago where Eric had spent 20 hours. The mailbox was jammed with hospital and ambulance bills. How, I wondered, can we re-engineer the delivery of health care so that it is as timely and efficient as the medical billing process?

The next day, our aggravations continued as we tried to find a lab to draw Eric’s blood and to schedule his follow-up appointments. What about the neurologist appointment required in two weeks? The next available appointment was in October. The vascular physician appointment needed in two weeks? The next opening was in July.

I started calling on members of my professional network to get appointments within the prescribed time frames. Each office where we scheduled an appointment asked that we bring all of Eric’s Chicago records and imaging studies. This was another problem: We’d given all of that information to the rehab hospital in Philadelphia — and it had lost everything. I needed, again, to gather all of the records and imaging studies from Chicago.

And that phone call saying we had an unpaid balance of $23,312? After making multiple calls, I discovered that the community hospital had incorrectly recorded Eric as having Medicare Part A and no other insurance. But the hospital informed me that its error was our problem. It would take at least 30 days to correct the bill, and in the meantime the hospital said it couldn’t reverse the collection notice. The calls didn’t stop until June 23, when the matter was finally resolved; in fact, we owed just $3,076.

Where were the nurses?

While he was in a hospital, I had 24/7 access to one of Eric’s registered nurses if I had a question about anything. After he was discharged, we were on our own. We had no one to call or e-mail for support or guidance.

Yet not a day went by when we weren’t coordinating his care among his health-care providers as his condition and needs changed. Someone from the hospital should have contacted us at home the day after Eric’s discharge to make sure we knew how to follow up on his care. They might have asked, for example, if we knew whom to call for appointments — and whether we had transportation to get to there.

As a patient’s wife, I would have welcomed having an RN as a point of contact. As a nursing school dean, I know the evidence demonstrating that registered nurses are critical to the operational and financial success of health-care delivery systems. Their education, knowledge, skills and competencies are as much an asset in outpatient settings as they are in hospitals. I also know that nurses have the expertise to bridge care transitions and are critical to coordinating care across all settings.