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Outside view of a hospital. Caption: "White Flint General Hospital." Transition to Kira Cook, Hospital Administrator, sitting at a table with a folder and four cups of coffee in front of her.
Kira [looking off to the side and tries to sound welcoming]: "Come on over. I appreciate how busy everyone is and how early it is." [smiling slightly]
Blake Fowler, Lead RN, and Ramon Diaz, Lead Technician, enter the room, sit and look at Kira.
Kira: "Thought the least I could do is provide the coffee. Help yourself."
Kira, Blake, and Ramon each pick up a cup of coffee. Blake smells his, looking intently at the lid.
Ramon [to Kira]: "Don't wanna say no to that. [turning to Blake and extending his hand] Hey, we haven't met before. I'm Ramon."
Blake [shaking Ramon’s hand]: "Blake, Lead RN, Admissions. You?"
Ramon: "Lead tech, [proudly] cardiology wing mostly." [chuckles]
Blake [inquisitively]: "Oh, you enjoying that?"
Ramon: "Yeah, it's been a great move for me. [pointing to Blake] Hey, didn't we come in together? You look very familiar—"
Kira [interrupts]: "Guys, so we're still waiting on Dr. Lavinus to arrive, but we'll just catch her up when she gets here. I formed this team because the hospital group thought it would be valuable to gain some new perspective on our discharge policies. [Ramon looks intently at Kira] We are having a difficult time clearing patients in a timely manner—”
Blake [interrupts]: "Yes, that is definitely an issue. I—"
Sarah Lavinus, Emergency Room Physician, enters the room and sits next to Kira.
Sarah [breezily]: "Sorry, had a seizure patient who came through on the way in." [takes a seat]
Kira: "Everything okay?" [looks concerned]
Sarah [matter of factly]: "Yeah, she's stable. We'll monitor her for a while, though."
Blake: "Good morning, Dr. Lavinus." [nods his head toward Dr. Lavinus]
Sarah [flatly]: "Hey, Blake. Did you catch that Georgetown game last night?"
Blake [scoffs]: "What a nail biter. Of course I had to watch it on a time delay because I'm always here. [smiling and glances at Ramon and then the others] God bless the DVR."
Ramon [smiling]: "Ain't that the truth." [looking at Blake]
Kira: "Okay, so guys, [looks at Dr. Lavinus who shrugs and looks engaged but tired] now that everyone's here, I thought, what I was telling Ramon and Blake [look interested] is, we are having some chronic discharge delays, which is putting us in the unfortunate situation of not having beds for our newly admitted patients. [Dr. Lavinus looks down] Or we end up having to place them in a different wing, which requires our doctors to have travel further to see them—"
Sarah [reaching for a cup of coffee]: "Is this for me?"[takes a sip]
Kira [nodding to Sarah]: "So my hope is that by forming this team, we can all come together, understand everybody's role in the lead up to discharge, and then come up with some new solutions together."
Sarah [matter of factly]: "Well, I deal with this every day in the ER, and as much as I'd like to get my patients out of triage and upstairs so that I've got more beds, it's not always possible."
Ramon: "Especially if you're trying to get them to go to cardiology, I bet. [chuckles] We're always slammed. [grimacing and touching his chest] Ooh, note to self, lay off the bacon."
Blake [states measuredly]: "How about some autonomy for the lead nurses? [looks at Kira] After the vitals come in and all the test results are in, we wait, 10, 12 hours just for the physician to come and sign the discharge papers." [Kira nods.]
Sarah: "Believe me, I know how short-staffed we can get, but I'm not comfortable with that. A physician needs to see her patient through every step of the process, including discharge." [nods her head at Blake while speaking]
Blake: "What about the non-criticals? Let's say an elderly patient is admitted with severe dehydration, which happens all the time. [looks around the table]
Ramon: “mm-hmm.”
Blake: “After she's rehydrated and the vitals check out, I'm just [stresses] as capable of determining if she's ready to go home."
Sarah [sternly to Blake]: "No. You're not. Your job is to assist the doctors and help the patients. That's it."
Blake [disbelief]: "That's it!? That's a lot! Doctors don't even realize how much we do on a given day."
Sarah : "Can you imagine the lawsuits that will be filed [Kira nodding] when patients start coming back through the door because they were discharged too early by a nurse?" [disparaging]
Kira [placatingly]: "Let's make sure everyone has a chance to express their opinion here. Ramon, what do you think?"
Ramon [jesting]: "I think you two should go back to talking about the Georgetown game." [looks at Dr. Lavinus]
Blake [to Kira]: "Nurses are the best advocates for the patients. [to Sarah] No, Dr. Lavinus, I didn't go to Tufts. But I know the patients. [Dr. Lavinus smiles sarcastically.] And I know when they're sitting on a bed for 10-plus hours, waiting for a doctor to glance at a chart and say, "Hey, it's time to go home," it's ridiculous. There has to be a better way."
Sarah nods her head, looks up at the ceiling, and sighs.
Sarah: "Well, I guess I would be open to a nurse practitioner being allowed to discharge, as long as it's within their specialty. Could that help speed up turnaround—"
Blake [interrupts]: "No, no. We only have three NPs on staff! That would barely make a dent."
Kira [trying to keep the others calm]: "Okay, you guys, we are here to collaborate, not tear each other down, so let's focus on ways we can improve the situation for our patients. [looks at Ramon] Ramon. You've still been pretty quiet over there."
Ramon: "It seems like the safer choice. Listen. [confidentially to Dr. Lavinus] I like this hospital. And we're always at capacity in the cardiology wing, but we get it done. [looks at Kira] I'm not sure what I would change."
Sarah [to Ramon sarcastically]: "I'm sorry, I don't even know who you are. [to Kira] How do you expect us to come up with solutions together when I don't even know what that guy does?" [Ramon looks off to the side looking slightly embarrassed]
Kira: "Ramon is one of our new hire lead techs, and a good one."
Sarah [to Kira]: "Great. It would have helped to know that. [to Ramon] Ramon, you seem like a funny guy, and I'm sure you're great at your job, but here's the thing. [a little rudely] Nurses don't discharge patients. [Ramon grins] Techs don't discharge patients. [Ramon opens his mouth like he is going to interject but doesn’t.] Doctors do. I'm not trying to put you guys down. That's just the facts."
Blake: "Well, here's another fact for you: there's not enough of you. I had to put a laboring patient in the hallway last week. I used a mobile curtain for privacy because the ER was out of beds and there was nowhere else to put her." [sounds exasperated]
Sarah [matter of factly]: "Yes, that was unfortunate. But she was only four centimeters dilated. [sarcastic] She had a lot of laboring to go yet, and we got her into a delivery suite with plenty of time."
Blake [excitedly]: "But that's not the right way for her and her husband to bring their first child into this world, especially their first baby." [looks at Dr. Lavinus]
Ramon [motions with his hand]: "My wife would kill me. She would have me put her back in the car and switch hospitals before she started having contractions in a freaking hallway."
Kira [trying to keep the others calm]: "Alright, so I think we're getting a little bit off track here."
Sarah: "Yes, thank you. [looks at Kira] That was an extreme incident. And getting back to the reason we're here, doctors [stresses] are the ones with the training and experience to discharge patients, looks at both Blake and Ramon; Blake looks frustrated] nobody else. So."
Kira [apologetically]: "Okay. So, I don't think we're gonna get much further than this today. How about we take some time, think of some solutions on our own, circle back next week?"
Sarah: "I don't see what good that will do. [looks at Kira] You should be having this meeting with a team of doctors, with multiple specialties and multiple work shifts, not nurses and techs. [disparaging] Get input from the people who actually have the authority to discharge." [head nodding and eyebrows raised]
Kira [ruefully]: "I suppose I should consider that." [looking at Dr. Lavinus]
Blake: "Well, this has been productive." [looks and sounds disgusted]
Ramon [quietly]: "Hey, [looks at Blake] if nothing else, it was great to meet you guys. If you're ever in cardiology, look me up and say ‘hey.’" [looks at Kira, then both he and Blake stand and leave the room]
Kira [stands]: "Okay, well, thank you guys so much for your time this morning. [grimace] I will be in touch on next steps." [smiles slightly and nods to Dr. Lavinus]
Kira is standing in a hallway holding a folder and cup of coffee.
Kira [regretfully]: "Well, that sure didn't go the way I planned. I thought if each of them could better understand their roles in the lead up to discharge, we could come up with a way to streamline things, speed it up a bit for the benefit of our patients and each other. I mean, these are smart, qualified employees who bring a different point of view to the table. Instead, Blake and Sarah just ripped into each other's ideas and made things personal. [nodding head and pointing to self] I do think I could have done a better job introducing everybody at the top. Blake and Sarah had never officially met Ramon before, and while I discovered that Blake and Sarah are big basketball fans, I could have also brought up that they both have moms who are RNs. It might have helped build some trust. And shown Blake that Sarah isn't anti-nurse, she was just against the idea of nurses having discharge authority. [grimaces] I also think Dr. Lavinus's point is a good one. Current hospital policy states that doctors do all the discharging. [thinking out loud] Maybe we should brainstorm with a team of physicians from multiple disciplines first, make sure that ground is covered, then bring Blake, Ramon, and a few other employees in support roles back in for their input. It will slow things down, but it might be the best way to get a new policy in place that will hold up over the long term. 8:00 am already. I've got another meeting in 15 minutes, and of course, [raises eyebrow] it's all the way in the other wing. Let's hope this one goes a lot smoother." [grins and turns to walk down the hallway]
Video has ended.
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