Every day, well-meaning healthcare staff and social service workers make decisions of consequence based upon inadequate information.
All too often, after a death or other serious incident, a new contact, connection or piece of information is discovered during a post-incident team review which could have dramatically altered the client’s outcome had this data been discovered sooner.
- If only the physician had known that the newly diagnosed diabetic, Mr. Miller, was homeless with no refrigerator, limited to eat only one or two congregate meals daily. The doctor would not have just discharged him with a week’s supply of insulin (which needs refrigeration) and instructions to change his diet. The doctor would have connected him to other support services. But, without this important context, it’s likely that Mr. Miller’s condition will worsen and result in a premature crisis.
- If only the intake coordinator at the senior day center had known that Mrs. Jones was an EMS/ambulance “frequent flier” – calling 9-1-1 up to 20 times last month –the staff member could have flagged her case record. This action would have alerted co-workers to include appropriate interventions to reduce unnecessary ambulance transports and emergency department visits in her care plan.
- If only the hospital discharge planner had known that Mr. Smith was previously asked to leave three prior homeless programs. However, he currently had a bed waiting at another homeless service provider with a case manager who had built a strong rapport with him. Had the discharge planner known to contact the case manager directly, Mr. Smith’s reserved bed might not have been allocated to another client, and the hospital could have avoided a subsequent inpatient day waiting until they were confident Mr. Smith could be safely discharged.
These, and numerous other examples, continue to propel CIE San Diego toward creating a better-connected, better-informed social and healthcare data network.