Health systems across the country have been making huge investments to create coordinated care delivery systems that allow patients to get the right kind of care at the right time—whether at retail clinics, primary care clinics, urgent care centers, or traditional bricks-and-mortar hospitals.
But my recent experience suggests that at least some health systems have a very, very long way to go to make that vision of coordinated care come to life.
A few weeks ago, I had the bad luck to slip on an icy patch of sidewalk and injure my ankle. Because I knew that one of our local health systems had urgent care centers in my area, I decided to forgo a trip to the emergency room and try urgent care instead. That’s where my troubles began.
Urgent care, as long as you don’t need x-rays
I called the central call center and got referred to a nearby urgent care center. My total hold time was nearly 40 minutes (with a phone disconnect in the middle). Despite this annoyance, I was certain urgent care would be a far more efficient option than the emergency room. Plus, the urgent care receptionist assured me that they could see me almost immediately and x-ray my ankle on-site. But I arrived to find out that they in fact had no x-ray capabilities at that facility, only mammography.
Our top urgent care research
I was shocked—even more so when the receptionist referred me to another location ten blocks away and then asked me apathetically, "So, how are you going to get there?"
I furiously ordered an Uber and hobbled outside. The Uber came quickly and took me to the imaging center, where I got more bad news: after x-raying my ankle, the tech there told me that there was no radiologist reading that day, and although the hospital radiologist could read the images, there was no way to order a "stat" read, so it would be three days before the x-rays would come back.
At this point, I refused to leave the urgent care center until they managed to get someone to read my x-ray, so I parked myself in the waiting room and waited. After a while, the tech came out and whispered, "You have to go to the emergency room, you have a broken ankle."
That was bad enough. But then, just like the other urgent care center, she asked, "How are you going to get there?"
I grabbed my borrowed crutches and left.
'Why would you ever trust the urgent care clinic?'
I ended up walking to the emergency room, where I waited for two hours to get triaged and another hour to get a bed, and then several more for another round of x-rays. Apparently the emergency department couldn’t access the images from its own outpatient clinic. Eight hours into the ordeal, and I wasn’t offered anything for pain or even so much as a glass of water.
To add insult to injury, more than one person on the emergency room staff asked me in disbelief, "Why would you ever trust the urgent care clinic?"
And, to close out the absurdity of the episode, when I went to a follow-up appointment with an on-staff orthopedic surgeon a few days later, she only had the x-ray images from the imaging center, not the emergency room.
Lessons for health systems
In retrospect, I can understand some aspects of how these serial missteps occurred. At the core of the issue, the health system has missed the mark on providing the right care, in the right setting, at the right time. They equate quick access with urgent care.
Unfortunately, getting in fast is necessary but not sufficient for delivering urgent care. The central call center did not have the information it needed about the equipment available at each location and how that relates to the type of care patients are seeking. The health system had not established all the necessary protocols among different sites that would allow them to care for urgent conditions at their urgent care centers. And this health system’s leaders had not successfully ingrained customer service as a high priority for its employees.
In record time: How an EMR changed my patient experience
But it’s sobering to think that I got such fragmented and poor-quality care despite being someone who works in health care delivery for a living and was able to anticipate and communicate my needs. I can only imagine what someone might have suffered if they had not known what questions to ask or what care they needed.
Based on my experience, I would encourage health system executives to examine their continuum of care closely—as much as possible, through the experiences of real patients. My guess is that even the best-run health systems have gaps in their care continuum that need to be addressed.
Access to Care,