For the following case studies, identify the source(s) of inefficiency and reduced quality of care. Then discuss what changes to the health care system could be made to have improved the patient’s outcome. Case # 1: Raymond Raymond, a 78-year-old man living in a motel, is found lying on the floor of his room, semi-conscious, by the housekeeper. The motel manager calls 9-1-1, and Raymond is taken to the closest emergency room, where he lies on a gurney in the hallway for 6 hours before being examined by a physician. Because it is unclear what is wrong with him and he cannot speak coherently, the physician admits him to the hospital for observation. Later, when it is determined he has suffered a stroke; he is discharged to an inpatient rehabilitation facility that has no knowledge of his medical history, including his current medications for hypertension and high-cholesterol. He dies there several weeks later. Case Study adapted from: Kovner, A.R., and Knickman, J.R. (Eds.). (2011). Jonas and Kovner’s Health care delivery in the United States. (3rd ed., p. 201-2). New York: Springer Publishing Company. Case # 2: Tanya Tanya, a 7-year-old girl who suffers from chronic asthma, is hospitalized when her asthma exacerbates a case of pneumonia. Although her pediatrician and pediatric asthma specialist are members of the same medical group, they recommend conflicting medications and treatments. Decisions about how to treat Tanya are made by the pediatric unit nurses, shift-by-shift. Her parents cannot understand why her treatment in the hospital is so confusing and uncertain. After a week as an inpatient, Tanya is discharged and returns to school where she is kept indoors at recess and the lunch period due to the fragile state of her lungs. Months later, her parents find out from the pediatrician that, in addition to the pneumonia, Tanya had a collapsed lung, and the pediatrician and asthma specialist disagreed about how to treat it. Case Study adapted from: Kovner, A.R., and Knickman, J.R. (Eds.). (2011). Jonas and Kovner’s Health care delivery in the United States. (3rd ed., p. 201-2). New York: Springer Publishing Company.
