Chapter 6

Two Different Outcomes

How did it all end?

Click on the recordings below to hear two possible outcomes. ​​

Scenario A

The Doctor goes ahead with the discharge...

Audio Transcript

After the doctor finds out that the patient’s wife has dementia, he calls a meeting with the interprofessional health team. He blames the team members for not communicating this critical information.

Several members of the team say that they thought the doctor was aware that the wife had dementia. They assumed he knew, so they didn’t feel the need to reiterate it.

The Social Worker speaks up to raise concerns that the home care assessment hasn’t been done. The Doctor gets upset and says: “It’s not my fault that the home care assessment wasn’t done – this should have been initiated weeks ago.” In his opinion, the patient has reached all the significant milestones and to deviate from standard procedure will affect hospital finances and prevent us from serving other patients in need of care.

I try to offer my opinion during the meeting, but I’m interrupted each time. I feel disrespected by the doctor – he doesn’t seem to value my opinion. Maybe it’s because I’m new to the team, or because I’m new to Canada. I also feel frustrated that the Charge Nurse isn’t noticing my frustration, that I need help getting my voice heard, or that I need support to feel confident sharing my opinion.

The Doctor goes ahead with the discharge and the patient is released the following day.

Being released from the hospital is very stressful for the patient and his wife – both are worried about how they’ll manage.

Because there was no homecare assessment done, the couple must manage completely on their own. They won’t receive any assistance until their needs are assessed.

The wife isn’t able to help with all her husband’s needs and there’s been no consideration into how the patient will get basic care. How will he use the washroom, get meals, travel to doctor’s appointments or get his prescriptions filled?

After a couple of weeks, the situation has only gotten worse.

The patient hasn’t been able to fill his prescription for pain medication from the pharmacy. His pain is significant and poor pain management has slowed down his healing.

Because neither the patient nor his wife are able to drive, he’s not able to get to his follow-up appointments. As a result, he hasn’t been assessed for after effects of the surgery like infection, constipation or ambulation.

At the same time, the wife’s mental capacity is getting worse because of the stress of trying to care for her husband. The patient’s slowed healing has put a tremendous burden of care on care her.

6 weeks later, the health and quality of life for both the patient and his wife have gone down even further.

The wife is experiencing agitation, paranoia and deteriorating problem solving skills. The patient’s mobility hasn’t improved, and without arrangements for meals, the couple isn’t getting their proper nutrition.

One day, when trying to use the washroom, the patient sustains another fall. He’s readmitted to the hospital with new injuries. The wife’s mental capacities have deteriorated so significantly that she is not able to live on her own while her husband is in hospital. She is sent to a long-term care facility.

When the patient arrives back in the hospital, it’s clear that we didn’t provide safe, quality care. The outcome of the case causes rifts within our interprofessional health team. Mistrust is growing between coworkers and everyone blames someone else for the patient being back in hospital.

Scenario B

I go to the charge nurse to ask for advice...

Audio Transcript

After realizing that the doctor was unaware about the patient’s wife having dementia, I go to the Charge Nurse to ask for advice. I tell her that perhaps it was my fault the doctor didn’t know this important detail, and I explain that I’m having difficulty feeling comfortable sharing my opinion.

She tells me that everyone was responsible for speaking up and sharing the information about the patient’s wife. She also empathizes with my feelings of not having a voice. 

“I didn’t realize that you were having trouble expressing yourself. I felt similarly when I first started working in Canada. It was difficult to adjust to a completely different team dynamic and environment.”

After the doctor finds out about the wife having dementia, he calls a meeting with the team.

He asks the team to provide their opinion. “There seems to have been a breakdown in communication,” he says. “I’d like everyone to brief me on the circumstances surrounding this case – explain it to me as if I don’t have any previous information, like I don’t know anything.”

He looks to the Charge Nurse first and asks her to start off the conversation.

She suggests that she’d like to hear my opinion first and that I should kick things off.

I go through all the details and share my concern that the wife isn’t equipped to care for her husband and requires care herself.

The home care coordinator reminds us that the home assessment should be done before the patient can be discharged.

Instead of focusing on who dropped the ball, the team starts to problem solve.

We decide to search for another unit or facility and find a bed within a different unit that can accommodate the patient while we arrange for all the necessary supports and resources.

The discharge is delayed for one week while we make all the necessary arrangements.

I create a discharge plan and develop a list of resources for the patient in case he needs help or assistance.

The home care coordinator conducts an assessment to determine what equipment and supports are needed. She arranges for a transitional bed that will help with his rehabilitation. She also arranges Meals-on-Wheels delivery so that the patient and his wife will receive proper nutrition during the patient’s recovery.

The patient’s wife is assessed for her capacity to cope with and manage stress and anxiety. Regular visits from the social worker are scheduled to monitor her mental health.

A week after discharge, the patient and his wife have been connected to a local community support group that’s making regular visits. The social worker asses their financial situation and makes arrangements for some financial assistance.

Prescription delivery is set-up and the patient starts to receive his medication. He’s able to manage his pain, which helps to speed up the healing process.

6 weeks later, his health has improved significantly. He’s now able to move around the house and his independence is increasing.

His wife hasn’t been overburdened because she’s had help in caring for her husband. 

The successful transition makes the interprofesssional team feel satisfied and proud. Improved quality of care means better job satisfaction for all the team members.

I wanted to show you two different ways the situation could have ended to emphasize the importance of communication and collaboration. In Scenario A, poor communication among team members impacted the patient significantly and led to him being readmitted to the hospital. In Scenario B, the team overcame communication challenges through teamwork and collaboration.

Of course, in real life we’re not able to choose the exact ending or outcome we want. But we can use an exercise like this one to think about how to handle difficult situations. Examining our choices and mapping those to possible outcomes can be a useful way of figuring out the best course of action. We can also reflect on our actions after the situation is over and think about how we might do things differently in the future.