Raymond, a 78-year-old man living in a motel, is found by the housekeeper lying on the floor of his room, semiconscious. The motel manager calls 911, and Raymond is taken to the closest emergency room, where he lies on a gurney in the hallway for 6 hours before a physician examines him. 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 that he had 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.

1. Identify the source(s) of inefficiency of medical care.

2. Identify the source(s) of reduced quality of care.

3. Discuss three (3) changes to the medical care delivery system that could have improved the patient’s outcome.

Any patient in such highly critical condition should be placed in the triage and first line of necessary intervention care should be provided to save the life. The patient should not be placed in a gurney and left unattended for such long hours.
First line of treatment given immediately after conditions like heart attack or stroke is very important and is crucial to save the life. The waiting period of 6 hours is too long which would further deteriorate the patient's condition.

Sources of reduced quality of care:

The first incident of placing him in the gurney and unattended for six hours
Even after knowing, the patient is struggling to speak, the physician just admits the patient for observation.
The staff of the inpatient facility does not have any basic knowledge of the patient's medical history. Without proper knowledge of patient's current condition, previous history, medications, allergies etc., could lead to erroneous treatment and improper rehabilitative measures. Since, the inpatient staff were not aware of the patient's regular medications for hypertension and cholesterol, they would not have prescribed the same. When an hypertensive stroke patient misses his medications, his condition becomes highly critical which makes him lose his life.

The three changes to the medical care delivery system:

Prompt immediate attention and initiation of first line of treatment is crucial for saving the life of any patient in critical condition
Proper line of communication within and among various departments should be there and maintaining electronic health record for access of healthcare details of the patient by everyone.
Understanding the patient's basic inabilities like lack of speaking skills (due to stroke)