Table 1.

Example of a Patient Care Process

A 68-year-old male with a history of COPD (Chronic Obstructive Pulmonary Disease) and poor pulmonary function is scheduled to have surgery to remove a lesion from his liver. Prior to coming to the work-up clinic located at the hospital for his pre-operative work-up, the patient was to have a pulmonary function test, but due to a bad cough, had to reschedule. There was some confusion as to whether he should have the test done at the facility near his home or have it done the day of his work-up visit. Several calls were made between the midlevel provider *, the facility’s pulmonary department, the patient, and the patient’s family to coordinate the test, which was then conducted the day before the work-up visit. The results from this test were faxed to the work-up clinic. However, the patient also had an appointment with his cardiologist back home prior to the work-up and the records from the cardiologist were not sent to the hospital by the day of the work-up.

The midlevel provider begins by contacting the patient’s cardiologist to request that his records be sent as soon as possible. The midlevel provider is concerned about the patient’s pulmonary status and would like someone from the hospital’s pulmonary department to review the patient’s test results and evaluate his condition for surgery. After some searching, the midlevel determines the number to call and pages pulmonary. In the meantime, the midlevel provider checks the patient’s online record, discovering that the patient did not have labs done this morning as instructed, and informs the patient that he must have his labs done before he leaves the hospital. Late in the day and after several pages, the midlevel provider hears back from the pulmonary department stating that they cannot fit the patient in yet today, but can schedule him for the following morning. Since the patient is from out of town, he would prefer to see his regular pulmonary physician back home. The midlevel provider will arrange for this appointment and be in touch with the patient and his family about the appointment and whether or not they will be able to go ahead with the surgery as planned in less than two weeks.

^*A midlevel provider is a medical provider who is not a physician but is licensed to diagnose and treat patients under the supervision of a physician; it is typically a physician’s assistant or a nurse practitioners (The American Heritage® Stedman’s Medical Dictionary, 2nd Edition, 2004, Published by Houghton Mifflin Company).