The Odyssey Initiative

The following is an open letter to the staff, administration, and my other colleagues at UPMC Bedford.

Abstract

Patients come to us hundreds of times every week. They seek help for countless ills and injuries, from the common cold to massive trauma and assault. No one comes to a hospital for fun, and it’s our job to alleviate both the physical and emotional pain that comes with an ER visit or hospital admission.

How much worse can it be than to be stranded at a hospital with no way home?

As a year-long member of the Patient Services team, I have seen a multitude of individuals who are left in an unfamiliar place with no means of returning to their own beds. This simply adds insult to often literal injury, and makes an already less-than-ideal situation seem hopeless. It soils the customer experience on which UPMC, especially our Bedford location, prides itself. In addition, it causes extra strain on the hospital staff as they try to accommodate an often distraught and frustrated patient. A stranded patient is an unpleasant and stressful experience for everyone involved.

With UPMC Bedford serving a relatively remote and rural area, many of these patients can be upwards of hours away from home, with seemingly no way to return safely. We have already seen in the past what can happen to someone without safe transport, and I feel very strongly that situations like that of last November should be avoided at all costs.

So what can we do about this? In the past we’ve had staff members drive patients home, but that can present a clear danger and liability for the staff member or, perhaps in some cases, the patient. Bedford has a taxi service, but with only one car, an often unaffordable price, and a much smaller geographical range than that which UPMC Bedford serves, it is simply not a reliable enough option. CART, as great a service as it is, is only available to certain qualified patients.

We must take it upon ourselves, then, to help Odysseus escape Calypso and reach Ithaca once more.

I would like to propose a new service called The Odyssey Initiative, which would guarantee safe transport either to a patient’s home or to a neutral location in which they will be safe until they find another way. While this is a very rough draft of the initiative, I feel that it is a starting point toward improving the UPMC Experience, as well as keeping our patients safe and in good health.

The Plan (Roughly)

This is a (very rough) outline of what the Odyssey Initiative would look like. Keep in mind that all of the below is subject to change pending implementation.

  • Drivers should be available on a sort of “on call” basis (whoever is available at the time of patient need).
    • Volunteers are preferred, but likely not viable given the involved risk.
      • A fund should be set up (like the petty cash fund from years past) to reimburse drivers for mileage.
      • It may be necessary to hire on contractors for the job if volunteers are unavailable; I can discuss with HR how/if this would work legally.
  • Patients must meet certain criteria to be eligible for the service, both for drivers’ safety and to mitigate abuse of the program.
  • Service range can be decided upon implementation; patients who live outside that range would be transported to a safe, neutral location (a local church or shelter) which could house the patient until (s)he can make arrangements to get home.
  • An outside sponsor of the Initiative would be immensely helpful in its viability and success. We must look into local businesses and groups which would be willing to assist.
    • The owners of the Bollman Bus company are close family friends of mine; I can ask if they would be willing to contribute in some way to the Initiative.
    • Crowdfunding is also an option worth considering, though legal research will be necessary before undergoing such an endeavor.

Ensuring Safety

One of the largest points of contention for a plan like this would be ensuring the safety of the patient and driver alike. While this is not an exhaustive list of potential measures, I am confident that it is a strong start in mitigating concerns.

  • Vehicles should require some sort of barrier between the driver and the patient, similar to a city taxi, such as those found here.
  • Drivers will need some sort of vetting process (no DUI history, criminal background checks, perhaps preference for CDL licenses over regular drivers’ licenses)
  • Drivers would need to “check in” via text or phone call upon arrival at a destination, or call in with any issues faced along the way.
  • Any and all further concerns should be directed to the monthly Safety Committee, preferably before the Initiative is implemented.
  • Patients will need to be cleared appropriately in order to use the initiative (see below).

Patient Eligibility

Another point of contention is whether or not patients may use the Initiative as an easy and free means of transport, or if they may have more nefarious intentions than a simple ride home. The below requirements seek to reduce such concerns.

  • A patient who is diagnosed with a highly-communicable illness (as determined by the his/her doctor) is not eligible to use the Odyssey Initiative without clearance from that doctor.
  • The patient must demonstrate to hospital staff an honest effort to contact anyone possible, including his/her listed emergency contact, before the Initiative should be considered as an option.
  • If paid transport (e.g. Bedford Taxi) is available and the patient has the available money to pay for it, the Odyssey Initiative should not be used.
    • Exceptions can be made if the patient can demonstrate extenuating circumstances, i.e. hospital staff can override this requirement through their own judgment of the situation. As below, the Patient Advocate has the final word.
  • Patients who present for psychological evaluation must be cleared by all of the following people as a non-threat to the driver before using the Initiative:
    • the presiding case worker
    • the attending doctor
    • and the highest-authority hospital administrator available
  • Patients who leave against medical advice (AMA) or without being seen (LWBS) may not utilize the Odyssey Initiative.
    • This will discourage patients from combining an ambulance with the Initiative as a means of free transport.
  • If a hospital staff member can indicate with good reason that the Initiative is being abused or used in bad faith, that staff member may present their concerns to the Patient Advocate (currently Beth Hullihen) or in her absence, the Nursing Supervisor.
    • The Patient Advocate has the final say regarding patient eligibility for the Odyssey Initiative! After administration operating hours, the Nursing Supervisor takes on this role instead.
  • The use of a checklist to add to the patient’s medical records, similar to an EMS necessity form, should be required for future reference and risk management, and should be filed with the patient’s medical records.

Conclusion

I am fully aware of the fact that this will not be an easy plan to set in motion, and that many aspects of it may need to be altered for the sake of security, affordability, and even legality. However, the fact is that we don’t work at a hospital because it’s an easy job, but because it’s a necessary job for the betterment of the community and the human condition. Stranded patients, while relatively uncommon, make an already stressful situation considerably more so, and having a failsafe for such instances will make life a lot better for everyone involved. I ask respectfully but urgently that the President of UPMC Bedford take the Odyssey Initiative, or some similar plan of action, into consideration.

Thank you for taking the time to read this,
– Brennon M., Patient Services Representative at UPMC Bedford

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