CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 20 0000. ref SDS 19 0000.
040502 -
040503 - Met with Erick who made findings of good progress recovering from
040504 - heart bypass surgery on 091022. Vitals are good, including oxygen,
040505 - which has been a concern. ref SDS 0 JB56 Due to limited time, the
040506 - agenda was not distributed to the medical team by the communication
040507 - coordinator, so nobody was prepared for the meeting. ref SDS 0 2O4I
040508 - Xray taken on 091117 shows fluid on lower left lung is nearly
040509 - resolved, ref SDS 0 938N, due to hiking at Lafayette Reservoir that
040510 - increases load to expand lungs. Examination today shows chest
040511 - breastbone incision has not been compromised, and is healing
040512 - correctly. ref SDS 0 936G Erick will check with the team on follow up
040513 - sonogram to evaluate resolution of DVT problem, and need to continue
040514 - with Coumadin (warfarin). ref SDS 0 K24M Erick will further verify
040515 - surgery for Heller Myotomy is scheduled on 091217 to fix the achalasia
040516 - problem. Scheduled next meeting with Cardiothoracic surgery team to
040517 - evaluate recovery from heart bypass surgery, on 091217 the day of
040518 - surgery for correcting achalasia. ref SDS 0 FW6W
040519 -
040520 - [On 091201 1103 letter to VA confirms understandings from
040521 - meeting today, ref SDS 23 QF7O; report interim progress
040522 - following meeting on 091119, ref SDS 23 M84T; present pending
040523 - issues to maintain progress. ref SDS 23 M86X
040524 -
040525 -
040526 -
040527 -
040528 -
040988 -
040990 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - We were late for the meeting today, arriving OA 1030, due to heavy
041302 - traffic on the San Francisco Bay Bridge, which took about 40 minutes
041303 - to cross, from the Oakland maze.
041304 -
041305 - [On 091201 1103 letter to VA confirms understandings from
041306 - meeting today, ref SDS 23 QF7O; report interim progress
041307 - following meeting on 091119, ref SDS 23 M84T; present pending
041308 - issues to maintain progress. ref SDS 23 M86X
041310 - ..
041311 - While still on the bridge, called the VA and advised that due to
041312 - traffic problems will be late for 1000 meeting this morning.
041314 - ..
041315 - When we arrived at the VA, could not find a place to park. Got out of
041316 - the car at the Emergency Entrance. Millie continued to look for a
041317 - parking place, which took another 40 minutes. Planned to meet in the
041318 - Cardiology Department on the 2nd floor of the hospital.
041320 - ..
041321 - For some reason she could not get into the parking garage.
041323 - ..
041324 - Went into the VA at the Emergency Entrance. Visited with a woman at
041325 - the Information Counter. She advised that meetings with the
041326 - Cardiothroacic Surgery team for follow up examinations occur in
041327 - "Clinics" and in this case Module 1, rather than in the Cardiology
041328 - Department on the 2nd floor of the Hospital.
041330 - ..
041331 - These "Clinics" were about 30 feet from the Information Counter.
041333 - ..
041334 - Walked into the Clinic area, and went to counter for Module 1.
041336 - ..
041337 - Saw Neil walking through the area, and said hello. He was pleased to
041338 - see his patient looking well.
041340 - ..
041341 - The attendant for Module 1 logged the arrival of the patient.
041343 - ..
041344 - The attendant called Millie on the cell phone. Talked to Millie. She
041345 - is still trying to find a parking place. Explained that the meeting
041346 - today is not in Cardiology on the 2nd floor of the hosptial, but in
041347 - Module 1 of the Clinics on the ground floor near the entrance to the
041348 - Emergency Department, per above. ref SDS 0 925O
041350 - ..
041351 - About 5 minutes later, a nurse called to obtain vitals.
041353 - ..
041354 - Vitals are excellent, including pulse and especially oxygen.
041356 - ..
041357 - Oxygen was 98 or 99, which is much improved from 93 and 95 at time of
041358 - discharge on 091104, and reflects improved breathing from hiking at
041359 - Lafayette Reservoir that has expanded the lower left lobe of the lungs
041360 - and this eliminates fluid from the operation on 091022.
041362 - ..
041363 - While waiting for the meeting, walked the aisle looking for Millie.
041365 - ..
041366 - After 30 minutes, met with Erick, rather than Neal.
041368 - ..
041369 - Saw Ramone in the hallway where vitals are taken, and which leads to
041370 - all of the examination rooms. Ramone was busy using the computer for
041371 - case management.
041373 - ..
041374 - Ramone said he did not transmit the letter with the agenda to Neal,
041375 - and the CT team. This aligns generally with his assignment to perform
041376 - case management as a one way communication channel from the team to
041377 - the patient, but not from the patient to the team.
041379 - ..
041380 - Erick had not received a copy of the letter sent to Ramone and to
041381 - Karen with the agenda for the meeting today. ref SDS 21 WQ6M Erick
041382 - proposed that rather than ask Ramone or Karen to send him a copy of
041383 - the letter with the agenda, which would take 20 seconds, and another 2
041384 - minutes to read, that the patient work from memory and relate whatever
041385 - happens to pop into the mind at the moment, and which is not crowded
041386 - out by ordinary dynamics of verbal conversation, and because relying
041387 - on fungible memory with conversation seems faster and easier than
041388 - checking the record.
041390 - ..
041391 - Erick was able to access results for the chest xray and EKG tests
041392 - performed at the VA in Martinez on 091117 1500. ref SDS 20 TD6M This
041393 - took about 5 minutes, because accessing data across the VA system
041394 - servers is slow.
041395 -
041396 - [On 100911 0800 VA credited for improving speed of access
041397 - to computer records; discussed "Knowledge Management loop"
041398 - that redundancy and ignoring the record collapses
041399 - productivity and vitiates care because health care
041400 - professionals do not have command and control of the record
041401 - on patient history, ref SDS 26 OL50, citing case study of
041402 - work at VA today on 091021. ref SDS 10 FB5N
041404 - ..
041405 - Erick reported that the chest xray shows minimal fluid still in the
041406 - lower lobe of the left lung. He feels this aligns with improved
041407 - oxygen reported in vitals this morning, and reflects increased use of
041408 - the lungs hiking at Lafayette Reservoir, per above. ref SDS 0 JB56
041410 - ..
041411 - Reduced fluid surrounding the lungs aligns with increased exercise
041412 - hiking 3 miles at Lafayette Reservoir, reported in the letter to the
041413 - medical team on 091118 submitting the agenda for the meeting today.
041414 - ref SDS 21 4P4Y
041416 - ..
041417 - EKG test indicates heart is beating normally with a strong uniform
041418 - rythm, showing that heart bypass surgery on 091022, has resolved
041419 - problems shown in stress test reported by Doctor Egan during the
041420 - meeting at the VA in Martinez on 091002 0900. ref SDS 4 1W5I
041422 - ..
041423 - Erick had difficulty getting access to the report for the lab
041424 - performed at the VA in Martinez on 091117. ref SDS 20 TC4I After 5 -
041425 - 10 minutes, the lab report appeard on Erick's monitor in San
041426 - Francisco.
041427 -
041428 - [On 091113 1017 article New England Journal of Medicine
041429 - credits VA for effective electronic medical records (EMR)
041430 - system provides access to patient records 100% of the time.
041431 - ref SDS 18 RN8Y
041433 - ..
041434 - [On 091208 1300 Doctor Tabrizi entered the history of
041435 - achalasia again, rather than rely on prior entries of the
041436 - same history, because access to finding relevant history in
041437 - VA computer system cannot be accomplished in time to be
041438 - effective, so asking patients and redundancy in the record
041439 - seems faster and easier than using VA computer records for
041440 - assessing patient care. ref SDS 24 T16L
041442 - ..
041443 - [On 100911 0800 VA credited for improving speed of access
041444 - to computer records; discussed "Knowledge Management loop"
041445 - that redundancy and ignoring the record collapses
041446 - productivity and vitiates care because health care
041447 - professionals do not have command and control of the record
041448 - on patient history, ref SDS 26 OL50, citing case study of
041449 - work at VA today on 091021. ref SDS 10 FB5N
041451 - ..
041452 - WBC 12 remains stable for lab at VA Martinez on 091117, which is above
041453 - the target range, but normal for patient history, indicating no
041454 - evidence of infection in either the right leg incision, as occurred on
041455 - 091103, ref SDS 16 G46G, nor from aspiration pneumonia, which was
041456 - diagnosed incorrectly on 091102 0642. ref SDS 15 PB6Y Albumin was 3.6
041457 - or so, which demonstrates good nutrition required to recover from
041458 - heart surgery, and prepare for stomach surgery to repair the lower
041459 - esophugal sphincter valve. This is accomplished drinking 6 cans of
041460 - Ensure per day, implementing Hellen's nutrition plan discussed with
041461 - the surgery team on 091030 0810. ref SDS 12 1O58
041463 - ..
041464 - Note - for some reason VA does not list the lab on 091117, for
041465 - medical chart on meeting today.
041466 -
041467 - [On 100928 0706 received medical chart for meeting today,
041468 - and there is no entry for lab used in meeting today.
041469 - ref SDS 27 UD6L
041471 - ..
041472 - Erick examined the chest incision, and the incision on the right leg
041473 - used to harvest veins to perform heart bypass surgery on 091022.
041474 - ref SDS 11 6H7K He indicated today these areas show good healing
041475 - recovering from the surgery.
041477 - ..
041478 - Erick advised that aspirin should not be reduced to avoid conflict
041479 - with Coumadin for the next 3 weeks, which was asked by the Coagulation
041480 - Control Case Manager during the meeting at the VA in Martinez on
041481 - 091117 1500, ref SDS 20 MG6G, and presented in the agenda submitted to
041482 - the team yesterday on 091018. ref SDS 21 Z65T Erick feels Coumadin
041483 - dose can be adjusted to accomodate concurent use of aspirin.
041485 - ..
041486 - [On 091124 0827 during meeting at VA in Martinez, Diana, the
041487 - Coagulation Control Case Manager, was notified that the
041488 - Cardiothoracic Surgery team wants to continue aspirin
041489 - concurrent with Coumadin. ref SDS 22 D234
041491 - ..
041492 - Asked about performing follow up sonogram test to establish DVT
041493 - identified with testing on 091030, has been fully resolved, and if not
041494 - then continue Coumadin treatment until testing shows problem has been
041495 - cleared?
041497 - ..
041498 - If Coumadin is continued, then treatments must be paused 5 days or so
041499 - prior to surgery for Heller myotomy to fix the achalasia problem
041500 - sceduled for 091217.
041501 -
041502 - [On 091124 0827 Diana, Coagulation Control Case Manager,
041503 - comments during meeting at VA in Martinez, that she saw a note
041504 - in the medical chart for the meeting on 091119 that mentions
041505 - this issue, but is inconclusive with respect to the treatment
041506 - plan. ref SDS 22 D26F
041508 - ..
041509 - Erick will investigate and review this issue with the team.
041511 - ..
041512 - Erick advised there is a meeting scheduled with Doctor Stewart in
041513 - General Surgery on 091208 1300, to review issues for surgery to
041514 - correct achalasia scheduled on 091217. Erick said his computer cannot
041515 - access the surgery schedule. We reviewed notice by Paula on 091103
041516 - 0347 at 1439, ref SDS 16 PS60, scheduling work planned by Doctor
041517 - Stewart during the meeting at the VA in San Francisco on 091031 0810
041518 - at 1406. ref SDS 12 KE3B
041520 - ..
041521 - Erick will investigatge and confirm surgery scheduled for 091217.
041522 -
041523 - [On 091201 1103 letter to VA confirms understandings from
041524 - meeting today, ref SDS 23 QF7O; report interim progress
041525 - following meeting on 091119, ref SDS 23 M84T; present pending
041526 - issues to maintain progress. ref SDS 23 M86X
041528 - ..
041529 - [On 091208 1300 Doctor Stewart ordered sonogram test to
041530 - evaluate DVT and need to continue Coumadin (warfarain)
041531 - treatments, since these treatments need to end or be paused at
041532 - least 5 days prior to surgery to resolve achalasia scheduled on
041533 - 091216. ref SDS 24 C46I
041535 - ..
041536 - Neil visited for a brief examination. He pressed on the chest in
041537 - several different ways, and commented that the breastbone incision is
041538 - healing correctly, without any indications of connection failure,
041539 - compromise, nor complications.
041541 - ..
041542 - Neil discussed ending treatment with post-surgery drugs prescribed in
041543 - the Medical Chart received from Paula on 091104 with discharge
041544 - instructions on medications. ref SDS 17 1Q6P Erick recalled that
041545 - Amiodarone normally ends 30 days from date of surgery. Since surgery
041546 - was on 091022, ref SDS 11 PQWU, Neil approved ending Amiodarone on
041547 - 091122. The other drugs end when the pills run out.
041549 - ..
041550 - Neil concurred with Erick's evaluation that examination today,
041551 - including tests, reported above, ref SDS 0 938N, and with patient
041552 - history of physical exercise hiking 3 miles per day, also reported
041553 - above, ref SDS 0 LC8G, shows recovery from heart surgery on 091022 has
041554 - progressed well. As a result, the date of 091217 planned for surgery
041555 - to resolve achalasia, reported by Paula on 091103, was approved
041556 - today.
041558 - ..
041559 - The CT surgery team wants another meeting in 4 weeks. Neil feels the
041560 - CT Surgery Department can coordinate with General Surgery to schedule
041561 - follow up examination for recovering from CABG, at the time patient is
041562 - in the hospital for surgery to recover from achalasia, planned for
041563 - 091117.
041564 -
041565 - [On 091208 1300 Doctor Stewart advances Heller Myotomy surgery
041566 - to resolve achalasia 1-day to 091216 0600, and advises that
041567 - patients are typically in the hospital for a few days to enable
041568 - post-op recovery; therefore, the CT surgery team can visit with
041569 - the patient in the surgery recovery area on 091217 as planned
041570 - today. ref SDS 24 UL9G
041572 - ..
041573 - [On 091219 0600 met with CT surgery team in TCU unit of VA
041574 - Medical Center in San Francisco while recovering Heller
041575 - Myotomy surgery, ref SDS 25 0M6S; examination showed good
041576 - progress recovering from heart surgery (CAGB) 2 months
041577 - earlier on 091022. ref SDS 25 Z98L
041579 - ..
041580 - After meeting with Erik, and in leaving the clinic, noticed that Neil
041581 - was meeting with Doctor Mark Ratcliff, Chief of Surgery, in another
041582 - examination room down the hall. Stopped and visited briefly to
041583 - commend Doctor Ratcliff for outstanding leadership of the
041584 - Cardiothroacic Surgery team, evident in coordination and collaboration
041585 - that multiplies benefits of highly talented people.
041587 - ..
041588 - Doctor Ratcliffe was gracious recalling the report on 091104 to Doctor
041589 - Tseng commending oustanding medical services at the VA Medical Center
041590 - in San Francisco. ref SDS 17 PR4V
041591 -
041592 -
041593 -
041594 -
041595 -
041596 -
041597 -
041598 -
041599 -
0416 -