From A TALE OF TWO PATIENTS CASE STUDY Question #1 1. Problem Statement 2. What are the factors of MH(Material Handling) that can be attributed to the problem. • Right time • . Right material Right orientation Right methods Right amount Right cost Right sequence 3. Recommendations for improvement 3 pages, 1.5 spacing. Need to answer the above questions in the form of a memo/n CASE STUDY A TALE OF TWO PATIENTS The emergency department staff were very busy tending a large number of patients when a patient, Mr. Murphy, followed shortly thereafter by another patient, Mr. Jenkins, first presented at their door, having both been transported by ambulances to the local hospital. Mr. Murphy, a rather obese individual, had fallen on his right hip in the locker room of his club house and was in a great deal of pain. Mr. Jenkins, a frail, elderly patient, had also fallen on his right hip at the long-term care facility where he was a resident. When the two patients arrived, the emergency department was very crowded, and the admissions registrar was behind in making the patient identification bands. The equipment for making the bands was very old and the registrar had other duties that occupied her time, thus neither Mr. Murphy, nor Mr. Jenkins, received their ID bands in a timely manner. Tests were ordered for Mr. Murphy and Mr. Jenkins including x-rays of both their hips. These were entered into the computer by the nursing staff. Mr. Murphy went to the x-ray department first. When he arrived, a requisition for an x-ray of the right hip had been printed out. Mr. Murphy had arrived without his ID band. This was not an unusual occurrence, and therefore, the technician did not check his name on the band and omitted asking him his name. the technician was certain he had the right patient because he had confirmed that the patient had arrived to have an x-ray of his right hip. The x-ray requisition that the technician was holding, however, was actually for Mr. Jenkins, and so it was Mr. Jenkins' name that was placed on Mr. Murphy's x-rays. In the meantime, Mr. Jenkins, who was fairly incoherent, had been transported to the radiology department. A different technician who had just returned from lunch and did not know of other patients who had recently had x-rays, took the requisition order with Mr. Murphy's name on it and read it. He then confirmed with the transporter that the patient who was lying on the gurney was there for an x-ray of the right hip. Unaware that an earlier patient had already had an x-ray of the right hip, this second technician performed the study and placed Mr. Murphy's name on Mr. Jenkin's x-ray. Thus, both patients had the wrong names on their x-rays. The radiologist called the emergency department, after both of the patients had been transported back, and reported that the x-ray with Mr. Murphy's name on it indicated a fracture. The x-rays with Mr. Jenkins' name did not reveal a fracture. Other studies, however, actually done on the real Mr. Jenkins revealed other medical problems and thus he was admitted to the hospital, despite not appearing to have a fractured hip. Because the x-rays labeled Murphy revealed a fracture, the real Mr. Murphy was also admitted to the hospital with a diagnosis of right fractured hip. The radiologist had seen neither Mr. Murphy nor Mr. Jenkins, nor had he been given any clinical information about either of them. Had the radiologist been given clinical information, he may have noticed that Mr. Murphy's x-ray revealed very little soft tissue, despite his being obese, and that Mr. Jenkins who was frail and thin had a great deal of soft tissue on his x-ray. Mr. Murphy was referred to the orthopedist. The orthopedist's Physician Assistant (PA) conducted the preoperative history and physical examination and noted in Mr. Murphy's medical record that there was a shortening of his right leg and an internal rotation. Although the orthopedist had had to speak to his PA about inadequately performed examinations in the past, he had not reported these performance problems to anyone else in the hospital. Even if he had, the hospital had no tracking system on performance data for allied health personnel. The orthopedist, who was very busy that day, did not conduct an examination of his own but instead relied on his PA's findings, and thus Mr. Murphy was scheduled for surgery the next day. In the meantime, Mr. Jenkins continued to complain of pain in his right hip and could not place any weight on his right leg. A second x-ray revealed the presence of a fracture, and despite the discrepancy in findings, no immediate investigation was done. The case was flagged for retrospective review to be conducted sometime in the future. The next day, Mr. Murphy went to the operating room. Although the x-rays were present in the surgical suite, they were not posted on the view-box, and therefore no discrepancy could be noted of the lack of soft tissue in the x-ray and Mr. Murphy's rotund physique. Surgery was initiated. Upon discovering no fracture, the orthopedist quickly stopped the surgery and called risk management to determine what should be done next and how the news should be given to Mr. Murphy's family that the surgery was unnecessary.

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From A TALE OF TWO PATIENTS CASE STUDY Question #1 1. Problem Statement 2. What are the factors of MH(Material Handling) that can be attributed to the problem. • Right time • . Right material Right orientation Right methods Right amount Right cost Right sequence 3. Recommendations for improvement 3 pages, 1.5 spacing.