Fulfilling Health Calls Mission One Relationship At A Time

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Health Calls received an unsolicited testimonial from a family this past week. It makes us so proud and speaks to Health Calls Mission.

‘Health Calls is a wonderful service! All of the nurses are of the highest quality and you really establish a relationship with them.

 

Health Calls is always available and ready to help no matter the time! I’d never use another agency with my mom’s care!

 

Congrats (to) everyone… associated with this fine organization!’

As invited guests in people’s homes, we must negotiate care. We cannot simply “do”. This is a shift in the perspective  that often accompanies health care provided in a hospital or other clinical settings. In those settings, the structure and processes require patients to adapt to the organization.

In home health, we are the guests.  The ‘house rules’ could get in the way. Instead, Health Calls staff is focused on teamwork, alongside other community professionals to treat patients where they live. This requires actively listening to the patient and family: finding out what is important, what can be negotiated, and then aid and inspire patients to become informed about their conditions and take an active role in their treatment.

The balance of power shifts away from the healthcare team to the individual and their family in a healthy partnership. We support the patient and family while they build skills, and foster their confidence to continue to lead active and fulfilling lives, long after our work
is done.

We are thankful to be invited!

S.A.F.E.: Be Informed, Be Empowered, Be Prepared


Patient Safety Awareness Week #PSAW2017

Most patients have taken care of their personal needs in a certain way most of their adult lives. When frailty occurs, or a person needs home health following an illness or surgery, the rehab team will often recommend personal care support for a period of time. That’s when  Health Calls Provides C.N.A. support to help with personal care until the patient is strong enough to do so safely and independently again. Cindy Babula, Certified Nurse Assistant suggests the following acronym to the patients she supports :

S. it
A. lways
F. or
E. very thing.

Frail or weak patients need time and patience to to do things safely. Of course, they may not need to do ALL things from a sitting position. Sitting to button a shirt, for example, allows time to conserve energy or catch one’s breath after showering. Many patients take pride in reminding Cindy when they have ideas of ways that she or they might do something in a safer way.

TOUCHE! Cindy says. It’s a give-and-take when each of us, patient AND a caring caregiver, puts SAFETY FIRST!

Cindy says a patient once pointed out a sleeping cat in their path as they were walking towards her bathroom; it was not a “stuffed animal,” but rather a living, shallow-breathing, deaf cat who would have to be picked up so the two could safely traverse the room.

Safety takes team work.

Here are more #SAFETYFIRST2017 ideas from the Centers for Disease Control:

 

 

 

The Answer Lies Within The Collective “Us”


My father-in-law celebrated his 90th birthday on Saturday. As I watched the 4 generations have fun together, I was struck by how much technology has changed in his lifetime while the basics of our needs and our nature as humans remains constant. Let me explain.

Some 50 years ago, my favorite cartoon as a kid was the “Jetsons”. and 30 years before that, when my father-in-law was 5, he and his family gathered around the radio on Sunday nights to listen to stories on the radio. For me the Jetsons was mind-boggling, as it was science fiction. To consider that one day cars would not only drive themselves, but fly the passenger from one place to the next was amazing to me. We are basically “there”, as MTT develops a wheelchair that drives itself, and  I watched my 20-month old grand-niece “Facetime” with her aunt who was 160 miles away but technologically with us during the birthday party.

Barry P. Chaiken, MD, MPH recently wrote an article in which he states:

The rapid expansion and evolution of medical knowledge makes it impossible for any single healthcare professional to assimilate and retain the up-to-date information necessary to properly treat patients”

– See more at: http://www.psqh.com/analysis/quality-and-technology-build-a-care-team/?webSyncID=289dd9d1-96b5-2ecd-a3e1-739c91ecd186&sessionGUID=ed38ec24-e92b-4be2-c60a-7999d29e9bb4&spMailingID=10139261&spUserID=MTY3ODg4NTgzNzQ4S0&spJobID=1062491382&spReportId=MTA2MjQ5MTM4MgS2#sthash.Xqds4hUj.dpuf.

We find ourselves dealing with mind-blowing technology in health care. As consumers, providers, and advocates for our loved ones who need health care, the reality of today’s science can cure one and be terminal for another. We all must face our mortal as well as technological limitations. Basics of communication and relationship management are key.

As mortals, clinicians (doctors, nurses, therapists, researchers) must work very hard to stay on top of the game. We must increasingly rely on and trust the expertise of our team members who know more about pieces of the equation than we may personally know. We can accomplish the best plan for each individual entrusted in our care when we consider the collective “Us“.

As family members and caregivers, we expect better, in fact the best plan of care for those we care for and about. Since I read the Chaiken article, I have given a lot of thought he presented that compares health care team members to musicians of an orchestra.

There is, in fact, too much complexity in health care for any ONE of us to know; to be the SOLE person responsible, and have the intellectual property and resources to carry off the plan of care. Instead, we must work together on the patient’s behalf. If the patient is surrounded by a symphony of experts, in concert of one another, we have a chance of success. As health professionals, we must recognize that we cannot act alone.

Political views aside, I find irony that our president stated this week that “Nobody knew health care could be so complicated”. Welcome to health care, Mr. President. You may not have known but many do. There are no easy decisions. Health care reform is far more complex than any of us realized. Life (and life-changing decisions) is not black and white. There are many shades of grey in between, that color and shape the right course of action for each person entrusted in our care.

imageAs care coordinators, family caregivers and advocates, we must see ourselves as the conductor, with the baton. You have permission. Take up the baton. The baton communicates and directs the movement of the music. As an advocate, use your baton to identify your loved one’s wishes, facilitate communication between and among health care team members and ask the hard questions to move the care along. The goal will be “what is best, in this situation, with the facts before us”. You alone will not have all of the answers. The answer lies in the symphony.

 

When Parents Don’t Want an Advocate: A Caregiver’s Dilemma


Giving up independence temporarily while working to get stronger will improve quality of life.Giving up independence temporarily while working to get stronger will improve quality of life.

 

One morning last month, a registered nurse in my office received a phone call from “Mickey” who was interested in referring her father for home health services. Her dad, an 83 year old man whom we will refer to as “Bill” had been in the hospital recently.

Bill was pretty sick when he was admitted. He spent time in Intensive Care and was treated with IV antibiotics for septic shock due to an infection of a non-healing wound on his leg. He was very lucky to recover.

Mickey did her best to advocate for her dad while he was receiving treatment in the hospital. She asked that he be referred to a rehab hospital to recuperate for a short time after his hospital stay. He had been in bed for 5 days and she was afraid he was too weak and might fall if he went straight home. Since Bill passed the walking test with the physical therapist he wasn’t a candidate for inpatient rehab. Mickey asked for home health to come visit her dad at home but Bill refused.

“I don’t need help,” Bill protested. While Mickey tried to advocate for her father, the hospital failed to consider that her father might have limited idea into his real needs at discharge and the discharge planner didn’t ask his daughter to verify the information he provided.

Mickey told me that even before spending 5 days deathly ill in the hospital, he needed help with the simplest of tasks at home. When Bill went home, Mickey and her mother did their best to help her dad settle in safely at home. Mickey works full time and her mom has health problems of her own. Now, Mickey was completely overwhelmed as she tried her best to hold things together juggling her job, her own home and her parents’ needs. She noticed that her dad was now short of breath with the most minimal activity, like putting on his shirt.

Mickey waited the long week to her dad’s follow-up doctor appointments. Finally, with the audience of the doctor, Mickey shared that things weren’t going well at home and asked some difficult questions. Wound care orders were never provided when Bill had outpatient surgery in the weeks before his hospital stay. While the doctor admitted he didn’t provide the right instructions, he never admitted he was wrong. The doctor insisted that her 83 year old father was capable of doing his own wound care, even after the hospital admission due to infection.

That same day, the family visited the family doctor. At this visit, Mickey laid out the hospital stay, how poorly things were going at home and revealed some of her own stress in trying to hold it all together. This time she came away with orders for home therapy and nursing visits. Mickey tells me:

People are going to say no because they are proud. My dad was really struggling at home so he was finally open to receiving help. The nurse and therapists were no longer strangers. These were people who took time to make a personal connection and so my parents were open to their visits. They were helpful without being bossy.

Bill allowed the nurse and therapists to visit, they formed a bond. Bill and his wife committed to the agency’s home equipment and safety recommendations, allowed these former strangers in to treat his wound, and provide therapy to make him stronger. Bill was back to his personal best in 3 weeks.

“What do people do if they don’t have somebody?” Mickey asks. Mickey believes this whole experience has helped reshape her caring relationship with her parents. She feels empowered. In the past, her parents would go to the doctor’s office and she would ask questions about the outcome and get vague answers. They weren’t being evasive; its hard to remember and the experience is overwhelming when you are the patient in the “hot seat”. Instructions provided by health care providers can get watered down in translation while trying to capture everything that’s been recommended. Mickey now realizes these types of errors and omitting important recommendations often lead to hospital admissions.

Now, Mickey goes along to keep notes, and to ask the important questions, understand and follow through on treatment. Fortunately, her parents now see that she has helped them and view her as more credible.

Mickey says the real turning point came when she said to her dad: “You have 2 choices. You can be a grumpy, unhappy old man who has to depend on others to live your life or you can be pleasant and appreciative while Mom and I care. We are not taking your independence away; we are helping you so you can get your independence back. You need to give it up, and work to get stronger, so you can get your independence back”.

Health Calls Home Health Agency recognizes and honors the 39.8 million adults caregivers (2015 Report Caregiving in the U.S. research report conducted by AARP and the National Alliance for Caregiving)  in the United States.

Weighing In On Medical Errors: What Family Caregivers Need to Know


Medical Errors can occur because, let's face it, we are all human.

Lets face it, medical errors occur because we are all human.

No one likes to talk about them, the unspoken: medical errors. What are we afraid of? Someone was wrong and needs to be punished. Someone should be sued. Isn’t that the way the course of conversation goes, or we think it will go? But here’s a reality: medical errors occur because we are all human. We NEED to talk about errors that occur, to learn and prevent the same thing from happening next time.

Vice President Joe Biden and former President Bill Clinton spoke at the Patient, Safety, Science and Technology Summit in Irvine California this past weekend to weigh in with healthcare professionals about medical errors and patient safety. The goal: “Zero deaths due to medical errors by 2020”. http://www.beckershospitalreview.com/quality/bill-clinton-joe-biden-weigh-in-on-patient-safety.html

What is a medical error? How often do medical errors happen? Is there anything a family caregiver can do while a loved one undergoes care?

Medical errors are often caused by subtle, difficult to pinpoint “melt-downs” in processes, functions, systems, communications. Medical errors result from assumptions made, misinterpretations of facts and data, limited viewpoints.

All health care providers, family members and patients contribute to the causes.  Communications are key and must be valid, concise, and pointed to assure a small misinterpretation of the information available doesn’t become a huge medical error and even accidental death. In medical error review, clinicians are taught they must ask “why” enough times to get to the “root cause” of any error.

Here’s a scenario from the case files that shows just how easily medical errors can happen (facts and names have been altered to protect privacy):

Muriel is visiting her 78 year old mother Mary, who has been in the hospital ICU for the past week. Muriel notices Mom is less alert today and is confused (not her norm), talking about Aunt Audrey visiting. Aunt Audrey has been deceased for the past 8 years. Muriel mentions her concerns to Stacy, her nurse today who has just entered her room to give Mary her medications. Muriel tells Stacy “Mom is confused today. She seems to think my dead aunt visited her today and she isn’t very alert. I had a hard time waking her and by the time I finished my sentence, she dropped off to sleep again”. Stacy tells Muriel that “ICU syndrome” or “ICU delirium” is not unusual, because Mary has been having a hard time getting a good night’s rest in the ICU. “It happens quite often, and besides she’s 78…she’s likely to be confused”, she reasons with Muriel.

While the nurse’s explanation may be a reason, Muriel’s hunch is that there is something more brewing. After all, she reasons, Mom has been here for a week and she hasn’t been confused before today. She’s different today…she’s using a lot of extra muscles in her chest to breath and seems to be breathing faster. So Muriel takes some time to think more about what else she notices different with her mom. She sees that her mom is having a very hard time eating her lunch with the face mask on and notices that her mom seems much more tired  after taking a few bites of food. She observes that Mom is resting her head back on her pillow while she chews and swallows. Muriel makes a note about her concerns and plans to talk to the doctor about it when she comes to make her rounds.

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In the meantime, the oncoming nurse visits with the day shift nurse at Mary’s bedside and they discuss Muriel’s earlier concern about Mary’s breathing. They review Mary’s case and ask Mary how she is feeling as the day has progressed. Mary says she is really tired.  Joanne, the nurse coming on duty listens to her lungs and notices that her lungs aren’t as clear as yesterday. Joanne makes a note and later reports to Dr. Johnson about her findings, and also shares the patient’s and daughter’s concerns.

Dr. Johnson decides to get a chest x-ray and blood work and visits Mary in her room. She tells Muriel and Mary that “it looks like Mary has pneumonia. I am concerned about this x-ray because it is now showing shadows that weren’t there just two days ago when we did the last x-ray.  I am also concerned that the blood gases show you’re retaining carbon dioxide, Mary, which can cause confusion. We need to lower your oxygen dose and monitor you closely to see how things improve. I am going to have a Speech Therapist visit to do an evaluation. I am concerned that you may be aspirating. Aspiration occurs when food or liquid goes into the lungs instead of down your throat when you chew and swallow. ”

The speech therapist visits a short time later and asks questions and has Mary chew and swallow several different consistencies of foods and liquids. Mary does fine with her evaluation. There is no coughing or choking with any of the food or fluid. After reviewing her findings with Dr. Johnson, Dr. Johnson reviews her concerns with Mary and Muriel. “I suspect that the force of the oxygen you have been using has caused some of the food and fluid you are eating to be blown back into your airway as you chew and swallow, Mary. You are receiving a high flow of oxygen through your mask and it may be pushing food and fluid into your lungs. From now on, we will switch your oxygen to a very low flow while you eat.”

Medical errors like this occur due to several small failures, or flaws in assumptions, mistakes in observations and failed processes. Individually, the failures aren’t big enough to cause an accident, but combined can result in an error. Such errors can ultimately result in accidental death.

Patients and their families can have a safer experience with the health care system by being involved and informed about their treatment. Improving patient safety requires constant communication between the institutions and people caring for patients, as well as patient and their families. Patients often are too ill (and often temporarily confused as Mary was) to advocate for their own needs effectively. Everyone has a role in patient safety, and everyone will benefit from its successes.

 Here are a few things that family caregivers can do to help health care professionals care for their loved ones:
 1. Be informed.
  • If you or a loved one is undergoing treatment, ask questions. Write down your questions before appointments, or in preparation for doctors rounds while in the hospital.
  • Seek additional information from reliable websites about illness or conditions that affect you or a loved one. Websites produced by the United States government end in .gov and include educational information that has been written by and edited by health experts. See websites that are also written by credible health care organizations, documented health care experts, and hospitals.
  • Research options and treatment plans. Gain some understanding and then discuss issues that arise with your health care providers.

2. Work with your team.

  • Share your health history with your health care team.
  • Pay attention. If something doesn’t seem right, call it to the attention of your team members.
  • Discuss any concerns about safety or potential errors with your health care providers. Follow your instincts. You know your loved one best.

3. Follow the treatment plan developed and agreed upon by you, your loved one, your doctor, and your team.

  • Be sure you receive instructions at the time of the visit and get it in writing to refer to later.
  • Take medication exactly as it was prescribed.
  • Use the treatments and supplies provided to you as you were instructed.
  • Report anything unusual to your doctor and team.

See more great information about Patient Safety and reducing Medical Errors at National Patient Safety Foundation (http://www.npsf.org/).

 

 

Medication Safety Prevents Complications and Repeat Hospital Stays


Larry came home from the hospital where he was treated for a lung infection. He spent 3 days in the hospital receiving IV antibiotics and recuperating from pneumonia. On the last day he received nebulizer treatments to help clear his lungs.

The morning after Larry was discharged home, his home health nurse came to evaluate Larry. An important part of every health care evaluation is the medication review. The nurse gathered all of Larry’s medications that he had been taking prior to going to the hospital and compared the list from the hospital discharge papers.

What the nurse discovered during the evaluation was that Larry had a change in the amount he is to take for three of his medicines and he had 3 new prescriptions. Only 2 prescriptions were filled at the pharmacy. Larry was not using the nebulizer and he took the wrong dose for 3 other medicines this morning. This happened because of adjustments made at the hospital due to his current health condition.

Larry has COPD and the machine helps put the medicine into the form of a fine mist that will reach to all areas of his lungs to make him breath easier and cough up mucus from the infection. Nebulizer medication may be used in addition to or in place of inhalers. Some people aren’t able to use inhalers properly and the nebulizer medicine gets to the lungs much more efficiently with the machine. In Larry’s case, he was to use the nebulizer four times a day when he is at home, and if he must be away from home, he can use his inhaler occasionally instead of the nebulizer as it’s more portable. The nebulizer helps open all of Larry’s airways so his lungs can clear the infection.

The medicine for a nebulizer machine comes from the pharmacy. Nebulizer machines come from a medical equipment company and is usually covered under Medicare and other insurances with a doctor’s prescription. In Larry’s case, the hospital sent the prescription to the pharmacy but they didn’t send a prescription for the machine to a medical supply company.

When Larry left the hospital, the nurse who reviewed the doctor’s discharge instructions mentioned that he should continue his breathing treatments. She assumed he had been using the nebulizer before. She did not do a complete medication reconciliation prior to his discharge. That was the first mistake. The second mistake was that Larry was distracted. He mentally prepared and organized all of his belongings for the return home. He did not recognize the importance of the discharge instructions. Larry missed the important details so that he would get his medication routine right when he returned to the safety and comfort of home.

Medication reconciliation is a process that all medical professionals need to follow in an organized way to make note of any differences between the way the medication was intended to be taken and how the individual is actually taking it. Larry and the nurse, if truly doing a medication reconciliation would have discovered that Larry hasn’t used a nebulizer machine before and the problem would have been fixed before he went home.

In another case, Theresa is at the doctor for a check up and her blood pressure is high today. Theresa is to take a blood pressure medicine three times a day. She understands that she is to take the medicine with each meal. In the doctors office the nurse asks her if she is taking her hydralazine. She answers, “yes”. “When do you take it?”, asks the nurse. “At each meal”, Theresa replies. While the nurse is satisfied with this answer, what is missing is finding out the times she takes it. More digging reveals that Theresa gets up at 11:00 am. She eats and takes her blood pressure medicine at 11:30 when she gets a Meals-on-Wheels delivery and then has soup and a sandwich at 5:00 at which time she takes her pill again. She never eats three meals and is actually only taking two doses a day.

Poorly controlled blood pressure may result in a stroke or heart damage, further affecting Theresa’s health and ability to live independently. As high as one-third (30%) of all patients find themselves back in the hospital less than a month after a hospital stay. Medication errors are one of the highest causes of repeat hospitalization stays.

Brown bag medication reviews completed by doctors, nurses, and pharmacists often reveal problems. “Out of 10-15 brown bag reviews, only 2 were accurate.”. People were also found to take duplicate medications because they were taking both the generic and brand name for the prescription. Filling medications at the same pharmacy every time will prevent these errors as pharmacists watch for these type of errors when filling prescriptions.

The bottom line, most important result of any medication review is safety. Patients who continue to take medications inaccurately are more likely to require a return admission to the hospital and possibly experience life-threatening medical harm requiring a stay in an intensive care unit.

How can you prevent medication errors from occurring?

1. Keep a current list of your medications in your wallet.
2. Take all of your medications in a bag with you to each doctor visit. Also, pull out your medication list and review it for accuracy as your pill bottles are reviewed.
3. Update your medication list every time a medicine is changed, added, or stopped.
4. Use one pharmacy to fill all of your prescriptions.
5. Pay attention to instructions provided by your health care provider.
6. Be comfortable asking questions about anything that you don’t understand when explanations are provided for you.
7. Request written directions to take along with you, just in case you forget parts of the instructions.
8. Ask someone to attend all doctors visits with you. Ask your companion to listen, take notes and ask questions during the visit to help you recall information later.
9. Review all the information provided you with your companion after you return home. Take notes about any followup questions you may need to talk about with your health care provider.
10. If you are hospitalized and are returning home, ask your family member or designated driver to be there with you for the discharge paperwork review and to help answer any questions at that time.
11. Don’t let the discharge instructions get buried beneath everything once you return home. It is a busy, hectic process to get reorganized when returning home from the hospital! Reviewing the instructions several times is important. There is so much information to remember, it can be overwhelming. Be kind to yourself and review the notes a few times knowing you are taking good care of yourself.
12. Request Medicare-certified home health agency services upon discharge home to assist you in the transition to home. If services weren’t started right after you leave the hospital, you may call your doctors office and request home health visits. The visiting nurse will assist you in assuring that you are taking medications accurately and provide more training and teaching about your health condition(s), medications, diet and fluid management, pain management, and lifestyle changes that are needed to help you remain healthy and avoid a return trip to the hospital. The nurse will make recommendations for other in-home visits such as Physical Therapy, Occupational Therapy, Speech Therapy, Social work services, and even home health aide services to assist with personal care for a short period as you recuperate at home.
13. Always schedule and keep follow-up health care provider/doctor appointments. An appointment to your health care provider is important to be sure that you are recovering well. Your health care provider may make further adjustments as needed to help you continue to recuperate at home.

These tips will prevent many complications in your health, no matter what the medical diagnosis is. “There’s just so much information to absorb”, as aptly put by Dr. Beth Ann Swan, Dean of Nursing at Thomas Jefferson University. In the end, communication is the key ingredient. We rely on each other. To your good health!

What Matters to You? Flipping Health Care


Ninety-eight year old Millie lives with her son and family in a suburban neighborhood. Millie has been in the hospital 6 times this past year for problems related to heart failure. She has been back home for the past week. Millie doesn't have much of an appetite and so when she says she would like a whole, old-fashioned deli pickle with her lunch, her son doesn't question her.

If Millie wants to stay home (she says that's her goal) there are some dietary guidelines that she needs to follow. The salt in one pickle is more than half Millie's daily allotment. Millie's heart failure requires a balancing act. The amount of salt she takes in with her food affects that careful balance.

We have entered a new age of health care. Unfortunately, we haven't see huge dramatic changes, yet. Change requires many shifts in mind set and many shifts in how health care is delivered. Health care reform will challenge each of us to change how we think. The patient plays the central role in managing their conditions and the entire health care team is there to help improve health.

Flipping Healthcare

Healthcare should be flipped, delivered in a way that’s convenient for patients, not their providers, says Institute for Healthcare Improvement president and CEO Maureen Bisognano, who used the phrase in her National Forum keynote last month.

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The idea, borrowed from education ( “flipping the classroom,”) is that healthcare should be provided in a way that meets what the patient wants, and providers should be allowed to teach caregivers what they need and that caregivers should listen. “We need to flip from focusing on the medical condition to focusing on the patient,” Bisognano says. In this framework, the balance of care is “flipped” from the hospital to the community.

In many respects, the healthcare community has been health professional-centered. If a person is not feeling well, a call is made for an appointment and the patient goes to the doctor’s office or hospital. People are asked “what’s the matter, what’s wrong?” as opposed to “what matters to you?”

In the “flipped” care philosophy, the focus moves away from health care to health.

Home health care providers are at an advantage with this focus. We negotiate, as invited guests, the focus of the care being delivered. Home health care professionals are focused on care delivery as a care team, at work with other community professionals to treat patient- where they live. The balance of power shifts away from the healthcare team to the individual and their family in a health partnership to support the patient and family build skills and confidence they need to lead active and fulfilling lives.

What are the risks to the person’s safety in their home?
What are the risks to the person’s health in how they live?
What matters to the person?
What are the person’s goals?
What does he hope to gain from our visits?

Visits to a person’s home provides clues to what is important, what may affect her health, what lifestyle choices may need to be negotiated for change in order for health to be realized. Flipping care requires active listening to the patient: finding out what is important, what can be negotiated, and then aid and inspire patients to become informed about their conditions and take an active role in their treatment.

For Millie, flipping healthcare could mean understanding that the deli pickle is not a point of negotiation. She may decide that she is not willing to stop eating the pickle. Flipping care means that the home care team gives her the knowledge to make the decision to eat the whole deli pickle, and budget the balance of her daily salt allowed by understanding food labels and using a food chart to find the salt values in foods without labels.

Knowledge is power. This power, coupled with understanding the early signs and symptoms of heart failure trouble, will give her a plan with actions steps to communicate with her doctor on the telephone. Together they make medication adjustments. This power is much more preferable than treating the consequences of poor health management with another hospital stay.

Flipping healthcare matters to Millie.