When Robin Orr was admitted to the ED of Santa Barbara Cottage Hospital (Calif.), she brought a long history of experience with hospitals, both as a patient and in her professional life. Orr is a cancer survivor who had undergone back surgery several months earlier and had suffered from increasing back pain since the surgery. Late one Friday night in June 24, 2005, the pain was so intense that Orr’s care partner, Sue Cook, brought her to the ED. Orr was given morphine and taken to a room for the remainder of the night.
Who Is Robin Orr?
Orr was no ordinary hospital patient. With nearly three decades of experience as a healthcare professional working with hospitals, she was well aware of how hospitals should work—and how they often don’t work. After seven years as a hospital administrator, she went to graduate school for a master’s degree in public health, then spent 12 years as executive director for Planetree Health Resource Center, San Francisco, a nonprofit consumer healthcare organization that focuses on patient-centered care. While Orr was with Planetree the organization created a revolutionary demonstration project that brought patient-centered care to three model sites. The project centered on changing the hospitals’ physical environments as well as providing patients access to their own medical records.
Approximately 12 years ago, Orr left Planetree to start her own consulting practice. The Robin Orr Group (Santa Barbara, Calif.) works with healthcare organizations to effect patient-centered care. At the time she was admitted to the ED at Cottage Hospital, Orr’s consulting work was tapering off as she struggled with constant pain.
From the perspective of a health professional, I could see that a hospitalist helps eliminate waste. I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.
Enter the Hospitalist
At 7 a.m. on the Saturday the morning after Orr was admitted, Eric Trautwein, MD, checked on her. Dr. Trautwein is a hospitalist with the Samsun Santa Barbara Medical Foundation, which employs approximately 200 physicians in multiple specialties.
“Eric was a breathe of fresh air,” says Cook. “He … had read all her charts and immediately asked about the pain and got it under control.” Throughout the ordeal, Cook says “everyone would ask Robin what the pain level was, and she’d say ‘11,’ and they’d write it down. Eric did something about it.”
The next step, as Cook recalls, was a thorough examination. “I’ll never forget—he noticed that one knee reflex had a very subtle difference,” she says. “He wanted to double check that, saying he never made assumptions. He immediately got tests scheduled for that day, which was a Saturday. That never happens.”
Orr was scheduled for an immediate CAT scan, PET scan, and MRI. The results were available by Monday: The tests showed a mass of 4.5 x 3 cm to the left retroperitoneum adjacent to the aorta, consistent with metastatic disease.
After months of dealing with healthcare professionals who focused on and treated Orr’s pain, both Orr and Cook believe that the hospitalist’s diligence in performing a thorough exam and insistence on immediate tests were remarkable.
“A hospitalist saved my life,” Orr says confidently.
Dr. Trautwein doesn’t feel his exam and diagnosis were unusual.
“I’m not sure I did anything special,” he says. “I know for sure that my partners would have done the same things I did, and so would most hospitalists.”
After the Test Results
At the end of the weekend during Orr’s stay, Dr. Trautwein’s shift ended and his partner, Jeffrey Yim, MD, took over. Before the change, Dr. Trautwein assured the women that he’d go over Orr’s case with his partner, and that he would stay in touch. This is standard procedure among the hospitalists in their practice.