Clinical TopicsCritical CareFeaturesMusculoskeletal/OrthopedicsTechnology

Precision and perfection


Blue skies and sunshine glistening on the snow promised a great day of spring skiing. But a few turns down, the hill transformed a ski vacation into a trip through the healthcare system. “Did you hear anything pop?” I was asked repeatedly by the ski patrol. To the contrary, I was asking myself how I could possibly have heard anything as my body, skis, and poles propelled themselves halfway down the slope, all connected, in a tumble that rendered one leg sore and wobbly.

An attempt to stand immediately told me I wouldn’t be going down the mountain vertically. Instead, I found myself cocooned in the rescue sled and safely taken to the mountain clinic. X-rays confirmed no broken bones, but the nurse practitioner (NP) diagnosed one or more torn knee ligaments and meniscus. She carefully explained her diagnosis and reviewed discharge instructions. The only problem was her documentation said left knee; my injury was on the right. “Oh, I always do that,” she chuckled. (Let’s hope not.) The chart was corrected. Ice, ibuprofen, and a long leg brace became my best friends, and family rallied to provide help and moral support.

The next day, Monday, 2,000 miles from home, I entered the insurance maze. “For benefits, press 1. For co-pays, press 2. For questions about billing, press 3.” You know the telephone drill. After several minutes of recordings, I could recite my approximate deductible and co-pay for the X-rays and emergency clinic visit. I conferred with my primary care provider (PCP), and a plan was put in motion for me to obtain a magnetic resonance imaging (MRI) scan at home in 5 days and then see an orthopedic physician.

The wheels set were in motion, but some of the lug nuts were loose. The efforts of a helpful, well-intentioned staff produced the following: an appointment with an orthopedic physician assistant the following Monday, and a request for a bilateral knee MRI with no available appointments until Tuesday night after the orthopedics appointment. The address for the orthopedic appointment posted in my electronic health record portal differed from the one my PCP’s office emailed; the link to the map opened to a page that read “No information available.” When the dust settled, 3 days and many phone calls later, I had the correct street address (neither of the two previous ones) for a Monday afternoon appointment after an MRI scheduled for Saturday. I faxed the discharge summary from the emergency clinic (which clearly indicated MRI as the required follow-up) to the PCP and orthopedics offices to pursue preauthorization for the MRI. On Friday, while I flew home, my PCP’s office sent me an email informing me they had insufficient information to complete the preauthorization and I’d have to sign a waiver to accept full responsibility for the cost of the MRI if I wanted to have it done before my orthopedic visit and if by some chance it wasn’t approved later.

When I arrived at the MRI appointment Saturday, the courteous clerk desk couldn’t tell me how much my liability would be if I signed the waiver, but guessed it would be anywhere from $500 to $3,000. I signed the document with full confidence the approval would come. I was ushered into the MRI room, where the technician instructed me to place my knee into the form-fitting cradle on the telescoping table. But there was a problem; it was set up on the left, and my injury was on the right. “I knew that,” he said, and quickly made the correction.

The rest of the story, I’m happy to report, has been as expected. The orthopedic surgeon recommended surgery to replace my torn anterior cruciate ligament and mend my meniscus. Two weeks later, the surgical experience proved efficient, and I’m on the road to recovery.

For the average patient, when things work out okay, the little mishaps along the way quickly fade from memory. In many cases, patients correct our mistakes. But uncorrected mistakes can be dangerous. I worry about the hiccups of mixed-up addresses and the inconveniences of insurance conundrums. But more importantly, I wonder: How pervasive are the mistakes? Can we measure their impact?

These mistakes or misadventures seem to happen anywhere and everywhere. Every little thing healthcare professionals say and do can affect those we serve. Even the simplest process can challenge experienced staff who know what they’re doing. We can’t let down our guard for a minute. From instilling confidence to providing full protection to patients under our care, our responsibility is to make sure no mistakes of commission or omission occur.

Nurses are the most trusted professionals. Imagine the effect we can have if we put our minds to creating the most trusted healthcare system. Perfection, the highest degree of excellence.

Impossible, you say? Many would agree. Difficult? Yes, but striving for perfection is our charge, one precise action at a time, to fulfill our duty to care.

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN



  • I was @ my RN daug’s BS postop after colon ca surg. She had a PCA cont+ morphine set on 1mg/h & was oversedated but still had pain. She had a bleed in surg due to them hitting a vessel. I had to prevent the nurse from turning the IV to KVO (ordered 175/h), remind about the O2, get the SCD’s on her myself, get the call bell fixed, & raise hell ’cause he never even checked her when I told him the RR was 10 for 1min. He knew I was an RN. She checked her chart later (she’s in IT) no RR of 10!

  • Sounds like my experience when my husband had open heart surgery. It started when we got to the hospital following our written instructions and were told that they knew the instructions were wrong but had never let the Dr’s office know. When he left the hospital 6 days later i had 22 oages of notes on system issues. Because of my nursing role I got a meeting with Head Nurse and after I finished she asked 1 question: “have we lost you as a patient?”

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