An understanding...

Winter, has arrived early!

I am an ED Nurse, and holding admitted patients in the ED awaiting an inpatient bed, has somehow become the "norm."  It is truly mind boggling that overall, hospital administrators, directors, managers, etc., have not realized that the main entry point for patients admitted to the hospital is the ED.

So when the entire admission process comes to a screeching halt, due to un-staffed beds (that is a bed is available, but no nurses are available to care for the patient)... I wonder about the reimbursement issues.  Now, recently, I can attest that the 31 patients being held in my ED, were a result of a lack of physical beds.  That is the hospital was full!  All available beds were staffed, and occupied.  But there were a few units closed due to renovations, etc.

With all the "metrics" and "QA/QI/CQI/etc."  No one has identified the problem?  No one has hypothesized a solution?  No research has been done?  No application of results have been implemented?

Oh!  I apologize.

The solution increases expenses in a time of decreasing revenues.  Got it!

Wow!

Over 7 years ago...

I was sleeping, alone in the house, early morning (aka after midnight).  I was suddenly awakened by a loud noise, so loud that I jumped out of the bed...  in those brief moments of semi-consciousness, when your body/brain tells you something is very wrong, get up and be prepared to survive...

I heard the car-alarm going off...

I grabbed the phone, and another thing, and went to investigate...

As I exited my front door, I saw my truck smashed, actually still smoking/dusty, and another vehicle, barely "limping" down the street.

I called 911.

I put the other thing away inside, and went back outside.  I quickly determined that my truck, parked in my driveway, had been struck by another vehicle, and said vehicle was now "limping" down the street... as the 911 Operator came on, I explained what had happened, what I was seeing, and what I subsequently was witnessing.

At least two people got out of the car and ran away.  The Police showed up very quickly and was able to detain the driver.  Who was subsequently charged with and convicted of a DUI.  They never got the other two.

When the sun came up, I was able to see the skid marks, the path the offending vehicle took...  I saw that had I actually pulled my truck into the garage, there would have been a vehicle in my kitchen!  Likewise, the glancing blow, caused the vehicle to literally rip through my front yard, completely missing an Ocotillo that was at least 100 years old... based on size and DBG (Desert Botanical Garden) consultation.


To this day, I'm glad the damage was minimal.  I am happy no one was seriously hurt. 

As a few after-notes...

Two weeks later, there was a microburst that toppled that Ocotillo!  A 100 year old plant, missed one death, but was taken anyways!

A few days after the microburst... there was someone who came to my door, asking permission to take some of the "green stalks" in order to try to replant them and allow them to continue to grow!

Now, over 7 years later, I recently saw several Ocotillos growing in an urban wash near that location...  I wonder... and I hope... that at least one of them came from my yard!

My glimpse...

Unfortunately, I have come to the realization that the solution, is so complex, that it is practically unattainable.

It has taken many years, 200+ actually, to get to this point.  Anyone that thinks it will be solved tomorrow, is a fool!  I guess a lot of people have been fooled...

This idea/thread is not finished.  I will post more of my thoughts.  It may be interspersed though...


Peace!

A glimpse...

I barely realized that I had caught a glimpse...

It was almost three hours later, when I was thinking about it again, that I realized that I had almost had it!

So, times are tough.  There are a lot of unemployed people, the actual numbers... who knows!?  The way things are reported are so convoluted!  First time applicants vs. long term vs. under-employed vs. those not looking anymore...  I guess the bottom line is that if you need a job/income and have a job/income, be thankful!  It may not be exactly what you desire, but at least it's something!

A few years ago, I remember saying that "If I lost my job tomorrow, I would be willing to take a minimum-wage job doing whatever..." just to remain employed and have a minimal sustenance.  But a full-time minimum-wage job, amounts to an annual income above the poverty level, so I would not be eligible for any additional government assistance.

And the "crack," the "slip-through," the most used solution...  develops.

Does it suddenly becomes apparent?

(to be continued...)

For Future Archeologists:

The other night, I watched a program on television that was highlighting a Forensic Anthropology program at a major State University... seems they store the "skeletal remains" left over from the research, under the University's football stadium.

I actually laughed at that little snippet...

I can't imagine what future archeologists will say about our present time when they dig through this layer!

Sorry if this somehow upset the entire 'science'... things are not always as they seem...  College Football is not a death match!

So I received a patient into a "Red" Zone... Seizure... within 5 minutes of this patient's arrival, they had been fully intaked (aka Triage done, ESI assignment), physician was at bedside, initial interventions (IV access, blood drawn, etc)...

I had to take the time to actually place a patient sticker on a form, and circle "yes" or "no" on a screening form... answering several questions...

I did this, only after I determined my patient was stable, and I was waiting for our Pharmacy to send me a medication that we don't have/stock in the Emergency Department.  The actual "Nursing Intervention," that is filling out the form, occurred about 30 minutes after the patient arrived, still within the time limit of this Initiative...  but still!

I am disgusted!  I knew that this patient wasn't Septic.  But who am I?  I am, "just a nurse."


Yet I found that this patient fell into the "inclusion" criteria for Sepsis... yet they were not Septic...

Even the subsequent lab results, confirmed they were a candidate for a "pathway" for 'severe' Sepsis...  yet they were not Septic...

Had the ED Physician not listened to me, nor recognized the same thing, there could have been a very different outcome for my patient!  This patient had a lesion on their brain, identified by CT Scan... a cause for there seizure.  Prolonged seizures causes increased body temperature, increased lactate levels, increased CPK... a bump in WBC's...

The next step would have been an LP... that may have been deleterious if it had been performed...

Give thanks to whoever, but my persistence, maybe even my "foot-dragging," as a Professional Nurse... I can honestly say I saved a life!

Yet contrast that with a patient that is hypoxic, hypotensive, tachycardic, tachypnic, mottled, Capillary Refill >5 seconds...again, I as a Professional Nurse knew that this patient was sick!  Luckily the Sepsis Screening wasn't in effect yet!


An ED Physician taking a Respiratory Pathway...  The instance of a nurse, the change of course... Sepsis, an ICU admission, Vascular & Cardiology consults...

I saved a life that day too!


Oh well...

Increasingly difficult... may be time to retire!

It has become increasingly difficult for me, as a Professional Nurse, working in the Emergency Department, to comply with all of the Federal Rules, regarding Emergency Care.

My employer has placed everyone on notice, that there are now Federally Mandated "time limits" on certain actions we take in the ED. 

Door to Doctor
Door to EKG
Door to CT
Diagnosis to this...
Diagnosis to that...

It creates unrealistic expectations!

How does one triage the situation?  A trauma patient that comes in, are they more important than the person having a stroke, or maybe a heart attack?

Trauma Center... Stroke Center... Chest Pain Center...

Really!?

It may result in the ultimate nursing shortage!