April 16th, 2011 by KerriSparling in True Stories
Tags: Damage, Diabetes, Insulin Pump, One Touch, Scuff
1 Comment »
If there’s one thing that takes a consistent beating as a result of diabetes (other than my internal organs, of course), it would be this little guy:
My insulin pump. This is a part of my diabetes management plan 24 hours a day, seven days a week. Very rarely do I take “pump vacations,” so for the most part, I’m connected at all times. On an average day, the pump endures sleeping in the bed with me, the baby’s wake-up routine (which includes her grabbing the pump site, regardless of where it is located), playing all day, working, cleaning the house and my body, conference calls and email blitzes, the gym, routine awkwardness, et cetera ad nauseum.
Which means that this expensive, life-changing little gadget gets battered around on a regular basis. Apparently, these things are built to be durable (to a certain extent), as I only cracked my Minimed pump once, and I haven’t injured this one irreparably yet. (Despite the months of clumsy, pre-eclampsia pregnancy hands during which I dropped everything I touched. I was like Gravity Midas.) But recently, I scuffed into the door jamb, and was left with this new, giant white scuff on the screen. Read more »
*This blog post was originally published at Six Until Me.*
April 14th, 2011 by DrWes in True Stories
Tags: Aging, Cardiology, Dementia, DNR, Ethics, Living Will, Pacemaker, Stroke
No Comments »
It was 11:00 pm when the pager vibrated, then beeped: it was the ER, Hospital #3.
“This is Dr. Fisher returning your page?”
“Thank you Dr. Fisher, just a moment for Dr. Frigamafratz.”
A brief pause, then:
“Wes, I think we’ll need your services. Old guy, found down at the nursing home, brought in unconscious, pulse 25 – hooked him up to an external pacer, he’s back with us now.”
“I’m on my way.”
When I arrived, there was the usual cacophony of activity in the Emergency Room. Someone screaming in one corner. Intercom sounding. Ambulance en route to our location. Breathing treatments underway in Bay 5. Room 10 headed to the CT scanner. Has room 12 got a bed? By comparison my patient was easy: his disposition in the eyes of the ER staff had been made: he was on the Express Track to the EP lab.
There he was, chest twitching. Big forceful jerking. He was a big guy, uttering something with purpose but impossible to understand. Next to him, his wife, just arriving and removing her coat. “Is he going to be okay?”
My head scrambled for an answer. “He’s okay for now,” I think I replied. Read more »
*This blog post was originally published at Dr. Wes*
April 14th, 2011 by Happy Hospitalist in Health Policy, Humor, True Stories
Tags: Cardiology, CHF, CMS, Geriatrics, Heart Failure, Internal Medicine, Medicare, Penalties, Readmission Rates, Salt
No Comments »
This was a classic moment of comical clarity that only comes along once a week. As you may or may not know, starting in 2013, The Medicare National Bank has promised to take back 1% of all of a hospital’s total Medicare revenue (to increase in future years) if the hospital has a higher 30 day readmission rate for congestive heart failure, acute myocardial infarction or pneumonia than an as yet undefined acceptable 30 day rate of readmission.
What does this mean? It means if the government decides that 20% is an acceptable rate for congestive heart failure 30 day readmission, and the hospital has a readmission rate of 25%, the hospital will be told to return 1% of all Medicare revenue for the year, not just their heart failure revenue.
Let’s use some hypothetical numbers, shall we? If a hospital generates $250 million dollars in a year on 25,000 Medicare discharge diagnosis related groups (DRGs) but only 100 of those discharge DRGs (or $1,000,000) were heart failure in 2013, what would happen if 21 CHF patients returned for readmission (a 21% thirty day readmission rate) within 30 days for heart failure instead of allowable 20%? The hospital would have to return 2.5 million dollars (1% of their total revenue on all Medicare admissions).
That one patient that took them from 20% to 21% will cost them 2.5 million dollars. The hospital would generate one million dollars in CHF revenue for the year and pay back 2.5 million dollars in penalty. That’s a pretty hefty price to pay considering that hospital profit margins from Medicare have been negative, on average, for most of the last decade. Read more »
*This blog post was originally published at The Happy Hospitalist*
April 12th, 2011 by Bongi in True Stories
Tags: Abdominal Closure, Anesthesia, Anesthesiology, Muscle Relaxant, South Africa, Surgery
No Comments »
There is a sort of love/hate relationship between the surgeons and the anesthetists. Neither one can survive without the other. We supply them with work and they get the work to lie still while we cut and dice. Yet their job is to keep the patient alive while we challenge their ability to stay alive. At the moment of surgery they play good cop and we play bad cop. Of course after surgery the good cop is suddenly the surgeon through and through. But that is another story.
I really appreciate a good anesthetist (I‘ve had bad ones) and to tell the truth these days I’m spoiled by the quality of the gas monkeys that I work with. However many years ago I remember a case where the anesthetist and I had a misunderstanding about time frame.
I was doing a laparotomy in Kalafong. The gas monkey was a long term medical officer. Read more »
*This blog post was originally published at other things amanzi*
April 11th, 2011 by Lucy Hornstein, M.D. in Humor, True Stories
Tags: Appointment Reminder, EMR, Medical, Phone Calls, Scheduling, Staff
1 Comment »
Like many offices, we have a policy of calling patients to remind them of upcoming appointments, usually one to two days ahead of time. With the advent of our new EMR, we have the option of having the system send them email reminders. The vast majority of folks who’ve received these just love them. But there are still several patients a day who get phone calls.
The other recent change in the office, cutting the staff by 50%, means that my one remaining staffer is the one who makes the calls. She has other stuff to do, though — lots of other stuff, actually — so that she may not get around to these calls until later in the day.
Thank goodness our patients are right on the ball: Read more »
*This blog post was originally published at Musings of a Dinosaur*
