November 22nd, 2009 by Happy Hospitalist in Humor, True Stories
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When I initiate final hospital discharge planning, I am making a clinical judgment that the patient is safe to leave the monitored confines of the hospital system. Hospital discharge planning begins on the day of admission.
Good hospitalists are always thinking in their minds how to get the patient safely discharged in the quickest, safest and most efficient way possible.
Sometimes the patient wishes to leave against the medical advice of the physician. Sometimes they refuse to leave at the advice of the physician. And sometimes the physician and patient agree it’s time for the next level of care. Read more »
*This blog post was originally published at The Happy Hospitalist*
November 7th, 2009 by Dr. Val Jones in True Stories
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I was hesitant to post this photo because it is an image of my girlfriend’s bathtub in New York City. I’m sure she wouldn’t want me to post this, but I figure it’s ok because I didn’t reveal her identity and also, she doesn’t read my blog.
My girlfriend is a physician. She is friendly and smart and well-groomed. Her bathroom, on the other hand, is pretty scary. It’s not unlike other bathrooms I’ve seen in New York – which means this could be partially a cultural phenomenon. She knows it needs cleaning – I guess.
She invited me to stay at her place during a recent visit – instead of a hotel – and I gladly accepted. We planned to have a nice dinner and drinks out on the town. She showed me to my room and casually mentioned that she needed to get some Draino for the bathroom. I wondered what exactly that might mean, and was surprised by her use of understatement in this case. Read more »
September 14th, 2009 by Emergiblog in Better Health Network, Opinion
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Emergency has something in common with Labor & Delivery.
Neither department has control over their census.
Medical/surgical, telemetry units and ICUs have a finite number of beds. When they are full, they are full; they cannot physically expand to more beds.
ED patients and laboring women are never turned away no matter how full the department may be. Oh, the ED may triage and L&D may send a patient in early labor home, but in both cases, eventually, all will be seen.
Labor and delivery has one advantage over the ED.
They can have someone on call.
I’ve never worked in an ED that has had an “on-call” nurse.
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I will never understand the logic behind staffing an ED based on the previous 24 hour census.
If the ED does not meet a pre-determined number of patients on one day, the break nurse for the next day is canceled and there is much wailing and gnashing of teeth as the department goes over budget.
Never mind that the acuity level of the patients who were seen was through the roof. Or that 50% of them were admitted. Or that the next day, acuity again sky high, the nurses go without meals/breaks and the department is required to give penalty pay. Again, there is much wailing and gnashing of teeth for having to pay this penalty, a penalty that would never have been required had the break nurse not been canceled.
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Now if the ED is slow, staff can always go home early. But not too early, because you never know what is coming in through the doors. So maybe an hour, 90 minutes early, knowing that the remaining staff can handle whatever they need to handle until the next shift comes in.
But what happens when the patients overwhelm the staff, both in acuity and numbers? Ambulance diversion doesn’t stop the walk-in critical patients. The MIs and the possible CVAs. The GI bleeders. The potentially septic. Trying to get patients out of the department and up to the floor doesn’t work when the floor won’t take the patient for four hours because it would put them “out of ratio”.
This is a huge issue on the night shift. When there is only one unit clerk/registrar, two nurses and an ED tech after 0300.
Of course, at night it is feast or famine.
Either the feces hits the proverbial fan or…it doesn’t.
Which is exactly why we need a nurse on-call.
The ED needs flexible staffing that accounts for those times when the acuity level/census is overwhelming. Not canceling the extra break nurse is one way of doing that on days and evenings; using the on-call system is another way that could be utilized at night. If it can be done in L&D, why can’t it be done in the ED? Surely the money saved in penalty pay for missed breaks and meals would make it budget neutral.
All I know is that trying to drop staff in an ED based on what happened the previous 24 hours makes zero sense.
(And don’t even get me started on why nurse-patient ratios are treated like unbreakable rules on the floors, but it’s okay for the ED to be waaaaay out of ratio and nobody blinks….that’s another whole post!)
*This blog post was originally published at Emergiblog*
May 22nd, 2009 by Medgadget in Better Health Network
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Earlier this week we reported on an effort at North Carolina State University to develop a better patient gown, seeing how no one ever liked the conventional tie-in-back style. To be honest, we weren’t particularly excited about the aesthetics – the design looked like a copy of typical nurse’s scrubs we see every day. Turns out that the University of Cincinnati has teamed up with Hill-Rom Company, Inc., of Batesville, Indiana, to brainstorm through possible innovations to improve the gown, the results of which will be shown at the university’s June 12 fashion show.
Here’s from the University of Cincinnati via gizmag:
And so, the solution eventually offered by the UC students is a “Progressive Recovery Collection.” These are options for multiple gowns that can, importantly, all be created from one pattern – a practice that would cut down on waste and inefficiency.
The options are:
One gown for seriously ill bed ridden patients. Another gown for the somewhat mobile patient. A third gown for the fully ambulatory.
The most important thing for a bedridden patient is to prevent pressure ulcers, according to Brooke Brandewie, a student who graduated from the product-development track of UC’s fashion design program in June 2008 and who is now working at the Live Well Collaborative as a design research associate.
“We created a gown that will allow the mattress to be the mattress. The gown is open backed for high-risk, immobile patients so the areas on the body (most susceptible to pressure ulcers) can be healed from the mattress technology, without fabric bunching in between,” Brandewie explained.
In addition, this gown (and the others created by the students) provides easy access at the shoulder – via slits and closures in the design – so that caregivers may operate IV units or other drug-delivery tools.
The students recommend that this gown – and the related versions – be made from naturally anti-microbial materials like bamboo or crabyon (a material actually made from crab shells).
There’s nothing as comfortable as a bath robe, or your own clothes that you wear at home. And that’s the inspiration behind a gown created by the UC students for the semi-mobile patient. It mimics “comfort clothes.”
Said Brandewie, “As the patient improves in condition, they will ‘graduate’ to the next gown appropriate for their condition and mobility. It not only represents the patient’s progressive physical improvement, it provides a psychological boost as well,” said Brandewie.
Like all the UC-created gowns, it closes not via standard ties currently in use with hospital gowns but via a closure like a bathrobe belt. It’s secure, comfortable, can fit to almost any size and is also more flattering to the human figure.
The gown has a full back and a kangaroo pocket in the front, recognizing that the patient will lie in bed, sit in a chair, stand and walk. Portions of the gown are made of special material to wick away moisture and sweat.
And in recognition of the reality that patients sitting or resting will be colder than those on the move, this gown comes with accessories: A scarf with a pocket, arm warmers, leg warmers and shawl, all made of bamboo jersey to integrate both extreme softness and anti-bacterial characteristics.
More at gizmag…
Flashback: “Down With the Gown” Redesigns Drab Hospital Wear
*This blog post was originally published at Medgadget*
