June 5th, 2011 by CodeBlog in Expert Interviews
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Ready to learn more about nurses who work beyond the bedside? Nurses who work in the Cardiac Catheterization Lab (CCL) play an important role in cardiac care. Amy Sellers, RN BSN CCRN CSC CMC blogs at Nursing Influence and graciously agreed to give us a peek at what a nurse is responsible for doing in the CCL.
Amy has worked in the Cath Lab for about 6 months now. She previously worked in CVICU for almost 5 years before deciding that she needed a new challenge. She is paid hourly and works three 12 hour shifts per week (all daytime Mon-Fri) with lots of opportunities for overtime and call shifts.
A cath lab is an area of the hospital that uses fluoroscopy and contrast dye to check for narrowing/blockages in arteries or veins in the body. Using special equipment, they are able to perform angioplasty (open the arteries with a balloon), place stents, insert IVC filters (a filter that is inserted into a large vein which prevents blood clots that form in the leg from getting to the lungs) as well as inserting pacemakers/ICDs. ICDs are Implantable Cardiac Defibrillators. They detect if a patient’s heart goes into a lethal rhythm and provides a shock to the heart if necessary to get it beating correctly again.
What do you do all day? Read more »
*This blog post was originally published at code blog - tales of a nurse*
May 23rd, 2011 by Michael Kirsch, M.D. in True Stories
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Photo Credit
I barely escaped from an embarrassing situation recently in the hospital. I was consulted to place a feeding tube, called a PEG, in an ICU patient. We gastroenterologists are rarely consulted for our opinion on whether these tubes make sense, which they often don’t. We are recruited to these patients simply to perform the technical function of inserting the tubes, so that Granny, or Great-Granny, or Great-Great… , won’t starve. Multiple medical studies have demonstrated that providing this nutrition to individuals with advanced dementia doesn’t benefit them. In addition, while it may seem intuitive that artificial feeding provides comfort, this may not be the case. It may provide more comfort to the physicians and family than it does to the patient. Read more »
*This blog post was originally published at MD Whistleblower*
May 7th, 2011 by Happy Hospitalist in Opinion
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So I’m rounding in the ICU the other day when I came upon this new hospital medical device. It’s called a pupillometer. What does this pupillometer do? It measures subtle changes in the light reflex of the pupil to help take the physical exam to the next level of precision.
Or eliminate it, depending on how you look at it. What used to be a basic physical exam skill is now being replaced by a $6000 piece of medical technology that can distinguish tiny changes in pupil size. Now the real questions remain. Has this pupillometer device gone through the rigors of randomized trials in the ICU to define whether a $6000 flashlight changes outcomes or mortality? And if not, how do we allow medications to require such testing but not the technology that often changes nothing and simply makes health care more expensive.
The way I see things, if I’m trying to decide whether someone’s pupils constrict 1% vs 3% vs 10%, I’m getting a palliative care consult instead and putting the pupillometer back in my holster.
First the vein light. Now the pupillomter. And I thought the super bright LED pen light was all the rage.
*This blog post was originally published at The Happy Hospitalist*
May 1st, 2011 by Shadowfax in Health Policy, Opinion
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One interesting comment I have seen come up over and over is the idea that end-of-life costs are the thing that is spiralling out of control and that if we could somehow find a way to curb the costs of futile care, then that would somehow solve the health care inflation crisis. Andrew Sullivan endorsed such an idea the other day, a “Modest Proposal,” which is not nearly as radical or amusing as Swift’s. And indeed, there is a modicum of sense in the idea.
Estimates are that spending in the last six months of a person’s life account for 30-50% of their overall health care costs, and that the spending in the last year of a person’s life accounts for 25% of overall medicare spending. So — simple solution, right? cut down on the futile care, and we’re good to go.
Only problem — as a doctor, I sometimes have a hard time telling when someone is in their last DAY of life, let alone last year. Read more »
*This blog post was originally published at Movin' Meat*
April 16th, 2011 by RyanDuBosar in Research
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Chronically-ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but their intensity of care increased as well, according to a report by the Dartmouth Atlas Project.
While in the hospital less, patients had many more visits from physicians, particularly specialists, and spent more days in intensive care units, as result of growth in intensive care and specialist capacity, the researchers said.
Intensive interventions can lower a patients’ quality of life and cost more, the researchers noted. About one-fourth of all Medicare spending stems from the last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease, the authors noted. Following patient preferences for end-of-life care may reduce such spending. Read more »
*This blog post was originally published at ACP Hospitalist*
