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Saturday, July 19, 2008

More money wasted in the ER

Well, you get what you deserve. After I jinxed myself yesterday morning when I gloated about not getting paged once on my shift Thursday night, I ended up spending last night in ER until about 1:00.

No, I didn't save any lives. In fact, I really didn't do much good at all. But, the doctor wanted those Q1 hour treatments on all her SOB patients. Who did the infamous Dr. Krane order Q1 hour treatments on last night?
  1. A lady with a history of pneumonia.

  2. A lady who was diagnosed with a pneumo

  3. An elderly gentleman with lung cancer (Left lower lobe removed) and Lymphoma. He never smoked a day in his life, so I would rule out COPD here.

  4. An elderly man who was scheduled to have a pleural effusion drained. He was diagnosed with sepsis and probable pneumonia.

  5. PE.

Sure, these all presented with symptoms similar to asthma, and the initial treatment did help on a few of these, but treatment # 3, #4 and #5 certainly weren't indicated.

Let's see. According to my new research, that is $88 * 5 = $440 worth of treatments when one and a good assessment would have been suffice.

ER treatments at our hospital are $88 a piece. Pharmacy probably charges even more for the medications used.

If Obama and McCain want to address something that would benefit the health care crisis, this is it. What a waste of resources.

Check out my 'olins at the bottom of the blog. I've finally updated them.


Heidi said...

Honestly, why Q1 treatments? Why not just slap a continous neb on them...10 to 15mg over the hour and be done with it. WHY waste everyone's time with the Q1?

We have a PA in the ER that orders 3 back to back V/A treatments BEFORE she will even think about ordering a continuous.

Seriously, I want to slap the shit out of her every time she does that crap.

Freadom said...

I think continuous txs are worse, because then I can't leave ER at all. Which I wouldn't mind, if the patient neede continuous.

I wish it was appropriate behavior to slap a doctor who ordered such stupid stuff, but unfortunately it's not.

However, sometimes, being a small hospital and I'm the only therapist on, some of those Q1 hours get done Q1.5-2 hours (unless they are really needed. said...

$88 bucks?...that's cheap!

At UCSF (where I go) Neb txs are $190 each .Throw in a PF check and it jumps $350. A cont neb is $ 1500 per day! A ventilator $3,000 per day.

This is my favorite...An Advair 500/50 diskus at UCSF is $900 bucks!

Someone's getting rich and it aint the RTs!

Mike said...

Yeah man that is kind of the bane of the RT's existence. I vary rarely encounter Q1 treatments, but when I do it is part of our asthma protocol and I can space the treatments out as the PT progresses.

It really sucks in your situation where you cover the ER and have to report back to your regular assignment.

I would think that hospital management would care about all this waste but they never seem to mind or do anything about all the un-needed respiratory treatments.

Freadom said...

Heck, the management loves it. Keep in mind, however, that the hospital rarely is reimbured the whole cost of anything. The only people who pay the full cost are people without insurance. Go figure that one out.

Heidi said...

Well, if you can't leave the ER that's a problem. We are able to place a patient on a continous if they are on the monitor, and then we are able to leave. They usually have to be in the ER, the Unit or in the Stepdown units. The RN's take the patient off the cont. neb when they are done.

But, if you have to stay with the patient...that is a big problem.

Freadom said...

If someone really needed a treatment in ER the same time someone on the floor needed therapy, the ER nurses are the best at helping out.

newRTguy said...

it may just be me being new but why did they need to treat a pneumo with treatment?

Freadom said...

my point exactly