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Monday, October 14, 2013

My one concern about hospitalists

One of my initial observations about hospitalists is they don't seem overtly concerned with getting patients off ventilators.  I mean, if it weren't for we RTs pushing them, I think the average length of stay for ventilator patients would skyrocket at our institution. 

The number of ventilator patines has indeed risen, which is good because it allows us RTs, and those nurses over there, to keep up our skills.  Yet within the first week we had the current group working at Shoreline, one of my favorite CCU nurses said to me, "Rick, my biggest concern about these guys is they don't seem overly concerned about getting this patient off the vent.  A part of me wonders if it's because ventilator patines are their greatest challenges and joys."

She made sense; she made a lot of sense.  Since that day, I've paid attention to the length of stay of ventilator patinets, and it is indeed high.  Some patinets stay on vents several days after we RTs and RNs figured the patient could have been extubated.  We currently have 2 patients on ventilators, and both are so sedated and paralyzed they aren't even given a chance. 

When our old Internists were taking care of patients, they were mainly concerned with their family practice, and only saw inpatients for less than 30 mintues a day.  That was a concern.  however, they did understand the importance of thinking extubation as soon as a patient was intubated.  They created an extubation protocol for us to follow.  We gave ventilator patines sedation vacations daily to try to wean that patient; to at least give the patient a chance to fail.

Now, there's always the chance I could be wrong.  However, let us assume for a second that I am not wrong, and our current group of hospitalists are indeed keeping ventilator patients on vents too long.  Why would this be?
  • Lack of experience:  this is possible, as some of our hospitalists are pretty young
  • Lack of wisdom: Now, this is not so likely, although possible. 
I'm not going to go into it any further.  I just thought I'd bring this up and see if my readers had any comments on the matter.  Thoughts?

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