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Wednesday, January 22, 2014

The priority level of admins versus hospital staff

I have another sensitive topic to discuss today.  In fact, I discuss this with my wife often.  We've decided that the powers that be among the hospital community focus on the wrong areas so much that they lose sight at what they really should be focusing on. Moreover, they focus on things that will make sure they get full reimbursement for patients, when they should be focused on the patient.

I'm going to give you a for instance. For instance, yesterday I was called to the emergency room.  When I got down there there were eight orders, five EKGs and three breathing treatments.  The charge nurse said, "I want you to do the chest pain EKG first."

I said, "Well, there are three breathing treatments in here.  A therapeutic breathing treatment is more important than a diagnostic EKG."

So I set off to check on the three patients who were ordered on breathing treatments.  If treatments were ordered when they should be ordered, those three patients would be short of breath. However, after checking on them, it turned out that they were all breathing just fine.  So then, and only then, did I do the chest pain EKGs.

But, you see, there is a national policy, or a state policy maybe, that all chest pain EKGs be done within three minutes.  It has something to do with ACLS, but it also has also something to do with how the hospital gets reimbursed for that patient.  Of course I think it all comes down to money, so the powers that be focus on those chest pain EKGs as priority one.

Me, I'm fine with doing an EKG in an hurry, but not at the expense of therapeutics.  In RT school, I was always taught the therapeutics comes before diagnostics.  If you get an ABG, EKG and breathing treatment ordered, you to the treatment first.  The treatment, and not the ABG and EKG, can make a patient feel better right way.

I have a friend who works in OB, and she says it's no different there.  They focus on whether or not a patient gets a circumcision, or whether or not a mom who is in no way sick gets the flu or pneumonia vaccine, when what they should be focusing on is why breast feeding is important and how to do it, or how to correctly strap a child into a car seat.

So, you see, I think that sometimes the admins think on a completely different level as nurses and respiratory therapists.  Is this something that you should go and tell your boss today, no.  But there is an appropriate time and place to speak your opinion about things like this.

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