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.

New strategy for change in the RT Cave

In my past few posts I emphasized the problem that has caused low morale in this RT Cave, in this post I will state the proposed solution to improving morale.

Yesterday I told my supervisor I was going to quit. I was serious. In fact, as soon as I got home I downloaded an application to another hospital, filled it out, and then went to bed. However, by the time I woke up I had a more level head on. I was ready to tackle the problem head on. The time had come. I had nothing to lose.

At first I thought my bluff wasn't taken seriously. But, when morning came about, and the hour of 4:00 rolled by and I didn't hear from my supervisor, I knew something was amiss.

And, as I was just about to wrap things up for the day, the head RT boss approached me and wanted to see me in his office. Apparently, the supervisor had told him I wanted to quit, and he asked me what the problem was.

"The problem is simple", I told him, "that I have gone home miserable the past few days, and while I had planned on working another 22 years at this place, I refuse to be miserable for 22 years."

"Well," he said, "How can I make it better for you." Wow. Is that all I need to do to get some attention -- threaten to quit. I suppose the squeaky wheel gets the grease. I'm taking advantage of this.

"The answer to that is simple," I said, "Communication. I think that we all seek the same goal of improving the department, but you guys decided you were going to do something and didn't' tell us about it, and then all of a sudden you expect us to be perfect in our charting. That's simply poor business. Thus, I propose, simply that you better communicate."

I could have sat in his office complaining about how poor of a communicator he is, or how stupid the administration at this hospital is, which is what the RT Complainers may do anyway, but I didn't want to stoop to that level. I wanted this meeting to be productive.

"What do you mean by communicate?" he said.

"Exactly like you are doing right now. You are listening to me, and allowing me to speak. And, I am sure, you will explain to me why you are all of a sudden cracking down and expecting us to chart perfectly."

"That makes sense." And he proceeded to explain to me why the crackdown. He explained economic hard times. While the hospital might be really busy today, it has had many slow days. So, when random procedures don't get charted, that amounts to money that is not made for the hospital.

He said, "Okay, any other ideas."

By golly I did. I rattled off a list off the top of my head:

1. I would like a 12 hour leeway in which we can do our charting, or fix any errors in our charting.


2. At the end of the day, I want to be able to print off a sheet that lets us know what we charted, so if we didn't chart something, double charted, or didn't chart something at all we'd be able to see it right then so we could fix it. He thought we had this list already, and I explained we didn't. There, one communication problem fixed.


3. Another co-worker I talked with proposed that instead of leaving notes every day that we made a mistake, that we create a monitoring system where this data is recorded, and at our monthly meeting we can monitor progress or lack there of. If a certain person has more charting errors than the average RT, then he should be set aside and a plan should be worked out to determine how this might be improved. If the department as a whole is making the same errors, then perhaps a new strategy for charting should be implemented.

After I left his office, I coincidentally picked up a book I had in my basement and read it, considering it was only 174 pages long and pertained exactly to the situation at hand in our RT cave. The name of the book was The Effective Executive by Peter Drucker.

In this book he talks about a model for effective executive leadership. It shows a way to turn a failing model around into a successful model. And, considering the new policy in our department that attempted to make us RTs perfect on a dime, and that resulted in excessive complaining, animosity and low morale, this situation was on my mind as I read the book.

According to Newt Gingrich in his new book Real Change, Drucker's strategy goes something like this:

1. What do you VALUE?


2. What VISION of success do you have for achieving what you value?


3. What METRICS would tell you whether you are making progress toward your vision?


4. What STRATEGIES would enable you to achieve your vision?


5. What PROJECTS would enable you to implement your strategies successfully?


6. What TASKS have to be done well to complete each project?

Before I left his office I cracked a joke to lighten up the atmosphere, and then I told him I felt better now that we communicated, and I thought it would be a good idea to communicate like this with the rest of the staff as well. I was impressed when one of my co-workers called me to inform me she was to have a meeting with the boss later in the day, as has every other RT in the Cave.

"What the heck did you tell him," she said.

"Everything," I said, "What did I have to lose."

We value more communication and good morale in our department. We want back what was stolen from us when this new policy was enacted. Our vision of success is involving the entire department in the decision making.

Jane Sage is the one who thought of a strategy for metrics, and this is her idea was to create a monitoring system that showed us what we were doing wrong and whether it was the entire department or if some of us were more more prone to making mistakes than others, and what exactly were the mistakes.

Metrics is more than just the statistics that are pounded on us at each department meeting, statistics that show ups and downs in the monthly financial status, or how well the hospital is perceived within the community, or the RT department for that matter (as a side note, we are viewed as excellent on a regular basis).

While the statistics can show some trends, statistics cannot show morale. Likewise, statistics can become stale. Thus, having good metrics is a far better means of solving a problem.

By my meeting with the head RT boss I listed some of my ideas for improving the problem. And, as he plans on talking with other RTs, they will list some of their strategies, projects and tasks, and then we will get together in our next departmental meeting an analyze all the information accumulated and try to implement a plan.

Newt Gingrich, in his book Real Change writes that "Albert Einstein had a firm rule for thinking about new solutions. He asserted the following: thinking that doing more of the same will lead to a different outcome is a sign of insanity (Emphasis added).

Thus, even before any of us had read any book on the subject, we were on the right track.

Thus it only makes sense for the RT bosses to implement a new strategy to achieve their goal. This meeting I had with the boss was only the first step, I'll keep you guys updated on how things progress from here.

You can control your own health care costs

You are responsible for your own healthcare costs. That is why I hereby link you to an excellent post on The Respiratory Report, "Cut your Health Care Costs. This humble blog post will provide you with a few personal weapons you have at your disposal at battling the high cost of medicine, and the importance of battling those who wish to resort to governmental or "universal" health care.

It's your responsibility to make sure you have control of your own health. Please check out the link above. A great post.

The skyrocketing healthcare cost debacle

Over at Respiratory Therapy Driven is posted an interesting post noting the high prices for various respiratory therapies, followed by an interesting discussion.

I no longer get to see the prices of therapies at our hospital because charges are automatically dropped when we chart, however I know that prices compare from hospital to hospital, and they all seem to charge way too much.

It seems ridiculous that each day in a hospital room would cost over $800, or almost $2,000 for an ICU bed per night. Or that one day on a vent would cost as much as $1,500, or that a BiPap charge per day $800.

However, after I think about it further, perhaps some of this cost can be justified because they do include services. And all you RTs and RNs know full well that one patient might require much more attention than just the usual Q2 or Q4 vent check. Some patients can be easy, but others can be down right challenging.

And then there is the liability involved. If the hospital gets sued there could be millions of dollars on the line, and the hospital would have to be able to cover this cost. Thus, the prices get jacked up a bit more.

And then there is the increase in supply of patients coming to the hospital since the inception of Medicaid and Medicare and, ahem, "free" health care. Well, you and I know it's not really free because you and I are paying for them via our taxes, but it's free to them. And what happens when you get something for free -- you grab it.

Isn't the simple rule of economics that when demand for a product increases and supply stays the say the price goes up? I'll have to look that up in my economics 101 book, but I think that is the case. Anyway, this simple law of economics would explain why the cost of medicine, coupled with the frivolous lawsuits, might explain why the charges have skyrocketed in recent years.

I can buy a nebulizer for less than $100, a box of Ventolin for around $20 and give myself breathing treatments for free. Or I can buy Ventolin inhaler for about $20. When I can do this myself for this low of a cost, why then does it cost as much as $350 for QID Albuterol and Atrovent nebulizers?

Likewise, why would doctors continue to order Nebulizers when they aren't indicated, when studies show that a correctly used MDI with spacer works just as well as a nebulizer, and most patients can do the MDI on their own for free, minus the initial education and cost of the inhaler.

And, if the cost of Nebulizers treatments is so high, why then do not more hospitals have more treatment protocols to cut down on useless breathing treatments? Would not this drive down the price?

Some of the cost of a hospital stay can be justified, as I mentioned the risk involved, but also for the simple reason of being able to pay competitive wages to doctors, nurses, ancillary staff, and all the other people needed for a hospital to function.

And, hospitals have to be able to cover the cost of keeping up to date on all the expensive new technologies in order to stay ahead of the game and provide the best care possible for its patients. In this regard, the high cost might be understandable.

I read somewhere that the cost of medicine used to be trivial before the government got involved, mostly because once people realized they could get medical attention for free in emergency rooms, they flocked to emergency rooms.

At the same time, regardless of the indication for an emergency room visit, hospitals are not allowed by Federal law to turn any person down for treatment.

Even illegal aliens get free health care in the U.S., and they have no billing address of which to send a bill to either. All of this, as per economics 101, drives up the cost of medicine for all of us who pay, and makes it challenging for those without health insurance to pay for hospital services.
Some people contend that the U.S. needs to create a federalized health care program in the mould of Canada and Europe. I for one am not convinced that this would solve the problem, and you can check out posts I've written on my other blog regarding Federalized Health care and decide for yourself (and feel completely free to disagree with me, but be nice if you decide to leave a comment.)

A good discussion on this topic in the arena of ideas is something that is much needed, and with the coming presidential elections, all options should be on the table. The only way to solve a problem this big is via debate, regardless of how hard this might be.

Still, $40 for a sat check is quite ridiculous. At our hospital doctors get paid $40 for just reading an EKG. I calculated once that if one doctor read all the EKG in a year, he would make $40,000 a year. And that was ten years ago.

Yet, 40 years ago people could simply walk into a hospital and pay cash for services rendered.

(CHECK OUT MY POLL)

(Here is a doctor's perspective on the high cost of medicine, and an RT from Canada.)

The conundrum of busy emergency rooms

"God, how long are we gonna have to wait. We should have just stayed home."

I hear that often as I walk by the crowded waiting room on busy nights at shoreline, and I think, "If you're even thinking of leaving, maybe you shouldn't be here in the first place.

Trust me on this: RT Cave Rule #7: if you are having a true emergency, you will not have to wait to be seen by the ER physician. If you are suffering from anything critical, you will find yourself in an ER bed faster than you can say ER.

"It's ridiculous I have to wait this long," I hear.

And I think to tell them, "So, do you want us to treat you before the man in room F who's having a heart attack, or should we treat you right away so you can get back to your beer and cigarette."

Being the good boy I am I usually keep on walking.

I had a discussion with an elder doctor who told me that 20 years ago he didn't even stay in the ER at night, he simply went home. If he was needed he was paged. And, he said, that when he came in he knew it was for an emergency, which is what the EMERGENCY room used to be for.

Not anymore.

So why are todays ERs so busy?

Anonymous over at Respiratory Therapy 101 wrote an excellent post on this today. I encourage you to read it, because he is right on. I can honestly say I agree with him 100%.

He writes that ERs are busy because the government does not reimburse independent doctors enough money, so these doctors have no incentive to accept Medicaid patients. This leaves Medicaid patients with no option but to flock to the ER for their non-emergent medical problems.

That, coupled with the threat of a lawsuit, has resulted in doctors ordering a bunch of tests that aren't' even indicated just to "cover my ass." This makes for a long ER visit.

There's another factor involved here, and that's the idea of FREE. It is a natural human tendency that when people hear that something is free, they flock to it.

And, since it's illegal for ERs to turn people down, they have no choice to accept Medicaid patients, and even uninsured patients they know will never pay up.

Like Anonymous RT, I'm not proposing that we throw these patients out of the ER. I do, however, believe we have a serious conundrum here that needs to be addressed.

Here is my 2 cents worth of ideas that should get the ball rolling:

1. Do not go to a Federalized Health Care system. Giving away more free stuff will only make the matter worse.


2. Force doctors to do the procedures they order. Frivolous orders would soon be a thing of the past. The ER will clear out faster.


3. End frivolous lawsuits by forcing people who file them to pay all court fees if they lose. Doctors will no longer have to order procedures, "just to protect myself."


4. Encourage RNs and RTs to chart when they think a therapy is not indicated and hope that insurance and government agents read that charting. When agencies stop paying for these not indicated therapies, hospital administrators will be forced to crack down.


5. Encourage politicians to spend a day shadowing in the ER. I bet it wouldn't take long for them to catch on.


6. Have mandatory health education classes for anyone using government health care programs. Here they will learn what constitutes an emergency.