Hospital incinerators

When I first started as an RT in 1995 the hospital I worked for had an incinerator.  When I pulled up to the hospital at night you could see the smoke billowing from a chimney in the backside of the place, and, if the air was blowing just right, you could smell the rancid smell of burning flesh.

About ten years ago the government passed a law making it difficult for hospitals to burn their own surgical waste.  Since that time the products had to be balled up and stuffed into large black plastic garbage bags and stored in the freezer.  About once a year a big black, unmarked freezer truck pulls up to the back dock and hundreds of large garbage backs are stuffed into it.

The truck drives to Florida, picking up more waste along the way.  Once in Florida it's driven to the Kennedy Space Center where the stuff is loaded into dilapidated NASA rockets and blasted off into outer space.

This was my lame attempt at an April Fools post this year.  The trick here is that part of this post is real, and part fools.  Can you guess which is which?

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The latest Hospital Statistics, RT and RN statistics

Here are some general statistics regarding the healthcare profession.  For statistics regarding the respiratory therapy profession, see below.

The following statistics are according to the American Hospital Association (AHA):

• Number of registered hospitals in the U.S...................5,795
• Total number of registered beds...................................944,277
• Total admissions..............................................................37,479,709
• Total expenses.................................................................$726,671,229,000

The trend in health care spending has increased exponentially since 1965 (see graph). Total health expenditures were:

• $41.6 billion in 1964
• $75.2 billion in 1970
• $232.9 billion in 1975
• $250.1 billion in 1980
• $420.1 billion in 1985
• $666.2 billion in 1990
• $1,101.9 billion in 1995
• $1,739.8 billion in 2000
• $7,681 billion in 2010 (16.2% of GNP)

Total cost of health care according to KaiserEDU.org:

• $253 billion in 1980
• $714 billion in 1990
• $2.3 trillion in 2008
• Total health care expenditures grew at annual rate of 4.4% in 2008 (slower than recent years, yet outpacing inflation and national income)
• Since 1991, employer sponsored health coverage has increased 131%, placing increased burden on employers and workers
• Medicare and Medicaid spending has increased 6.8-7.1% per year from 1998 to 2008, a little slower than the rate of private insurance spending

According to Centers for Medicare and Medicaid Services (CMS), here's how U.S. heathcare 2008 dollars were spent (see graph )

• 31% hospital care (down from 40% in 1995 NHS stats)
• 21% doctor and clinic services (same as 1995)
• 10% prescription drugs
• 7% administration
• 7% investment
• 6% nursing home care (down from 7% in 1995)
• 6% other professional services
• 4% dental
• 3% gov't public health activities
• 3% other retail projects
• 3% home health

Why the cost of healthcare costs?
Who has healthcare coverage (% below will be greater than 100 because some people have more than one insurance coverage and are approximated):

• 86% of U.S. population has healthcare coverage
• 75% of those covered have private healthcare insurance
• 61% with private insurance are covered through employers
• 13% with private insurance purchase their own insurance
• 13% of population has insurance through Medicare
• 10% of population has insurance through Medicaid
• 4% of population has insurance through military or veterans programs
• 17% of population has no health insurance (up from 14% in 1995) This is about 50 million people.
• Under insured has grown 60% bankruptcies are due to medical expenses

The following facts regarding hospital admissions from the AHA:

• 35 million people are admitted to a hospital each day
• 118 million are treated in emergency rooms each day
• 481 million other outpatient services per day
• Hospitals deliver 4 million babies per year
• In 2006, hospitals provided $35 billion of services that were not reimbursed
• Hospitals employ more than 5 million people
• Hospitals are the 2nd largest private sector employers (behind restraunts)
• When accounting for hospital purchases of goods and services from other businesses, hospitals support 1 in every 10 jobs in the U.S.
• Thus, hospitals account for $1.9 trillion in economic activity
• 1/3 of hospitals lose money on operations
• Hospitals operating margins (money left over after paying costs) were 4.0 in 2006, down from 4.6% in 1996 prior to the balanced budget Act of 1997.
• Medicare and Medicaid paid for 55% of care provided by hospitals
• 64% of hospitals are paid less than cost of services provided by Medicare services
• The Medicare funding shortfall exceeds $18 billion
• Hospitals receive 86 cents for each dollar spent on a Medicaid patient
• 76% of hospitals are paid less than cost of services provided by Medicaid services
• The Medicaid funding shortfall exceeds $11 billion
• Medicaid and Medicare shortfalls have been found to add costs (12% in California) to private insurance programs to make up for the shortfall
• 47% of hospitals reported their emergency rooms were at or exceeded full capacity
• 56% of hospitals transport overflow patients to other hospitals
• There are 116,000 nurse vacancies
• By 2020 it's estimated there will be a nursing shortage of 1 million nurses

Nursing statistics from Minority Nurse:

• There are 2,909, 357 registered nurses in the U.S. (2010 statistics)
• Approximately 168,181 registered nurses are men
• Only 8% of nurses are under 30
• 30.1% of male nurses are under 40
• 26.1% of female nurses are under 40
• 65.7% of male nurses are under 50
• 57.4% of female nurses are under 50
• 56.2% of all RNs work for hospitals
• 10.7% of nurses work in community/public health community
• Average salary of full time nurses is $57,785
• Average salary for nurses with a Master's degree is $74,377
• Nurse practitioners average $70,581

Respiratory Therapy Statistics according to the American Association for Respiratory Care (AARC) and National Board of Respiratory Care (NBRC):

• There are 105,900 RTs working in the U.S.
• 75% of RTs work in the hospital setting
• 48 states regulate the practice of respiratory therapy
• Employment of RTs is expected to grow 19% from 2006 to 2016, or 211% from 2008-2018 (faster than average for all occupations)
• 25% reported making $7e,000 or more
• 50% reported making $60,000 or more
• 25% reported making $48,000 or less
• New RTs reported earning $42,078 to $42, 497
• Median annual wages for RTs was $52,200 in 2008
• The middle 50 percent earned between $44,490 and $61,720
• The lowest 10 percent earned less than $37,920
• The highest 10 percent earned more than $69,800.

Overall hospital workers (stats from ehow.com:

• The U.S. Department of Labor estimates there are over 700 different job categories in teh healthcare industry
• 661,000 doctors in the U.S. as of 2008 American Bureau of Labor Statistics (ABLS).Most doctors earn more than $150,000 annually
• Anesthesiologist mean salary $197,570 or $94.99 per hour (ABLS)
• Internists make $176,740 per year, or $84.90 per hour (ABLS)
• Family Practitionars make $161,490 annually or $77.64 per hour (ABLS)
• Obstetritians and Gynecologists make $192,780 annually or $92.68 per hour (ABLS)
• Pediatritians make $153,370 annually, or $73.74 per hour (ABLS)
• Surgeons make $206,770 annually or $99.41 per hour (ABSS)
• Psychiatrists make $154,050 annually or $74.06 per hour (ABLS)

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What makes a good hospital

It's weird how one hospital can be bad and one be decent. I work at a really nice hospital, and I hardly ever heard complaints about it even before I worked here.

Over in the next town where I grew up there's a hospital many call Death Medical Center. And that's where I always went when I had bad asthma as a kid. I always thought I got good care. Although one of my coworkers who worked there back when I was a kid told me that even my doctor was a loopy one. Yet how was I to know? Well, I didn't care because I was just a kid, yet how were my parents to know? And even if they did know, what would my parents have done anyway? When I was having breathing trouble they certainly weren't going to drive me 20 miles to Shoreline Hospital when Death MC was five minutes away.

When I started as an RT, I thought where I worked had a nice down homey atmosphere, and all the people were great. We don't have the newest facility, but you know you're going to get the best care. Over at Death MC they have all the nicest rooms. They even have private rooms, and in their OB they have hot tubs. It's really nice. Yet the people are dip shoots. Well, not all of them, but the aura is different from where I work. I think the aura of a place comes down from the top, and here at Shoreline we have a nice aura.

I remember the first time I ever came into this place for my physical, a volunteer met me right at the front door and escorted me herself to where I needed to go. I had a good impression right off the bat. When I interviewed at Death MC the lady at the front desk "told" me how to get where I was going, and I never did quite find it. In fact, I'm still looking.

In fact, when I did work at Death MC 10 years ago, one of my friends who worked there said one day as we were walking into work, "I never met a bunch of a##holes all rolled in to one building in my life." I think she hit the nail on the head for dip shoot hospitals. It's weird how two hospitals so close can be so different in all regards.

Seriously, I think where I work, here at Shoreline Medical Center, there is an extra emphasis on public relations. When you say you're going to do something, you do it. When you see a patient looking lost, you walk them to their destination, and if you're too busy you at least stop and point them in the right direction. If a patient is sitting on a bed a long time, you go out of your way to at least make them aware that we didn't forget them. It's just that little extra effort can make a big difference in how people view your institution.

Yes we still do have our politics that irritate you from time to time. You have your occasional administrators who leave you notes every time you do something wrong, yet when you save a life nothing is said. Yet those events are normal, and to be expected. After all, the bottom line is making money.

Likewise, if I put myself in their shoes, I can't say I'd do it any different. In fact, I'm pretty sure I wouldn't. You do whatever it takes to keep your job, and to keep your institution in the black. And while the bosses don't mean to seem one sided, that's sometimes how they come across, especially to the complainers.

Yet a good pat on the back, a good comment, a smile, a nod of the head, or even just that little bit of going out of your way to make a difference can really help make an institution that much better.

It's true that I would like to see more protocols, and I would like to see administrators and doctors allow RTs like myself to share our opinions more, and have them listen and heed our advice. There is a process and we do get heard, yet sometimes it doesn't seem often enough nor fast enough nor efficient enough, and I think that's what's the most irritating.

Politics is irritating. And as much as I hate people in Washington deciding what pot holes in Shoreline to fill, I don't like Admins deciding how the nurses nursing station should be set up and arranged. Decisions should be made by local people who see the problems and know exactly what to do to fix them.

Our hospital has made progress in this ares with Keystone meetings, Huddles, and the like, and asking me and others in my department to participate by writing policy, creating protocols and working with admins and doctors and RT bosses to make our institution better.

Yet it's slow progress regardless. Like when you stare at a clock, it seems to be not moving at all. Daunting it is. That's just normal. You'll have your politics wherever you go. Yet, overall, I think Shoreline has a good, down home atmosphere filled with people who care. I think it starts at the top, and it starts with a smile.

Reimbursement criteria going a bit overboard

I had to laugh as my co-worker today told me that he was approached by the lady in charge of double checking charts to make sure we are complying with quality management.

The basic purpose of her job is to make sure that charting is as such that we will be reimbursed for therapy. She also has to make sure that the patient meets criteria for payment.

"Hey Dale," she said, "What is it with all these Q4 breathing treatments being given 10 minutes late or 10 minutes early.

Dale told me he looked at her with a blank face. What was he to say? He told her that we are a busy department, and because this is a job with many interruptions, we have to have some leeway in doing our therapies.

"But," she said, "In order for our insurance to pay, Q4 treatments have to be done every four hours exactly."

Dale said, "At first I thought she was joking, then I realized she was being serious."

What is the medical world coming to. Not only are we incapable of deciding who really needs breathing treatments, we have to do them exactly when we are told.

However, that's not going to happen.

Fewer Vent paitents is ailing small town RT Caves

It used to be really busy here at Shoreline. In fact, even back two years ago I remember being so busy I didn't even have the time to read a chapter of whatever book I stuffed into my tote bag.

In the past year, however, I feel like I could literally sit here in the RT Cave and write an entire novel -- each night.

About a week ago we had a patient on the ventilator when I arrived. Don't laugh, but I had to actually search for the silence button. And then, that same night, I had to set up a vent. My brain was a little rusty, and I couldn't remember the formula for determining ideal body weight.

Other than that I was in RT Heaven that night; it felt great to be doing real RT work.

But that was one night. The next night we were back to our usual 10 patients, 9-10 of whom giving the treatment was equivalent to having them drink a glass of water for pneumonia.

I saw a recent trends report for Shoreline, and it went something like this: 99 vents set up in2000, 98 set up in 2001, 88 in 2002, 80 in 2003, 84 in 2004, 74 in 2005, 48 in 2006, 24 in 2007.

None the downward trend.

What's the reason for this? Total patient admissions have been consistent, so it's not because people are choosing a different hospital. BiPAP set-ups have been consistent, so it's not because the BiPAP is saving people from going on vents.

Another trend is length of stay on the ventilators, which has dramatically dropped from an average of 100 hours per patient all the way down to 21 hours per patient. This, I believe, can be attributed to a variety of factors, including quality staff, great doctors who are more receptive to protocols, and new microprosessor ventilators.

So, technology can be attributed to some of our decline, but what about the lack of ventilators overall trending down? I have theories here too.

Many of the most critical patients are being shipped to specialty hospitals, i.e. cardiac, neuro, trauma. While we used to take care of more cardiac patients, it doesn't make much sense to keep them here when they can be minutes away from a cardiac doctor.

Not that we still couldn't take care of these patients here. We could.

Likewise, more and more patients are prevented from moving to the critical care floor due to early intervention and treatment. This goes along with improved education, quality of care and increased vigilance regarding patient's showing early signs of problems and nipping them in the bud.

So, now I sit here with seven or eight expensive state of the art ventilators collecting dust in the back closet. I'm prepared to take on an epidemic, and yet here I sit while my skills atrophy.

I've written before on these pages how we have been trying to get protocols, and how the RT leaders are against them more so because they are afraid they will result in less work for us. Well, what better time than the present for them to make their case.

I know from reading other blogs, and talking with other therapists, that we are not alone in this.

This is part of a developing trend for small town hospitals. In fact, it might be the wave of the future. We might never get back to the level of having 100 vents in a year again, even though we are more than equipped to handle it.

The reason I saw these statistics is because the admins are concerned about recruiting RTs here in the future. Are we going to be able to recruit RTs to a hospital when they know they'd just sit around waiting for an emergency to happen, as my main character does in "The RT Cave in the Year 2020."

If you're a young RT fresh out of RT school who wants to keep his skills up, a small town RT cave may not be for you anymore. But trust me when I say that wasn't true two years ago, and it definitely wasn't true when I started here.

Rumor has it the admins are aware of how a high quality area is being underutilized, and are seeking to bring something in to generate some business for us. That in itself is a scary idea, especially if this downward trend is an aberration.

We are all vulnerable

Today is my 8th day off in a row. It hasn't actually been the most ideal vacation since it took spending 3 nights in the hospital to get days off, but I'm feeling quite refreshed none-the-less.

Even though I wasn't even close to deathly ill, I came home last Thursday and appreciated my wife and children more so than I normally might. My job allows me to spend quality time with my family, but I spent even more quality time with them.

I suppose I came home with a growing appreciation for what little I have. Not that I didn't appreciate it before, but I appreciate it more so now -- at least for a while.

I also feel vulnerable. I think that's a normal feeling people get after spending a few nights in the hospital. By vulnerable I mean not feeling as though I'm going to live forever, and I need to take care of myself so I'm still around when my kids have kids and their kids have kids.

Perhaps all people who work in a hospital have some sense of vulnerability, since we see what happens to people when they don't take care of themselves on a daily basis. Despite this, however, we still tend to turn a blind eye to this. For lack of a better word, we become numb to it.

We become numb to it despite all the people who tell us, "If I'd have known I was going to live this long I would have taken better care of myself."

Yet, how many among us still continue to smoke, to drink on a regular basis, or eat excessively? How many among us are going to fill up on all that candy sitting around the nurses stations this year? How many among us are still going to pig out at all those Christmas parties until we are bloated?

The truth is, most of us will. And even while I had been working out in an attempt to get in better shape before becoming an in-patient last week, I had been slacking to some extent. Yes, I am in better shape than most people my age, but I am still overweight. I am still vulnerable.

We all can think of many among us who smoke, drink and eat and be merry all day long or at least "socially" and never seem to have any consequences to this. While I do all of these (except smoke) on occasion, I have learned I have bad genes that won't allow me to not suffer any consequences.

Not that this would have prevented my most recent hospital visit, because my doctor said it was simply, "luck of the draw" that I got H. Pylori in my small intestine. But still, people with good genes would not have been hit this hard.

There is no way anyone of us can be perfect. There is no way to avoid all the temptations proffered to us this time of year, so long as we are aware of what we are doing; so long as we are aware of our vulnerability.

I think it's this vulnerability that we feed when we educate our patients on what they need to do to improve their lives. While most of these people will follow what we say to a tee while they are still feeling "vulnerable" after their release from the hospital, they will soon forget, as most of us forget too as time passes by.

They will forget until they get sick again. They will forget until they get so sick they are forced to change their lifestyle, because their disease process will no longer allow them to smoke, or to drink, or to eat excessively.

It is important to enjoy life. It is also important to at least be aware that we are also not impervious. We are all vulnerable.

Click here for my experience with vulnerable.

The winners and pinheads of hospital life

Some people are really great, and they make life easier for all of us. They are the winners. However, some people make life worse for all of us, and they are the pinheads. Here is a pithy list.

Winners: Dennis Quaid for not suing the nurse and hospital who overdosed their Twins with Heparin. Yes the nurse screwed up, but the Quaids weren't out to destroy them, nor to seek their money. To me that's a classy act.

Pinheads: Baxter Health care Corp for failure to change the labeling on similar looking bottles but different doses of Heparin, even after three kids died from receiving the wrong dose for this reason.

Winners: The few politicians who seek to to put an end to frivolous medical lawsuits.

Pinheads: Politicians who are more intersted in getting re-elected than doing what's right.

Winners: Prescription drug companies for continuously gambling millions of dollars researching for new medicines for today's many illnesses.

Pinheads: Any politician who's out to punish prescription companies for making a profit when they do succeed. They do this sometimes by proposing price controls. This may give the poor cheaper drugs right now, but it would stymie the incentive to risk further money on new drugs, especially considering the cost of a new drug reaching commercialization are 6000 to 1, & costs 10-20 years of research and $15-20 billion.

Winners: Medical workers who keep up on their research.

Pinheads: Medical workers who don't keep up on their research.

Winners: The people who do medical research.

Pinheads: Doctors who believe every study out there, especially the ones done by pharmaceutical companies on their own new drugs. Xopenex rings a bell here. Does it really have fewer side effects as Albuterol. Some new studies say no.

Winners: The makers of Xopenex. Hey, it's a new option, and options are good.

Pinheads: The makers of Xoponex for getting us foolish RTs and DRs to buy their product by way of our stomachs and fancy restaurants.

Winners: Hospitals who give Christmas bonuses.

Pinheads: Hospitals that are cheap at Christmas time.

Winners: RTs who volunteer to work overtime to make life easier for everyone else.

Pinheads: RTs who only help out when it's convenient for themselves.

Winners: People who do the scheduling and put up with all the whiners.

Pinheads: Bosses that require mandatory overtime. I refuse to work for them.

Winners: Volunteers

Pinheads: Greedy bosses

Winners: Fun to work with people.

Pinheads: Complainers.

Winners: Dr's for writing Doctor's orders. You guys are awesome.

Pinheads: Dr's for writing doctors orders. Some of these orders are just plain quacky.

Have another donut Mr. Respiratory Therapist

"Have a donut." My coworker Dee slouches back in her chair, apparently exhausted after a long, busy day.

"No, I'm trying to stay fit." I grab the worksheet and sit down.

"Oh, come on, one donut won't hurt."

"Well, I suppose just one." There goes my diet. "You have a pen."

Dee reaches into her pocket, yanks out a pen, and hands it to me. "You'd think people who work in a hospital would be among the healthiest, most fit people in the world."

"I don't want your favorite pen," I said with a mouth stuffed with donut,

"I don't care. I just want to get out of here."

"Oh, well I can tell you from personal experience working in a hospital makes it impossible to stay healthy."

"Why do you say impossible?"

"Well, I get to work and you offer me a donut. Last night In ER they insist I eat the chili and apple pie in the break room. Then I go up to North and they insist I have some sloppy joes and chips, and then I go to CCU and I'm offered more food.

"Oh, I see what you mean."

"And that's not even mentioning the candy jar Jerry keeps filled in her office. And then I go into Mrs. Roger's room and she insists I take a handful of candy bars. In fact, not only does she insist I take some, but she insists I eat one in front of her. And how the hell do you say no to one of your sweetest patients?"

"And this isn't even a Holiday."

"There's no hope of dieting within a month of a Holiday around here. I try every year. In fact, I'm trying right now. The Halloween candy is already out and about. And then comes Halloween and New Years."

"True. And look around at all the overweight people working here. Well, you're not, but I certainly am."

"What do you mean I'm not fat. Look at me. I've been working out the past 5 weeks and I'm still 20 pounds overweight. In fact, I've lost 30 pounds or more 4 times since I got hired here, and every time I gained it all back.

"Really?"

"Yeah. I'm telling you, it's impossible to lose weight in a hospital."

"Want a piece of chocolate?" She slides the box across the table.

I grab one " Okay, now give me some times so you can get out of this unhealthy place."

"Sure, and then you can eat that last donut."

"Oh, you know I will, right after I visit Mrs. Rogers."