Ongoing Hospital(s) Discussion

[EMSLaw]

These areas might need a contract made between other services to cover while their truck is on a transport. FDs do this. Even SFFD (San Francisco) will use AMR as a backup when their trucks are busy.

We do have mutual aid arrangements with surrounding towns and a private company, if necessary. Unlike some volunteer services mentioned on these boards, we don't have any problem getting a rig out, but it has happened that we've had three or four rigs on the road already and there are physically no more ambulances to send. Then you have to call for extra help.

 

[reaper]

Have you read some of the threads lately or attended any of the major conferences to listen to some of the bi...ing that goes on in this profession?

Did you even bother to read my previous post about how some of the decision making to transport to one facility vs another can come down to a few feet on the wrong side of the line? Yes, I have. This is not that discussion. This was about a transport an hour and half away, not around the corner.
There are also areas where protocols are inadequate as well as the education and training. Look at the thread we just had about medical needs children. No the parents can't ride. No the child can't take their vent. No the child can not have a vascular access device. And no we are definitely not taking your kid to the children's hospital that is a mile away. Different scenario, That I happened to agreed on. Those systems are ones that need changes.

Maybe you should look at some of the things you do from a patient's point of view. Yes, most transplant candidates do try to relocate close to a city where their primary doctors will be. However, not everyone plans on having a catastrophic illness in a place that works with the plans of the EMS providers. Personally I think the patients should be given a list of areas that has EMS providers who are more qualified and dedicated to patient care than others. Learning the difference between an EMT-B and P should be essential. They should also be aware if the ambulance company or FD runs a medic mill just to have warm bodies fill positions.
Agreed, inform the pt about what services can be expected. Even from a well educated and well run system!
We do provide serious training to most of our patients and their families from neo, pedi, transplant recipients and those with devices like LVADs to not rely on EMS if at all possible and make arrangements as early as possible or have their case manager arrange for a specialty team transport.

Why not push to educate the EMS systems around you? Instead of scaring Pt's away from something they very well may need!

 

[VentMedic]

Why not push to educate the EMS systems around you? Instead of scaring Pt's away from something they very well may need!

If you had read the medical needs of the child thread, you would have seen we have tried. Things perceived as BS, routine, chronic or boring do not attract EMS providers. If we give a cool class with lots of blood and guts slides we get a packed auditorium. Few want to know about home care trachs, vents, vascular access devices, pegs etc.

We don't "scare" the patient from EMS. We just tell them to watch for signs and symptoms before they need to call 911. We are of course very realistic as to what a Paramedic can and can not do. There is just so much you can do when many of the EMTs and Paramedics are products of the mills and the everyone be a medic mentality. Again, read the medical needs child thread and you will see some examples of how agencies and protocols vary.

 

[reaper]

These areas might need a contract made between other services to cover while their truck is on a transport. FDs do this. Even SFFD (San Francisco) will use AMR as a backup when their trucks are busy. Again, you are comparing large cities, to small rural areas. Most systems do have mutual aid agreements with surrounding counties. But, when those counties only have 1-2 units they may not be able to send anyone to help.
Your responsibility is to one patient and if you do not know what is best, that is what your medical control is there for to advise you.

It would also be a waste to watch a patient die waiting 12 - 24 hours for an IFT to be arranged while you were watching TV at the station and that one patient was your only call for the 24 hours.If you are waiting 12-24 hours for a transport, then your hospital has some greater issues to deal with.
Yeah the "what if" factor of getting a real cool trauma and heaven forbid we have to do an IFT with some "medical" patient is always an issue and is often used as an excuse. No one has said anything about "a real cool trauma"! This is the same as a triage scenario. You have to do the best for the most. You have decided that the patient in front of you is not worth saving because the "what if" call that might happen. I have decided that the pt in front of me will be transported to the closest appropriate facility, for evaluation by a "Dr".
Rural areas must have plans A and B in place even if it is stopping by the rural hospital to pick up one of their staff members to accompany them to the next hospital. There are times when a helicopter can not fly due to weather. Rural areas again should have other options to get the patient to the more appropriate facility. Most do, it is called stabilize and transfer!
Yes, that may mean taking one of your ALS trucks with a hospital staff member who can at least access the vascular access device or establish an airway that you are not allowed to. What makes you think that Rural medics cannot treat these Pt's or access devices? If the Dr at that facility thinks the pt needs transfer, then they will be transfered!The more progressive rural systems do have their acts together and do work with the hospitals and external resources to do what is best for their patients. Some may even have early activation of a trauma system or an agreement with the ED to get a helicopter in the air. BINGO

According to this thinking, all SOB Pt's should be transported to a transplant center. They may need a new heart and we don't want to delay care to anyone!

 

[reaper]

If you had read the medical needs of the child thread, you would have seen we have tried. Things perceived as BS, routine, chronic or boring do not attract EMS providers. If we give a cool class with lots of blood and guts slides we get a packed auditorium. Few want to know about home care trachs, vents, vascular access devices, pegs etc. Then push the systems to make it mandatory to attend!
We don't "scare" the patient from EMS. We just tell them to watch for signs and symptoms before they need to call 911. We are of course very realistic as to what a Paramedic can and can not do. There is just so much you can do when many of the EMTs and Paramedics are products of the mills and the everyone be a medic mentality. Again, read the medical needs child thread and you will see some examples of how agencies and protocols vary.

I have read the thread and agreed on the need for more education. Yes, systems do vary. If you have not seen the change for the better in EMS, over the last 20 years, then you are not looking. It has been a slow evaluation, but the change is happening. Why not work to encourage the change, rather then put down every Paramedic. Yes, there are plenty of mill medics, but there are also plenty of degree educated medics.

I have watched the change in systems for the better. As the larger systems push for change, the smaller ones are following. Look at how many colleges have changed their programs to degree programs. Look at how many MD's are now pushing for evidence based protocols. You cannot continue to place all EMS in a category with the bad ones. If we do this, the nursing industry would be in a lot worse shape, then EMS could ever be. We do not place all Rn's in the group with the bad ones.(and there are plenty)

I agree with most of your posts for education. Now instead of berating all medics, push for those that are educated to push for better changes in the systems.

 

[VentMedic]

Again, you are comparing large cities, to small rural areas. Most systems do have mutual aid agreements with surrounding counties. But, when those counties only have 1-2 units they may not be able to send anyone to help.

That was an example of where a system as large as SF needs assistance from a private company since there seems to be a stigma about private ambulance services. Did you not read my example from the smaller hospitals and little services? We have been moving trucks around to maintain coverage in many parts of the state which includes the very rural and the cities.

If you are waiting 12-24 hours for a transport, then your hospital has some greater issues to deal with.

I don't know where you are but if you PM me the names of some of your hospitals, I can probably get some of their transfer times from the QA person. We also had a discusssion about this on EMTcity and the ED doctors confirmed this was an issue. You have to deal with accepting facilities, insurances and finding the right team. You have to see that all of the EMTALA paperwork is done and you have to make sure the other facility has an ICU bed since they may no longer qualify for an ED to ED transfer. Some hospitals have had to hold patients for 3 days and by then it is generally too late. By the time we are given the okay to fly, we are essentially transporting a corpse that just happens to have a heartbeat.

There are times when a helicopter can not fly due to weather. Rural areas again should have other options to get the patient to the more appropriate facility. Most do, it is called stabilize and transfer!

Many of these patients are anything but stable and we will do our best to get them to a facility of higher care without them dying in flight. Often the local little general does not have the means to properly stabilize. The patient may need dialysis in the form or CVVH. They may need nitric oxide or some form of higher ventilation. They may need a balloon pump. They may need a ventriculostomy. They may need a surgeon. And for neonates, while the little hospitals are friendly and give EMS providers lots of snacks, many of them suck when it comes to stabilizing a sick baby or child. While Neo and Pedi teams can be mobilized quicker than some of the adult teams, they may still have to drive if weather does not permit a flight.

What makes you think that Rural medics cannot treat these Pt's or access devices? If the Dr at that facility thinks the pt needs transfer, then they will be transfered!

Does your area not have any STEMI or trauma protocols? Does every patient have to go to the closest facility and have the doctor say yes the patient meets trauma criteria or yes that chest pain with ST elevation is an MI and needs cath lab? Why would I think you might be trained with various vascular access devices if you are not allowed to make a decision about trauma? Of course if every patient has to go to the nearest facility, why would you need to know about some of the other devices?

 

[VentMedic]

I agree with most of your posts for education. Now instead of berating all medics, push for those that are educated to push for better changes in the systems.

I honestly don't know what more I can do. I consult. I am a faculty member at the college. I freelance when asked for an outside educational seminar. I attend as many state, national and local meetings as time allows I talk about education but there not a lot of people who are motivated to pursue higher education. We had a great thread here about some young person wanting a 4 year degree but again there will always be those that say it is a waste of time. Too often some will just go for a quick fix with a mill cert and a union card.

Unfortunely, I run into too many like 46young who will use every excuse not to attend an education class or I am up against a FD that has other training issues scheduled.

Try putting yourself in my position and understanding all the excuses I have heard over the years at the many legislative meetings between the cities, counties, the state and the unions.

 

[Sasha]

They have many hospitals in California and that is one very, very broke state that can not reimburse for Medi-Cal.

They do have an image to maintain and that may mean they employees will not get raises or bonuses for a few years. I will say their pedi wings in a couple of hospitals were in dire need of updating. I also know some of their employees buy their own coffee for their units as it is not always just given to them.

Have you been to the Pedi wing at south? It was amazing. Admittedly I hadn't been in their NICU just the PICU and stable pedi floor. Their "image" wouldn't be hurt by smaller TVs or cheaper couches. And I am not talking a floor, but an entire, multi story wing.

I personally wouldn't care if they cut out the water, juice, snacks, etc (I am a powerade and fruit snack junkie.) but instead of spending absurd amounts of money on patient rooms, they could be spending it on the staff which would make for happier, nicer nurses and CNAs which would draw patients in a lot quicker than a big TV, and with patients comes money.

 

[VentMedic]

Have you been to the Pedi wing at south? It was amazing. Admittedly I hadn't been in their NICU just the PICU and stable pedi floor. Their "image" wouldn't be hurt by smaller TVs or cheaper couches. And I am not talking a floor, but an entire, multi story wing.

You have to remember they also have a foundation that provides alot of the frilly stuff. When they put their name on something it won't be Wal-Mart quality.

 

[Sasha]

You have to remember they also have a foundation that provides alot of the frilly stuff. When they put their name on something it won't be Wal-Mart quality.

The foundation should be focusing more on improving staff and taking care of them.

A hospital is a hospital, it should not look like a hotel room.

 

[VentMedic]

The foundation should be focusing more on improving staff and taking care of them.

A hospital is a hospital, it should not look like a hotel room.

The foundation is not a labor union and its purpose is to make the patients feel comfortable. That may mean having their environment look nice. Before some of the remodeling, the rooms were hideous in some parts of the hospital. I can also tell you about hospitals that are in dire need of an update but can't get it done. The staff isn't too happy in those hospitals either when they are constantly apologizing for TVs not working and wall paper falling off the walls. It also makes their life difficult when some of the electrical outlets and water faucets are out of service.

The foundations that are active with the hospitals are a good thing and don't deserve bashing. They also donate the ambulances or at least help equip them for specialty transport for neo/peds at some of the hospitals.

 

[Sasha]

The foundation is not a labor union and its purpose is to make the patients feel comfortable. That may mean having their environment look nice. Before some of the remodeling, the rooms were hideous in some parts of the hospital. I can also tell you about hospitals that are in dire need of an update but can't get it done. The staff isn't too happy in those hospitals either when they are constantly apologizing for TVs not working and wall paper falling off the walls. It also makes their life difficult when some of the electrical outlets and water faucets are out of service.

The foundations that are active with the hospitals are a good thing and don't deserve bashing. They also donate the ambulances or at least help equip them for specialty transport for neo/peds at some of the hospitals.

You don't have to have either a rundown room or a hotel room, you can find a medium that makes it comfortable without being ridiculously extravagant. It is a hospital. People go there when they are sick, they go there to get better. I agree it shouldn't be a slum, but a hotel room? That's a bit much.

 

[VentMedic]

You don't have to have either a rundown room or a hotel room, you can find a medium that makes it comfortable without being ridiculously extravagant. It is a hospital. People go there when they are sick, they go there to get better. I agree it shouldn't be a slum, but a hotel room? That's a bit much.

Why are you complaining about patient comfort? Some of these patients spend months in those rooms and they should be comfortable. I do not fault the hospital for having nice rooms. However, I do question a million dollar fountain occasionally but then considering what the FDs spend on landscaping and lawn maintenance, that really isn't a lot.

 

[Sasha]

Why are you complaining about patient comfort? Some of these patients spend months in those rooms and they should be comfortable. I do not fault the hospital for having nice rooms. However, I do question a million dollar fountain occasionally but then considering what the FDs spend on landscaping and lawn maintenance, that really isn't a lot.

I am not against patient comfort. I understand patients can be in the rooms a long time. However, I think a patient would be more comfortable with a nurse who is not overworked and frustrated and can better attend to their needs, such as toileting and pain medication in a timely manner. Instead of TVs, hire more nurses instead of overwhelming them with too many patients!

There are other areas of hospitals that can be addressed. Patients can be comfortable with moderate amenities as oppose to luxury rooms.

I've had patients who would have been more comfortable waiting for transport in their rooms, in bed where they can lay on their sides instead of being down sitting in a chair on their decubs in discharge care because they had to pull the nurse that was in charge of their room to work somewhere else because they are short staffed and overwhelmed!

 

[VentMedic]

I am not against patient comfort. I understand patients can be in the rooms a long time. However, I think a patient would be more comfortable with a nurse who is not overworked and frustrated and can better attend to their needs, such as toileting and pain medication in a timely manner. Instead of TVs, hire more nurses instead of overwhelming them with too many patients!

There are other areas of hospitals that can be addressed. Patients can be comfortable with moderate amenities as oppose to luxury rooms.

I've had patients who would have been more comfortable waiting for transport in their rooms, in bed where they can lay on their sides instead of being down sitting in a chair on their decubs in discharge care because they had to pull the nurse that was in charge of their room to work somewhere else because they are short staffed and overwhelmed!

There are many other factors to this and it is not as simple as you make it appear. The hospital rooms and appliances can be used as depreciation and written off over many years which benefits the accounting issues. However, a nurse costs over $100K each year and that is under a totally different budget.

The patient spends 24 hours a day in that room. Depression is also a big issue for some with illnesses. How depressing to be stuck in a hospital with an illness and a crappy room which you will see every waiting moment.

If you have ever looked at the patient surveys that the hospitals send out, the biggest complaints some places get are about the shape of the building and the rooms along with the condition of the bathroom. If you go to a restaurant or read any ratings, the decor is almost more important than the food. Have you ever gone to someone's home that may look spotless but yet they are apologizing for the mess? People put a lot of emphasis on appearances and associating that with comfort.

Now imagine a nurse that is overworked AND he/she must apologize to every patient for a shabby room as well as having to work in a shabby envirionment everyday.

Would you feel comfortable driving around town and transporting patients in an ambulance with paint falling off, lots of dents and ripped up cushions? There are a few ambulances like that and some EMTs who talk bad about them or refuse to work there regardless of how good the pay is or quality care provided.

 

[Sasha]

I worked for a company with crappy ambulances for a very short time, and LFL might be able to validate if he spent time in their BLS ambulances how pathetic they were. However, I left because of the company, not the ambulances.

I don't understand why you seem to refuse to acknowledge that there is a medium between a shabby, run down room and a luxury room that rivals hotels.

 

[VentMedic]

I don't understand why you seem to refuse to acknowledge that there is a medium between a shabby, run down room and a luxury room that rivals hotels.

I work in hospitals and I talk to patients. If they feel like they are special by being in a nice room, it does help when the staff is having a stressful day and are not always as attentive as they should be. It doesn't take that much more to make a room look nice than it does to look like something from Motel 6. From the broader financial picture, it is to the hospitals benefit in the long run to do quality rather than K-Mart style which might have to be replaced in a year due to cheapness. The beds the patient are on can cost over $60K each and that is probably the most important piece of equipment. The decorations are there for pleasing esthetics. If you are ever stuck in a crappy hospital room for weeks as a patient or have ever taken the time to talk to patients about their hospital experiences, you might have a different view.

And, if you think the rooms at Florida Hospital are "luxury", you have led a sheltered life. There are hospitals that do have suites that are definitely luxurious. Some also have Comfort Care rooms and Maternal suites that are by far more comfortable than some of the rooms at Florida Hospital. There are also private specialty hospitals that could rival the best hotel chain.

 

[Sasha]

I work in hospitals and I talk to patients. If they feel like they are special by being in a nice room, it does help when the staff is having a stressful day and are not always as attentive as they should be. It doesn't take that much more to make a room look nice than it does to look like something from Motel 6. From the broader financial picture, it is to the hospitals benefit in the long run to do quality rather than K-Mart style which might have to be replaced in a year due to cheapness. The beds the patient are on can cost over $60K each and that is probably the most important piece of equipment. The decorations are there for pleasing esthetics. If you are ever stuck in a crappy hospital room for weeks as a patient or have ever taken the time to talk to patients about their hospital experiences, you might have a different view.

And, if you think the rooms at Florida Hospital are "luxury", you have led a sheltered life. There are hospitals that do have suites that are definitely luxurious. Some also have Comfort Care rooms and Maternal suites that are by far more comfortable than some of the rooms at Florida Hospital. There are also private specialty hospitals that could rival the best hotel chain.

I was talking mainly about their new tower and the rooms they are renovating, not the generic hospital rooms that they haven't gotten around to redoing yet. Have you seen those rooms?

 

[VentMedic]

I was talking mainly about their new tower and the rooms they are renovating, not the generic hospital rooms that they haven't gotten around to redoing yet. Have you seen those rooms?

No I haven't but again, if you are going to renovate a hospital, you may as well put some quality into it and do it right.

At least most hospitals are no longer segregating the patients based on their ability to pay and the type of room they got and that didn't just mean private or semiprivate. This used to be very prominent especially in some children's hospitals. Even the kids noticed that one side of the hall was nicer then theirs.

 

[AKidd]

Try housing 4 patients and their parents in a single room - house 2 people in a 10x10 cubicle with nothing for privacy but a curtain and a walk down the hallway for restroom facilities for 2 months, and you'll see that regardless of where you go, there will always be room for improvement. Foundations DO NOT pay for staff - ever. They exist to raise donations for capital expansions and patient amenities. They pay for the comfy chairs and TVs. You think you would like to hang out in a room for weeks/months at a time without even the privilege of watching TV, be my guest, but when it is a PT's only escape - don't deny it.

Close those 2 curtains - and live there for 2 months, and then tell me "extravagance" is unnecessary. BTW - that chair is also the parent bed.