Bed Delays.... The foreign concept, only not.

[Akulahawk]

mycrofft, that hospital addition also has to take over for another hospital, particularly everything maternity-related. Once that new facility opens, Sutter Memorial starts moving all their functions over to the new place and will shut down. I've at least seen a floor-plan for the maternity-related stuff. Pretty much everything is supposed to be closer together instead of being spread across several wings and floors...

I don't think the new place has increased their ED size/staff to compensate for the impending loss of the other facility.

 

[JPINFV]

How about airlines take Federal money; hospital associations and the AMA donate to federal (andy state and local) elections?

When I see new medical facilities being built with minimal architectural flourish and no offices larger than my house, then I'll cry them a river about how they can't afford patient care.

A recent "cancer center" addition to a local hospital (one of the two major emergency receiving hospitals and a nonprofit) is a little over twice the size of the hospital. I've been inside, and much of it is admin space. Sheathed in reflective glass, at least two large fountains outdoors, and without adequate parking for patients so they hire valets for parking the vehicles of cancer patients.
Cancer center (not called that since the project was finished) under consruction, hospital on its right and partially obscured/out of frame

PS: this was near the end on construction which took about four years. There were four of the tall red cranes most of the time on the site.

The hospital is listing it as a 10 story "women's and children's center" with 242 inpatient beds. Granted, that's not a lot of beds for a 10 story structure (my hospital is 6 floors and around 450 beds), but the question is also going to be how much of that is being dedicated to non-bed treatment rooms (i.e. cath lab, ORs, etc) and outpatient services. Additionally, administrative services do need space.

In regards to the architecture, what do you want? Simple windowless poured concrete structures? I'm going to bet that the cost of those fountains are negligible in the overall cost.

Additionally, when you do have a family member in the hospital in critical condition, and you're spending 16+ hours/day at the hospital, it really is nice to have someplace to walk around for a few minutes that isn't the patient room or the cafeteria.

 

[Akulahawk]

Also, while you can't see it in this picture, this new tower has a helipad on the roof. Neither facility (that one OR the one that's being replaced) had one before this tower was built.

 

[Rialaigh]

Never had an issue with a bed delay, all of our area hospitals (including large level 1 trauma centers) will put any "non emergent" patient back in the waiting room and have you give report to the nurse at triage. Also every facility I have ever been to utilizes "hallway stretchers". I will have to say I am not a fan of placing a patient on CPAP in the middle of the hallway...I have put CPAP patients, active strokes, and all variety of nasty trauma with the possibility of internal injury in hallway stretchers...

 

[SandpitMedic]

How about airlines take Federal money; hospital associations and the AMA donate to federal (andy state and local) elections?

When I see new medical facilities being built with minimal architectural flourish and no offices larger than my house, then I'll cry them a river about how they can't afford patient care.

A recent "cancer center" addition to a local hospital (one of the two major emergency receiving hospitals and a nonprofit) is a little over twice the size of the hospital. I've been inside, and much of it is admin space. Sheathed in reflective glass, at least two large fountains outdoors, and without adequate parking for patients so they hire valets for parking the vehicles of cancer patients.
Cancer center (not called that since the project was finished) under consruction, hospital on its right and partially obscured/out of frame

PS: this was near the end on construction which took about four years. There were four of the tall red cranes most of the time on the site.

Is that the new Sutter G?!

 

[Akulahawk]

Is that the new Sutter G?!

Yes, it is. The cranes are gone and the exterior of the facility looks pretty darned complete.

 

[SandpitMedic]

Man that's crazy. I was working Sac during the first year "skeletal" phase.

Looks nice.

 

[mycrofft]

mycrofft, that hospital addition also has to take over for another hospital, particularly everything maternity-related. Once that new facility opens, Sutter Memorial starts moving all their functions over to the new place and will shut down. I've at least seen a floor-plan for the maternity-related stuff. Pretty much everything is supposed to be closer together instead of being spread across several wings and floors...

I don't think the new place has increased their ED size/staff to compensate for the impending loss of the other facility.

They have not expanded the ER. And Sutter Memorial just finished a bunch of facelift stuff too.

But hey they were supposed to shut in 1989 after the Loma Prieta earthquake, along with Mercy down the street and Kaiser on Cottage.

 

[mycrofft]

The hospital is listing it as a 10 story "women's and children's center" with 242 inpatient beds. Granted, that's not a lot of beds for a 10 story structure (my hospital is 6 floors and around 450 beds), but the question is also going to be how much of that is being dedicated to non-bed treatment rooms (i.e. cath lab, ORs, etc) and outpatient services. Additionally, administrative services do need space.

In regards to the architecture, what do you want? Simple windowless poured concrete structures? I'm going to bet that the cost of those fountains are negligible in the overall cost.

Additionally, when you do have a family member in the hospital in critical condition, and you're spending 16+ hours/day at the hospital, it really is nice to have someplace to walk around for a few minutes that isn't the patient room or the cafeteria.

Good that they are expanding the scope of the facility. We actually just had to use their cancer section and, other than not working with our insurer, it made things very easy and convenient.

The building originally there (it still is, the new one engulfed and dwarfed it) was originally "the Cancer Center". It was also the main facility for fundraising events, with a grand piano in the lobby and a large space used for classes and seminars comprising most of the rest of the ground floor. The original pitch for the new building was labelled "Cancer Center upgrade".

Local news reported years ago their original plan to buy up more land in the immediate vicinity and open a large campus, including a movie theater (?). That went by the wayside; in fact, a major building to the south was declared historic and the plans to replace it were thwarted.

But the point is that they have been digesting many small local hospitals, they ate most of the freestanding emergency centers (docs in a box) in the late Eighties, and they are not devoting money to fix ER bottlenecking but are making themselves a taller and better ivory tower while directing more referral and other more lucrative cases their own way. They were collecting $0.19 cents on the dollar for ER calls a decade ago, and I doubt that has improved much.

Poured concrete bunker, no. Eleven stories of reflective glass without sufficient parking and no expansion of the ER , no also.

 

[JPINFV]

But the point is that they have been digesting many small local hospitals, they ate most of the freestanding emergency centers (docs in a box) in the late Eighties, and they are not devoting money to fix ER bottlenecking but are making themselves a taller and better ivory tower while directing more referral and other more lucrative cases their own way. They were collecting $0.19 cents on the dollar for ER calls a decade ago, and I doubt that has improved much.
...
no expansion of the ER , no also.

...and the argument can be made that at least they have an ED. After all, surgery centers and long term acute care hospitals don't have EDs, but are still treating patients every day.

 

[Ensihoitaja]

These threads always amaze me. I work in Denver and I've never had bed delays like this. 5-10 minutes tops- and that's considered unacceptable!

 

[mycrofft]

...and the argument can be made that at least they have an ED. After all, surgery centers and long term acute care hospitals don't have EDs, but are still treating patients every day.

JPINV, you're right. At least nowadays they have to put a sign out front advising of that! (In the old days I remember taking a friend to the nearby Kaiser and being turned away , with about 20% mixed second and third degree burns, because she wasn't a member).

I understand the hospital I've been mean-mouthing does have a good ER, it is just galling to me that they do not direct more into removing the ER bottleneck. And their older facility, which besides being old and not up to date on earthquake resistance, is two blocks from a levy and has vital building services in the basement and ground floor. But when they close it, that will create one more catchment area for the regional trauma center (UC Davis) and thus add potential wait time. (IF they close it).

 

[Handsome Robb]

That's interesting to me that hospitals can't go on divert in some places. We have multiple types of diverts. 'Closed Divert' which is exactly what it sounds like, not accepting ambulance patients. 'Critical Care Divert' which means they have no ICU beds and cannot accept patients that may need an admit to Intensive Care. 'ED Capacity Divert' meaning the ED is full and has an extended wait however the hospital still has beds. 'Internal Disaster Divert' is exactly what it sounds like, can be an actual emergency like a shooter, fire, smoke or can be vital services unavailable like no CT or something like that. Finally the 'Bypass' I was talking about which actually has my agency's name in front of it, 'XXXXX Bypass" which is the only one we initiate, otherwise the hospitals put themselves on divert.

Certain things overrule diverts or even our bypass protocol. "Divert status (except for internal hospital disaster) does not apply in cases of airway obstruction, severe shock, cardiac arrest, uncontrolled hemorrhage, imminent delivery or any patient that may be jeopardized by the diversion."

 

[Akulahawk]

Sacramento's hospitals all have similar diversion policies. Of course, the EMS system can force the hospitals to open back up to ambulance traffic, but that's on a rotating "round robin" basis.

 

[Bullets]

In busy urban hospitals, incoming ambulance patients are often left in a hallway, with their patient on the ambulance stretcher for long periods of time, prior to ever being seen by anyone. You've never turned over care, so you're stuck. Even if you could find someone to take report and take over your patient, there's no place to put them. In many cases you're still treating the patient while you're waiting in the hall.

I transport to University Hospital in Newark, NJ, Robert Wood Johnson New Brunswick, NJ and Capital Health Trenton, NJ

Id say they count as busy urban hospitals and ive never had to wait more then 5 minutes to get a bed or a chair, maybe 10 minutes to give a report to a nurse.

When we bring the patient in we are directed to a triage nurse, who assigns us a bed, a recliner or the waiting room. We give a report to that nurse and put the patient where she tells us. Not all patients get beds, only if they cant sit in a chair for whatever reason. This is pretty standard for the dozen or so ERs ive been to. One hospital has a room with chairs dedicated for asthmatics for nebulizers!


Thats insane that a hospital would make an EMS crew wait, delaying patient care, for hours. Thats almost negligent! If this is acceptable to the EMS agencies then there are bigger problems in Las Vegas then this little genital waving contest

 

[TransportJockey]

I transport to University Hospital in Newark, NJ, Robert Wood Johnson New Brunswick, NJ and Capital Health Trenton, NJ

Id say they count as busy urban hospitals and ive never had to wait more then 5 minutes to get a bed or a chair, maybe 10 minutes to give a report to a nurse.

When we bring the patient in we are directed to a triage nurse, who assigns us a bed, a recliner or the waiting room. We give a report to that nurse and put the patient where she tells us. Not all patients get beds, only if they cant sit in a chair for whatever reason. This is pretty standard for the dozen or so ERs ive been to. One hospital has a room with chairs dedicated for asthmatics for nebulizers!


Thats insane that a hospital would make an EMS crew wait, delaying patient care, for hours. Thats almost negligent! If this is acceptable to the EMS agencies then there are bigger problems in Las Vegas then this little genital waving contest

EMS maintains care of their patient, and since every patient is in the care of a medic (pretty much at least in ABQ and LV) we can maintain decent level of care. You can't just wave your arms and extra beds and staff will pop out of the woodwork. Generally these hospitals (again, at least in ABQ) keep a crash bed or two open for the truly serious that come in the door via EMS or the waiting room, but the problem is things like low acuity bed bound nursing home patients that are brought in for a G-tube or foley replacement, or any number of things teh SNF is incapable of doing. It's not acceptable, and I know in NM there are many things that are being tried to cut down on wall hold time, but it takes time.

 

[BEN52]

This is a matter of simple economics. Most urban emergency departments operate at a loss or break even at best. They are very resource intensive and have a very poor payer mix. This is why you see development of medical centers in the suburban areas while urban emergency departments continue to be to small and to short staffed to be of adequate capacity. The healthcare systems are simply placing there resources where they can generate a profit or at the very least remain economically sound. Healthcare is a business at it's core. No other business is expected to continue to grow to rising demand while losing money. Everyone want's more but nobody wants to pay. Until the improper access and poor collection rates improve the problem will grow. If your patient was able to sit on your stretcher for several hours they did not need to be in the ER anyway. The only solution to this problem is ultimately money. The only way to significantly increase ED throughput is to increase the size and staff of the ED including ancillary services such as radiology and lab services. Nobody is willing to throw money at a patient population that does not even begin to cover the costs of their care.

At my previous employer it was routine to have at least half of our ambulances tied up waiting at hospitals. Multi hour wait times were not uncommon. Other than one occasion with a gun shot victim who received a chest tube and fast exam on our stretcher all of my patients who waited for extended periods of time were low acuity patients who would have been better served by a PCP or urgent care.

 

[Bullets]

I have waited 10 minutes to unload and give a report at University Hosptial in Newark, NJ. In addition to being in a huge urban area, it is the State Trauma Center, Level 1. So i dont want to hear that economics and patient load ect ect. If Newark can hang, so can everyone else

 

[terrible one]

The only solution to this problem is ultimately money.

Disagree. There are a lot of issues that must be resolved before just simply throwing money at it.

 

[Handsome Robb]

Disagree. There are a lot of issues that must be resolved before just simply throwing money at it.

Abuse of the emergency medical system as a whole sounds like a good place to start.

Cut down on these complaints hat should be dealt with in the primary care setting and you open up beds for acute patients.