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View Diary: Hospitals, Emergency Rooms, ICUs: We Can Do Better (15 comments)

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  •  There has been a lot of upgrading to (11+ / 0-)

    even regional hospitals to have the same amenities as the major cities.

    A lot of those features have been around for a long time in metropolitan hospitals, especially the pneumatic tubes.(There are back up policies for when the tube systems are down.)

    Critical care units are one of the few places nurses can have a decent patient load at this point. Floor nurses are often swamped with too many patients that need a lot of care. This is measured, rather haphazardly, by acuity ratings. Since the insurance companies are so determined to get patients out the door ASAP, this exacerbates the problem of patient assignments that are impossible to provide safe care, let alone ideal.

    I think the hospital corps decided that part of attracting patients was to promote those amenities. The costs of electronics and space are spread out over time and the room charges are still high. I think it was ~ 10 years ago the community Lutheran hospital I was working at went to this kind of patient approach. We started calling it 'Hotel Lutheran'.

    The nursing salaries are the big item on their budgets. That nursing care is the most visible and important to patients, is not reflected in the salaries, working conditions, benefits or respect. Ultimately, if the nurse doesn't catch and report important symptoms to the doctor, it can be too late to save the patient or they can survive with new chronic diagnoses. This goes further; if the doctor does not intervene appropriately, it is the nurse's responsibility to pursue that physician, a superior or colleague. Charge nurses, house supervisors and STAT teams some hospitals are using to assist floor nurses with crashing patients, are the usual avenues, but all are fraught with negative backlash.

    People don't speak up enough because most don't have the experience - it is the chronically ill and elderly who make up the repeat customers. They have limited energy and power. Have you been back to that hospital in 12 years? Likely has been heavily upgraded.

    The whole system is now heavily influenced by money and status, not good care. Which does not mean making eye contact and smiling with every one as you walk down the hall (with a narcotic med you are taking to a patient and focused on evaluation, etc.) Or high quality terry bathrobes with the hospital logo embroidered on them.

    To the extent many community hospitals are dependent on local funding, GOP controlled councils have cut it to the bone, and removed even healthy fats.

    The ACA is a start, and will slow down absorbing the health insurance industry employees into the job market. Hopefully the change in problems and good stories of people getting long delayed care will get the idea that health care is both a right and economic essential.

    "People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone. " Audrey Hepburn "A Beautiful Woman"

    by Ginny in CO on Tue May 28, 2013 at 02:08:02 PM PDT

    [ Parent ]

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