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Things I've noticed while visiting the ICU

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Re: Things I've noticed while visiting the ICU

#201
post #167
post #161

I'm a nurse and I find the 7th point on the post especially relevant. I will add a disclaimer that I never worked in the ICU so I can't speak for what happens in that type of unit. There is a serious issue with the flow of information in healthcare, (or at least in the U.S, I never worked elsewhere to know if it's any different). But If you find something during your shift which will be important to know later on, it…

This comes up every once in a while when discussing the crazy 24+ hour shifts that doctors in residency are often assigned. One argument in favor of keeping the hours is that continuity of care is by far the factor most strongly correlated with good patient outcomes. So the argument goes that a change in caregiver is more detrimental to the patient than continued care from one doctor even if that doctor is sleep depr…

As a physician, shift length is honestly a red herring.

As much as I hated doing 24-28 hour shifts on inpatient services, continuity of care does matter and errors do occur in handover.

You have to keep in mind that medicine between 12am and 6am is what we call “keep people alive.” 6am to 12pm after an overnight is for handover.

You’re not trying to diagnose a new illness overnight or make changes in management, your job is to deal with acute overnight concerns only. Furthermore, you’re supported by services such as RACE (an in hospital emergency response team) so you’re not dealing with critically ill patients alone. If you’re on a surgical service and need to go to the OR, staff/fellow + senior residents come in to help.

Acute care services where you’re seeing new/undifferentiated patients and need to be on your game, such as ER and radiology, tend to limit shifts to 8-12 hours.

Re: Things I've noticed while visiting the ICU

#202

I noticed a lot of the same things when my dad was in the ICU. Some additional thoughts: 1. "Almost every patient has delusions and nightmares" I personally felt "off" when visiting my father. The sounds, smells, lights and constant buzz of activity all contributed to a feeling of being in a surreal dreamworld. Lack of sleep contributes. I can't imagine what my father experiencing. 2. Food was HORRIBLE. One meal was…

Yes - my wife is a physician and she routinely describes how well meaning family members make care harder for their loved ones by trying too hard in the wrong ways. Requesting more care doesn’t get you better care - “squeaky wheel gets the grease” doesn’t really apply in many situations.

I certainly saw that. The issue we had was my sister grilling everyone who came into the room, or even walked by, often the same questions that she already asked that person earlier. I could see everyone starting to dread seeing her. The “squeaky wheel gets the grease” doesn't apply if people are avoiding the patients room.

My father's cardiologist was explaining the procedure he was about to perform and my sister and mother were so upset they just flooded him with irrelevant questions and questions that he had already answered. I kept trying to get them to stop talking over top the surgeon and actually listen to the answers he was giving. He finally asked me if I could "socialize this with your family" so he could return to the operating room.

Re: Things I've noticed while visiting the ICU

#203

Author of Hacking Health for O'Reilly, managed operating companies for hundreds of hospital facilities, etc... One widely under realized aspect to healthcare costs in the US (there are many) is the very high number of ICU beds per capita, ~35 per 100,000 people. While it gets a little complicated to compare apples to apples, a reasonable person could say we have 30% more than germany which is the only european contry…

Can you explain why one ICU room costs millions, and why they cost 10k a day even if no one is in them? Neither makes sense to me. I can imagine say 100k in monitoring equipment in a room.

Maybe it's the hospital inflation applied to equipment?

Re: Things I've noticed while visiting the ICU

#204

Author of Hacking Health for O'Reilly, managed operating companies for hundreds of hospital facilities, etc... One widely under realized aspect to healthcare costs in the US (there are many) is the very high number of ICU beds per capita, ~35 per 100,000 people. While it gets a little complicated to compare apples to apples, a reasonable person could say we have 30% more than germany which is the only european contry…

My impression as a Canadian resident was the bar seemed a lot lower to get into the ICU in the US. Unless they needed a tube to secure an airway, pressors, or CRRT we managed COPD with BiPAP, pretty profound hyponatremia, cirrhosis with& bleeds, DKA/HHS on the ward pretty regularly just as examples of repatriated patients I remember. I always figured it was due to an overly litigious culture and a money maker for the hospital. To be clear I didn't practice in the US.

Re: Things I've noticed while visiting the ICU

#206
post #60

These threads always have lots of people jumping on doctors and their decisions/callousness/lack-of-reason/etc.etc.etc. My wife is a physician (OBGYN) at a major city hospital that primarily serves a very poor population. I'd like to share her schedule, and see if you think what kind of care you could perform under these circumstances: Monday - Friday - Wake up at 4:30 AM - Get to hospital by 5AM to start rounding on…

The AAMC should increase the number of students they admit. The average medical school is turning away 95% of applicants. The top 10 schools in America are excepting <2.5%.

[deleted]

Re: Things I've noticed while visiting the ICU

#207
From the article, "We are spending an enormous amount of our healthcare budget on patients in the last 5 or 10 years of their life."

It is even worse than that in the U.S., estimated at 10% of total healthcare expenditures in the last year of life.

See https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-he...

Re: Things I've noticed while visiting the ICU

#209

Author of Hacking Health for O'Reilly, managed operating companies for hundreds of hospital facilities, etc... One widely under realized aspect to healthcare costs in the US (there are many) is the very high number of ICU beds per capita, ~35 per 100,000 people. While it gets a little complicated to compare apples to apples, a reasonable person could say we have 30% more than germany which is the only european contry…

Can you explain why one ICU room costs millions, and why they cost 10k a day even if no one is in them? Neither makes sense to me. I can imagine say 100k in monitoring equipment in a room. Maybe it's the hospital inflation applied to equipment?

For one American medical workers earn absolute insane wages compared to their European counterparts.

Re: Things I've noticed while visiting the ICU

#210

I noticed a lot of the same things when my dad was in the ICU. Some additional thoughts: 1. "Almost every patient has delusions and nightmares" I personally felt "off" when visiting my father. The sounds, smells, lights and constant buzz of activity all contributed to a feeling of being in a surreal dreamworld. Lack of sleep contributes. I can't imagine what my father experiencing. 2. Food was HORRIBLE. One meal was…

I had a family member who wasn't even in ICU, and still experienced delusions simply from being sick and being in the hospital for a few days. He thought there was a group of family members around the corner waiting to jump out and surprise him and was insistent that I tell them not to disturb the other patients. I had to argue with him to get him to accept that, no, there is not a random group of family members wait…

Now thinking about how this applies to the acute mental health wing.
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