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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

#301

Post by surgeryres »

I am a vascular surgeon, and have many patients in the ICU constantaly. #6 confuses me - the original operating surgeon should be a constant through the patient’s stay. And while the ICU doctor might be the captain while the patient is in the ICU, the original surgeon is the general. He has complete control and should dominate the patient’s care. While the surgeon can not be bedside 24/7, they or someone from their team should “round” at least once daily on these ICU patients, talking to family, checking catheters and tubes, reviewing medicines, checking wounds.

At least that’s how it’s done in Texas.

Re: Things I've noticed while visiting the ICU

#302

Post by lostlogin »

duffpkg wrote: post #220
Blammar wrote: post #203

Earlier quoted context omitted.

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?

An ICU unit isn't exactly a single room. There are different configurations but they typically involve some sort of centralized monitoring station and 5-20 ICU "beds". Total cost of that / number of beds. Everything in hospital construction is expensive, ICUs are at the extreme end of that. Huge power requirements, medical gas lines, fixturing and surfaces needs to be able to be disinfected, special air, special wate…

To add to this, the costs the one area I understand are huge.

Radiology generally needs to have a CT ready to go when there is an ICU. It likely needs an MR too, and staff for running after hours. Portable X-ray and ultrasound, a PACS, a RIS, services contracts and a load of other smaller costs.

That’s several million in hardware costs.

The running cost is huge with MR service contracts alone into the hundreds of thousands per year.

Staffing utterly dwarfs that expense and getting skilled people to work out of hours requires a lot of money, and additional cover for when they sleep.

Staff need to be kept competent with courses and training, certificates and leave to get to these sessions. More money.

The consumables are silly expensive and expire fairly rapidly. Everything needs to be available and a few spares should be present.

Radiology can be a cash cow for day to day operations in a private clinic. But having staffing and equipment that can run 24 hours a day with 100% uptime is a massive cost multiplier.

Re: Things I've noticed while visiting the ICU

#303

Post by mannykannot »

civilized wrote: post #223
giantg2 wrote: post #197

Earlier quoted context omitted.

Not lost, but I've had a lot of trouble with information being captured incorrectly. Things like date are pretty commonly messed up. I've also had doctors and nurses put their own, incorrect, interpretation on information I've given them when they repeat it to others. When I say "my child wasn't eating and drinking normally and had half of what they normally do throughout the day", it's incorrect to say "the patient…

I've noticed recently that there are people out there who simply can't accurately listen to others and repeat back what they say. It's not about being stressed for time, the skill is just not there. You say ABC, they write CBD, and they have no idea it's not the same thing.

Add to that the people who reply to an email or other message without providing any response to the questions it explicitly poses.

Re: Things I've noticed while visiting the ICU

#304

Post by nradov »

giantg2 wrote: post #197
ler_ wrote: 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…

Not lost, but I've had a lot of trouble with information being captured incorrectly. Things like date are pretty commonly messed up. I've also had doctors and nurses put their own, incorrect, interpretation on information I've given them when they repeat it to others. When I say "my child wasn't eating and drinking normally and had half of what they normally do throughout the day", it's incorrect to say "the patient…

OpenNotes can help a little with this, but only if the patient or one of their caregivers has the time and ability to do a detailed review of every chart note.

https://www.opennotes.org/

Re: Things I've noticed while visiting the ICU

#305

Post by snarfy »

Aeolun wrote: post #276
watersb wrote: post #200

Earlier quoted context omitted.

> I think it would be much better for both patients and healthcare staff alike if there was a greater emphasis placed on focusing on the series of successes and failures that happen over the course of someone's care, not just seeing it as a single shift or a single problem happening in some isolated point in time. I once had a week as a patient at the Mayo Clinic in Scottsdale AZ. There were many remarkable aspects o…

For someone that hasn’t heard of they Mayo Clinic other than through webite articles describing medical conditions, are they that desired/high-quality?

My wife was diagnosed Devic's disease, a rare disease with a grim prognosis. Almost every paper we could find on it had the name of a doctor that worked at the Mayo Clinic in Scottsdale. We lived in Arizona at the time so we went there and found that doctor. He corrected her diagnosis as MS, not Devic's. They both suck but Devic's is much worse. We paid out of pocket and getting the correct diagnosis was worth every penny.

Re: Things I've noticed while visiting the ICU

#306

Post by Mezzie »

notacoward wrote: post #188
Mezzie wrote: post #138

Earlier quoted context omitted.

I wish we (Americans) had universal healthcare, but at this point I'm pretty jaded about that ever coming to pass. So I agree with you there, and your point about them having paid taxes is also a good one. That said, we do care for the elderly because of their vulnerability but we then shit on younger disabled people. Old people can have assets, most younger disabled people can't, and younger disabled people can lose…

> am I just supposed to suffer and accept I matter less than an old person? Absolutely not. The situation is deplorable, and I hope we can get to a better one some day. Fight for all you're worth. All I'm saying is that others who receive care are not your enemies. (Or at least not because they receive care. There's bound to be some overlap.) The enemy is the people within the system who restrict the labor supply, dr…

I agree with this. The problem for me comes in that elderly patients (again as a class/group, there are obviously exceptions) have no problem with this system. They don't care because they benefit. I've also gotten several snide comments from elderly people and heard numerous tales from other younger disabled people that it's happened to them too. That we're too young to be there/to be sick, snide comments about when/if we can't work, etc. In fact, given that the elderly are living off of social security + investments, they have common cause with the politicians and profiteers as they won't allow any action that either risks their property values or their investment income. If line go down, old people can't retire, so we can't do it.

I will never have access to my enemy until there's a critical mass of upset people, and the elderly seem willing to let younger people die of treatable problems as long as they're not effected, so the only way to get them to care and join us seems to be to make them feel as insecure as the rest of us, which sucks.

I believe the elderly have agency and for the ones who are still alive (since of course the people who live to 85+ to begin with are those who didn't have to ruin their health due to poverty and blue collar labor), they've used their agency to say 'we don't care about you'. Which is fine, but then they turn around and get all mad when they're not cared about in return. Either they want to be a part of a community, including accepting the responsibilities, or they don't. They need to stop wanting to have their cake and eat it too.

Re: Things I've noticed while visiting the ICU

#307

Post by Mezzie »

throwaway821909 wrote: post #163
Mezzie wrote: post #138

Earlier quoted context omitted.

I wish we (Americans) had universal healthcare, but at this point I'm pretty jaded about that ever coming to pass. So I agree with you there, and your point about them having paid taxes is also a good one. That said, we do care for the elderly because of their vulnerability but we then shit on younger disabled people. Old people can have assets, most younger disabled people can't, and younger disabled people can lose…

People who are net-contributors feel like they're likely to eventually be elderly, and unlikely to become disabled, I guess (so the inverse of your feelings)- combined with deception by governments that social security programs are like a savings account for the future, not a tax to pay for today's expenses. From each according to his ability, to each according to his needs is the only solution for healthcare.

I support universal healthcare, I just don't think it's going to happen in America.

Right now the answer seems to be 'take as much from the young as you can and guarantee them nothing' and that's not sustainable. It's just that most of the young can avoid looking at this reality until they have a health problem.

Re: Things I've noticed while visiting the ICU

#308

Post by civilized »

Aeolun wrote: post #283
civilized wrote: post #221

Earlier quoted context omitted.

I wonder if part of the issue is having to remember a bunch of random things about a bunch of different people so that you can apply the information at the relevant time. E.g. the left arm is easier to find a vein, but this information is only useful for 30 seconds a day during a blood draw, so it's hard for people to remember or even retrieve (how much notes do you have to read through to find this info?) If the inf…

Like, google glasses but for ICU workers?

I was gonna say augmented reality, but there are probably low-tech options that could do the trick.

I would start with "sticky note on the relevant machine" type interventions first.

Re: Things I've noticed while visiting the ICU

#309

Post by throwaway2037 »

Aeolun wrote: post #276
watersb wrote: post #200

Earlier quoted context omitted.

> I think it would be much better for both patients and healthcare staff alike if there was a greater emphasis placed on focusing on the series of successes and failures that happen over the course of someone's care, not just seeing it as a single shift or a single problem happening in some isolated point in time. I once had a week as a patient at the Mayo Clinic in Scottsdale AZ. There were many remarkable aspects o…

For someone that hasn’t heard of they Mayo Clinic other than through webite articles describing medical conditions, are they that desired/high-quality?

I'm not sure if you live in the United States, but Mayo Clinic is probably a top 5 hospital system in the US. It is legendary. Just read the opening paragraph from Wiki: https://en.wikipedia.org/wiki/Mayo_Clinic

    The Mayo Clinic (/ˈmeɪjoʊ/) is a nonprofit American academic medical center focused on integrated health care, education, and research.[6] It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, across three major campuses: Rochester, Minnesota; Jacksonville, Florida; and Phoenix/Scottsdale, Arizona.[7][8] The practice specializes in treating difficult cases through tertiary care and destination medicine. It is home to the top-15 ranked Mayo Clinic Alix School of Medicine in addition to many of the highest regarded residency education programs in the United States.[9][10][11] It spends over $660 million a year on research and has more than 3,000 full-time research personnel.[12][13]
A little deeper:

    Mayo Clinic has ranked number one in the United States for seven consecutive years in U.S. News & World Report's Best Hospitals Honor Roll,[19] maintaining a position at or near the top for more than 35 years.

Re: Things I've noticed while visiting the ICU

#310

Post by throwaway2037 »

retconn wrote: post #262
throwaway892238 wrote: post #224

Earlier quoted context omitted.

This is similar to problems that would often happen in car manufacturing. The person assembling the car the standard way finds a problem, but the problem doesn't get addressed, or information isn't disseminated correctly, so the cars go out with problems. Toyota developed a methodology whereby such problems are addressed immediately and fixes were disseminated immediately, and would not send a car out otherwise. That…

This is my favourite ever episode of This American Life, about NUMMI, the shop floor level and individually fraternal miracle that was created by workers at Toyota and GM in a CA GM plant, until management shut them down: https://www.thisamericanlife.org/561/nummi-2015

This episode is incredible! I also listened to it a few years ago. It provided so much insight into (a) Japanese vs American manufactoring and (b) the impact of poor labour union relations. (Please do not read [b] as me being personally anti-labour union. Some of the revelations from union members in that podcast were shocking to me -- drinking and drugging while on the manuf line!)
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