Things I've noticed while visiting the ICU

No.

In case it was unclear, I was being sarcastic in my reply and pointing out the hypocrisy of being offended that "regular people" would have to foot the bill for ICUs - as if they weren't the ones relying on their existence.

Conceptually, I'd agree with you. I don't think medicare alone needs to fund residency spots (its just currently tied to the amount of spots last I checked). I'm more concerned about the total number of residency spots.

This number includes level 2/step-down ICUs inclusive of regional/community hospital.

This is not the bed count of units capable of having cardiac support or prolonged ventilation.

I can’t readily find the OECD figure but if you look at ventilator capable beds in Canada the number drops to ~9.7, again inclusive of community/regional hospitals mostly staffed by non-ICU trained physicians which are only equipped for short term ventilation.

Which center in Canada have you trained at where there isn’t constant pressure to offload ICU patients to the ward due to a lack of beds?

House is not real, it falls under "arguing from fictional evidence"; House's patients are written by a writing team to have obscure and surprising - yet easy to fix - ailments. They are generally young with acute short term symptoms leading to a race against time and a boolean toggle outcome healed/dead. They are rarely the 70+ year old ICU inhabitant with age related complications who is mentioned in the blog post with long periods of 'boring' illness to keep track of and treatment rotating between many doctors.

House gets to choose his patients, he pre-rejects any that he doesn't want to deal with or has no ideas about, or no interest in. Real world doctors can't do that. House gets to do basically any test for any cost without having to justify it or argue with insurance, scheduling, resource constraints, practicality or side effects. If he needs an MRI, it's available, if he needs his team to spend all night tonight on blood tests in the lab, they can do that and the lab is there and they have no consequences tomorrow of having no sleep.

House has plot immunity, the worst that happens to any hospital employees as a consequence of his behaviour is the loss of a lot of potential money, or some paperwork or audit. The show never focuses on the life of the patient who has to be on dialysis forever because of House's risky intervention before he knew what was really wrong. House blackmails and barters with and sleeps with the hospital administration to get away with things no real doctor could do.

House and Wilson are named as a play on Holmes and Watson, and the original Sherlock Holmes books were notable because Holmes walked the reader through deducing interesting conclusions by looking at evidence anyone present could see but with a fresh viewpoint, things like the height of scratches on a wall. Recent Sherlock TV shows and films, he's written to magically know things that nobody could know, by means the viewer isn't shown and can't participate in, and presents them as amazing accomplishments to wow the viewer. House is the latter, in an episode I saw recently (Series five, episode 1) he is absent all episode with the usual array of organ failures and suspected pregnancy and suspected cancer, then in the last five minutes he walks in, stabs the patient in the leg, declares she has leprosy because she looked youthful, and walks out. And of course she has leprosy. It's not even good storytelling, it's a background thread for House and Wilson's interpersonal problems and his assistant's own terminal disease diagnosis.

Or to put it another way, you read a blog post about heoric troubleshooting of some tech problem and it's good reading. That's self-selected from someone who had an interesting problem and the time and skills to diagnose it and the luck of it coming to an interesting conclusion. Most troubleshooting is not that, it's mostly the basics over and over, or it's above your skill level or outside your skills, or it might not be but you can't spend time on it, or it comes to a boring conclusion like "we never got to the bottom of it before the system was decommissioned".

In Series 3, Dr Foreman goes to be head diagnostician at another hospital, pulls a House move of risk taking treatment, saves the patient, and gets fired. The dean of medicine tells him the procedures work for 95% of cases, and everyone needs to follow them in all cases because everyone thinks their hunch is in the 5%. It works for House because that's the show.

Your comment made me think about this for a bit. It is almost fun imagining something like seeing a short little warning floating up in the air above a patient's arm, saying "blood draws from here". It would be pretty darn cool. If this were possible, it would be worth seeing how much it helps with continuity of care.

To let my imagination run a little wilder, I tried to think of what a system like that would be in practice, and how it relates to the problems that we currently face with the systems we already have. As much as it would be interesting to have all that information available through some sort of AR, there are really three important things that I would like to see about a patient: code status, vital signs and how they get up from bed.

It's really crazy to me how even the simplest of stuff is buried in a chart or EMR. Most do show the patients code status easily, but quite often it is in a small little font beside not-quite-as-relevant stuff like their marital status and what type of insurance they have. Why isn't this in big bold red letters in every room and in every chart as soon as you open up a document? Even for vital signs you have to click through two or three different things to get the information you need (but thank goodness I get to see some stuff right away, like that ICD-10 code for unspecified follow up for dietary counseling!)

One thing I think a lot of people may also not realize is how little information a nurse often has to go off of when walking into a room. If I am answering a call light for a patient who is not one my assigned ones, and they are screaming that they need to go to the bathroom yesterday, and you see them with both feet planted on the floor ready to get up, you have a quick second to think about a few different things. 1) How alert is this patient? 2) How mobile are they, do we need two people in the room? 3) Is this someone with a massive diabetic ulcer who wasn't supposed to be putting any pressure on that heel at all and they are about to do just that? Of course, you can look at the whiteboard, but you better pray that it's updated haha.

So, going back to the AR stuff. If I could have a snapshot of all this information as soon as I walked into a room, it would be a life saver, especially for situations like the above.