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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

#351

Post by bradknowles »

throwaway2037 wrote: post #309
Aeolun wrote: post #276

Earlier quoted context omitted.

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 5…

IIRC, the Mayo Clinic invented the medical checklist. Like, people actually read the checklist and make sure that they tick off all the boxes they are required to tick off.

That's why they are number one. Because they actually use checklists.

Re: Things I've noticed while visiting the ICU

#352

Post by mncharity »

20after4 wrote: post #193
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…

Thanks for sharing! Even outside the medical field, it seems like most humans are pretty bad about both writing down and consulting notes. Even worse for the notes written by another human. We really aren't particularly good at transferring knowledge / experience and it takes a lot of effort to do a good job of it, so most people don't even make much of an effort. This really seems like a problem that still needs a l…

> a single coordinator to be responsible for continuity of information and coordination

Years ago I saw a talk by a VA (US veteran's health care) thoracic surgeon, who was trying to entice tech folk to address the following problem. A surgeon is both team manager and skilled technician. When heads down in the technician role, the management role suffers for lack of attention. Especially severely at the VA, which did randomized staffing of operating teams, so you don't get the "group mind" and practiced gap filling of team which stays together. So surgeons would say "do X", and being distracted, not notice the order was dropped, and then proceed assuming X had happened, with regrettable results. The VA surgeon envisioned a voice system which noted the request, waited, and then whispered a nudge in someone's ear "did we do X?".

Re: Things I've noticed while visiting the ICU

#353

Post by kerryoco »

DoingIsLearning wrote: post #82

> So, when it comes to prescribing (...) Giving psychiatric medicine “as needed”? Go wild. This implies a lack of duty of care which is painfully unfair. As a counter story to this I have a friend of mine who is a _former_ ICU nurse with a gigantic scar on her forearm. I much later in our relation found out that the scar is from a patient who basically ripped her forearm biting down on it while she was trying to stop…

his "go wild" sounds like it's blaming the nurses, which it is partly, but I think moreso he's trying to point that this situation is just pretty awful. Or at least he should be trying to focus on the bigger picture. I certainly don't blame the nurses for showing up to work and trying. But I think we can all see how the 'path of least resistance' and financial incentives also leads us to this 'medical factory' type of treatment of people. And that's not the nurses' problem, that's just all our problem.

Re: Things I've noticed while visiting the ICU

#354

Post by ars »

froggertoaster wrote: post #317
theNJR wrote: post #57

My wife just gave birth and it was my first multi-night hospital stay. The midnight pokes and checks were infuriating. It also doesn’t help that dads aren’t the patient after a birth, so they aren’t fed or given a bed. Constant nurse changes were difficult too. On the plus side, I was surprised at the decent quality of food given to my wife. Steamed vegetables and mid grade proteins with every meal. After two nights…

Father of four here, had one two months ago. > It also doesn’t help that dads aren’t the patient after a birth, so they aren’t fed or given a bed. Yes, and? You're free to go to the cafeteria and buy food or leave and go buy food. And there's usually at least a chair. What do you expect, a Marriott?

The father is the wife (and baby's) advocate in the hospital, and should leave as little as possible. You need to be there for every test and consultation.

So yah, they should be bringing the father food, and there should be a bed for him because the father is critical in having good care for the wife.

Re: Things I've noticed while visiting the ICU

#355

Post by incone123 »

throwaway2037 wrote: post #319
incone123 wrote: post #268

Earlier quoted context omitted.

I'm not old but I have an Advance Directive on my file that essentially says if I'm fucked then they should let me go. (And I'm in the UK where treatment is free at point of use).

Wow, this is a great post. I never knew about this NHS programme. I wish I had the same where I live. https://www.nhs.uk/conditions/end-of-life-care/advance-decis... https://www.nhs.uk/conditions/end-of-life-care/advance-state... At the risk of sharing some PII, are you willing to share some of the conditions that you set?

It's not an NHS programme as such, just that the law recognizes these documents. It would work with a private GP too.

I used a template document but don't recall where I got it.

Re: Things I've noticed while visiting the ICU

#356

Post by incone123 »

Aeolun wrote: post #288
incone123 wrote: post #266

Earlier quoted context omitted.

You still have the problem of writing a sufficiently detailed tree. I had a blood test last year and when I discussed the result with the doc, he asked me the clinic location where the blood was taken, because then he could estimate time between blood draw and lab test and interpret the result accordingly.

It’s your blood usually tested immediately? At least my hospital gives me results right away (well, say within 30 minutes).

I think you just made my point about a sufficiently detailed tree.

GP orders test. I go to a test center to get the blood drawn. They have couriers taking samples to labs a few times per day.

Re: Things I've noticed while visiting the ICU

#357

Post by rapjr9 »

_xnmw wrote: post #256

There should be a name for this, "medical theatre", analogous to security theatre. A brilliant performance art, with all its buzzing machines, expensive insurance, bright lights, pretty graphic logos, well-dressed specialists and doctors that aren't able to apply their knowledge correctly because they can't get simple things right, like letting patients sleep properly or recording and passing on information specific…

I suspect part of what causes the hallucinations is withdrawal from alcohol combined with opiates. When you need emergency care nobody asks or seems to care if you are dependent on alcohol, they simply put you in the ICU and wait for you to wake up, going cold turkey. Maybe there is nothing they can do about it, but it seems like they should at least be aware of it and perhaps working on a solution. That they have not seems to be due to moral judgements (you shouldn't have been drinking so much in the first place.) Perhaps small intraveneous doses of alcohol would help (although the opiates would make that complicated since they interact with alcohol.) Maybe some type of blood cleaning would help. Ignoring it seems like the worst choice, particularly since it can cause physical effects besides hallucinations. This is one of a number of areas that medicine ignores. Another is environmental causes of diseases; when was the last time your doctor asked for air, water, soil, and food samples from your home as part of your regular checkup?

Re: Things I've noticed while visiting the ICU

#358

Post by gus_massa »

haldujai wrote: post #337
gus_massa wrote: post #280

Earlier quoted context omitted.

> As a physician, shift length is honestly a red herring. This is how the Stockholm syndrome feels. I manage a few T.A. in the university, and they barely can think after a 6 hours of teaching (two consecutive classrooms, with like half an hour of rest in each one for the students, and perhaps another informal half an hour in the middle). Sometimes they have to speak in the blackboard, sometime grade informal take ho…

It’s essentially unheard of to have someone die because a resident made a mistake on call. On-call medicine is so rote as to not require much, if any, thinking. Ward medicine is far less intellectually challenging than teaching. Patients who are active/critical are not managed by a single tired resident overnight.

We had a case a few years ago in Argentina, when a child got an overdose of Potassium Chloride. The nurse was new in the hospital and in the previous hospital they had a different concentration, so she prepared a wrong dilution. [1]. Anyway, it's a problem that is common enough that the English NHS added it to a list of recommendations [page 8] https://www.england.nhs.uk/wp-content/uploads/2020/11/2018-N...

It looks like a random accident, but it's one of the silly mistakes that are more common when someone has worked 12 or 24 hours straight and has no checklists.

[1] I tried looking for the case, because the details matter, but most of the recent news are about a case where it apparently was intentional https://www-telam-com-ar.translate.goog/notas/202208/602435-...

Re: Things I've noticed while visiting the ICU

#359

Post by hansthehorse »

Ensorceled wrote: post #347
throwaway2037 wrote: post #314

Earlier quoted context omitted.

I have heard an equal number of stories that are exactly opposite. Only through aggressive, pushy "squeaky wheel" behaviour was someone able to get the correct care.

My dad definitely got better care because both my brother and were assertive in our advocacy, but my sister’s aggressive, undirected badgering didn’t help at all.

As someone who has spent much more than my fair share of time in ICU and on "the floor" I can honestly say that being in the hospital is similar to being in prison in one respect. Having someone on the outside working for you is critical. Medical staff will almost immediately try to establish a power dynamic over you to keep you cooperative and docile. Having people from outside who are polite but inquisitive and questioning is key. I've also noticed that people who have frequent and varied family visitors get more attentive care than those who never have visitors such as the elderly whose family may all be gone and friends can't really travel.

Re: Things I've noticed while visiting the ICU

#360

Post by KSteffensen »

mannykannot wrote: post #303
civilized wrote: post #223

Earlier quoted context omitted.

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.

This can be intentional rather than a misunderstanding.
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