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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

#191

Post by heavyset_go »

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…

I think this is a symptom of hospitals being understaffed, whether that's from a deliberate lack of hiring or an actual labor shortage. I feel like many of the problems in this aspect of healthcare could be solved if doctors, nurses, etc weren't run ragged with insanely long shifts and expected to care for a ton of patients.

Re: Things I've noticed while visiting the ICU

#192

Post by fhsm »

Healthcare is mighty complex. The "why don't you just _____" or "the problem is _____" impulse among all who touch it is strong and typically well intended. Eventually it will even be right.

For the many who have shown the impulse here, a bit of context: Apple global revenue in 2020 was 274B[0] and US healthcare spend was $4T[1]. If you can capture just 6% of just the US you've got an Apple sized (in one sense) operation. Six percent isn't so big, Google is at 90%[2]. Little old United Airlines picks up twice that 6% target for 13% share[3]. If you pulled in 13% of US healthcare you'd have a Walmart sized operation[4].

Apple, Google, Amazon, Microsoft have made a multiple runs at it. Maybe Apple Watch and PillPack count as successes, maybe.

The world is waiting for, dying for, someone who actually knows _____.

[0] https://www.statista.com/statistics/265125/total-net-sales-o...

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

[2] https://gs.statcounter.com/search-engine-market-share/all/un...

[3] https://www.statista.com/statistics/250577/domestic-market-s...

[4] https://www.macrotrends.net/stocks/charts/WMT/walmart/revenu...

(obviously the math is approximate, the sourcing iffy, and the comparisons flaky ... particularly Walmart which is a big player in healthcare so is getting double counted).

Re: Things I've noticed while visiting the ICU

#193

Post by 20after4 »

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 lot more attention, especially in critical places like hospitals and really any long term crisis response situation where there is important knowledge gained over time with a (poorly handled) hand-off to successors.

I had some exposure to formalized incident management[1] at a previous job. There, I learned a few formalities and practices that seemed valuable, especially assigning a single coordinator to be responsible for continuity of information and coordination between many independent actors over a long period. The coordinator role had explicit hand off to their successor where the stated purpose was to transfer important working knowledge and prevent the kind of problems you (and the article) describe.

1. https://en.wikipedia.org/wiki/Incident_management

Re: Things I've noticed while visiting the ICU

#194

Post by late2part »

rednerrus wrote: post #153
HEmanZ wrote: 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%.

excepting?

Re: Things I've noticed while visiting the ICU

#195

Post by JamesianP »

ericmcer wrote: post #137

His observation that the ICU is full of the elderly reminded me of the Obamacare debates when I was younger. I always felt like I was taking crazy pills when I would leave my conservative elder parents who hated the idea of universal healthcare, and go to my younger liberal friends who were all for it. It was such a clear case of peoples ideology running directly against their self-interest. Young people being agains…

If you abandon your ideals when it conflicts with your own self-interest, it is not ideology at all, just self-interest. You are criticizing integrity here. such as it is..

Re: Things I've noticed while visiting the ICU

#196

Post by haldujai »

rscho wrote: post #159
haldujai wrote: post #150

Earlier quoted context omitted.

I’m not sure where you’re getting this from. I / my nurses silence alarms at literally every hospital I’ve ever worked at (granted they’re temporary silences by design so you have to hit silence q1h/q30mins depending on the alarm). Stanford Healthcare recently installed a system where all alarms/notifications get sent to a hospital assigned device the nurse carries rather blasting in the sleeping patients room as 90%…

You're right that silencing alarms is strictly forbidden in anesthetic territory only, not ICU. I'm biased bc I'm in Switzerland, and here the coverage ratio is usually 1:1. The country is so rich, that many things are different here... they really are near the patient at all times. To give you an idea: the day COVID really hit, we received 180 shiny new Hamilton respirators complete with additional staff overnight,…

I want to clarify two points given the language used in your response:

1. I used the possessive “my” in reference to nursing staff for simplicity in writing and clarity to the reader rather than to indicate ownership, we are on a team. This is akin to saying “my goalkeeper wears Nike soccer cleats”.

2. I do not “order nurses around.” I verbally communicate and leave medical orders in the chart that nurses act on. It is not about a power struggle, we are all trying to do our jobs and do what’s right by the patient. I’m grateful when nurses question my medical orders (as long as it’s a positive/educational discussion, which it is 99% of the time) as they catch my mistakes and we all learn together.

If you are concerned that you can’t order nurses around, I strongly suggest reflecting on whether this leadership style is the most conducive to providing quality patient care as this can increase barriers and hostilities in the workplace resulting in communication breakdown and adverse events.

Re: Things I've noticed while visiting the ICU

#197

Post by giantg2 »

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 didn't eat or drink all day". That's the type of shit that can look really bad if it's recorded and looked at later. But it's like nobody cares if they record things correctly.

I've also had trouble with people not doing anything with important information. Like maybe you should slow down on the morphine and oxy if the patient is answering fewer basic questions correctly than when they came out of surgery. But it's OK if they can't tell you their own birth date - just give them more and later order a CT ro check for a stroke. Sorry guys, but it should be pretty obvious you're putting them into a opium stupor...

Re: Things I've noticed while visiting the ICU

#198

Post by IX-103 »

Eleison23 wrote: post #98
questime wrote: post #25

Earlier quoted context omitted.

> Often it's a 4 week old baby. You are stretching the word often, most people in the ICU are close to the end of their life. A lot of people don't realize but most of the time if you needed to spend weeks in an ICU you are probably not "living" in a dignified way. Almost all ICU doctors/nurses I've talked to would rather have a DNR in their old age than live like that.

Your human dignity is not predicated on how much pain you're in, how awake you are, or how able you are.

You mean yours.

My human dignity does depend on whether I have to endure the rest of my life pooping my pants, not remembering my own name, and hooked up to some noisy machine telling my lungs to breathe and my heart to beat.

Re: Things I've noticed while visiting the ICU

#199

Post by QuarterReptile »

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…

That makes sense. When I worked shiftwork (8 hr days), you'd get good info from the people before you, but not about the people before them (after you), so you'd often have the same problem in that rhythm. But we would stay on shift for months on end, and obviously that helped with all the knowledge walking away all the time.

Re: Things I've noticed while visiting the ICU

#200

Post by watersb »

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…

> 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 of care there versus the impossible mess out here in the other world.

But the single most significant aspect of care at Mayo Clinic is that the doctors and nurses and techs get to read your chart before seeing you.

That's it. You write something in the chart, it doesn't get tossed. It might not get parsed completely, but the essential info is there. And the staff does not get penalized for reading it.

(The other big reveal for me at Mayo was the sheer scale and throughput of the system. Healthcare at Mayo did not cost more than healthcare in my small town. It. Cost. The. Same.

It took six months to get in, I had a week, then it was someone else's turn. I presume that the high paying "celebrity" customers can get seen more regularly. So it's not perfect. But holy cow I wish it were easier for healthcare professionals to do their job.)

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