Medical News

The Effect of Cost Cutting

Five days ago, I posted about the hospital where I work trying to save money by cutting out the shift bonuses that were being used to entice the staff to work 50 and 60 hour workweeks. Today was the first day where I worked and there were no overtime people. Where a 50 bed ED normally needs 14 nurses to operate? We had 10 for most of the day. Meaning that we should have 5 patients to each nurse.

Nope, we were too busy for that. We tried to tell EMS agencies that we couldn’t take any more patients (it’s called being “on divert”). It didn’t work. At one point, we had 90 patients. For ten nurses.

I work a swing shift, which is supposed to be 11am to 11pm. Most of the ED works 7-7. By 9pm, my patients were:

  • A 37 year old female who kept having seizures. She had 6 of them the first 2 hours she was my patient.
  • A 26 year old male fentanyl overdose.
  • A 76 year old with a bowel obstruction that is vomiting coffee grounds.
  • A 35 year old who came to our facility two weeks ago complaining of chest pain and went into cardiac arrest. He is complaining of chest pain and has elevated troponin levels.
  • A 78 year old woman with perforated diverticulitis.
  • A 56 year old intoxicated woman who is with us for altered mental status and is covered head to toe in her own feces.

For those of you who don’t know, most of those patients need to be in a unit that offers a higher level of acre than what we can provide in the ED. The problem is that all of those units are already full.

In the meantime, there are 22 people in the waiting room, waiting for us to have room to treat them. At one point, there were 7 ambulances lined up at the door, waiting to drop off patients. So I wound up ordering Wendy’s through DoorDash at around 8pm, and eating it at the nurses station while I wrote notes on patient’s charts.

Needless to say, everyone was getting testy, patients AND staff.

As 11 o’clock approached, the charge nurse asked me to hold over because we still had more than 60 patients, and three of us were scheduled to go home at 11, which would leave her with no techs and only 8 nurses. Because I like her and she always does me favors, I agreed to hold over for a couple of hours.

Right at 1, when I was planning to go home, all hell broke loose. An intoxicated woman was brought in by EMS, who claimed they were unable to get an IV. Ten minutes after they dropped her off, she vomited about a 1.5 liters of blood.

So a third of the remaining nurses spent the next 45 minutes trying to keep her alive. All of their patients were getting ignored in the meantime.

One nurse remarked, “As long as we keep doing this, they will keep making us do it, until it becomes the ‘way we have always done things.'”

I finally left the place at around 2 am, having worked a total of 15.5 hours. But think of all the money they are saving by not having to pay those bonuses.

By Divemedic, ago

Shortages

Last month, I mentioned that the hospital where I work is bringing Philippino nurses in to fill vacant positions for less money than hiring Americans. There is more news on that front.

We have been short staffed for nearly three years. They have made up the shortfall by paying huge bonuses to get nurses to work extra shifts. They tried foreign workers. Still, they don’t have enough. Determined to save money now that the COVID funding has dried up, hospital administration announced on Saturday that there will be no more bonuses offered. Once the shifts that are already promised bonuses are paid out, they will be no more. Nurses who were making $2500 a day for working a 12 hour over time shift are now being asked to work the same overtime hours, but for $600-$900 each 12 hour shift.

I know that I was working 60 hours or more a week. I was making good money to do that, but now that the money has dried up, I am not working those kinds of hours for a fraction of the pay. No one that I know is willing to do that.

So now the entire staff of the ED is not taking any extra shifts. They are working their contracted hours, and that is it. Me? My contract says that I have to work 4 shifts a month. That is all I am doing. Everyone else is doing the same. So now the hospital is even more short handed.

Here is what was texted out to us this morning by the ED department head:

Hello team
We know this week has definitely had its ups and downs already and we appreciate all the hard work done by everyone. While we all fight this same battle we still have patients who are expecting the best care we can provide.
Starting tonight through the weekend we could use anyone on any shift to assist your fellow team and patients.
Please any help is appreciated.

As if guilt tripping us will get us to work all of those extra hours for a third of what we were making before. I want to help my patients and coworkers, but at the end of the day, this is a financial arrangement. It’s business.

So now the hospital is getting desperate. A third of the ED beds were shut down today for lack of staff.

The hospital where I work can only fill itself to somewhere near 60% capacity because they don’t have enough nurses, and that was when people were working extra shifts for bonus money. That means that patients often stay in the ED until there is an open bed on the inpatient floors. Our ED is frequently more than half filled with patients on “admission holds” awaiting beds. Couple that with the fact that the ED is also short nurses, and you have a problem.

Picture a 50 bed emergency room. To staff a 50 bed ED takes 14 nurses, 4 paramedics, 4 general technicians, 3 doctors, a nurse practitioner or PA, a respiratory therapist, secretary, three registration clerks, two lab technicians, three radiology techs, and two janitors. Every shift.

Now picture that you only have enough nurses for 10 per shift. Now you can only handle 40 patients at a time instead of 50. Now also picture that you have 30 admit holds, taking up beds and waiting for an inpatient bed- some for more than 48 hours. Now you can only handle 10 patients because your staff is busy caring for holds. So the waiting room backs up.

This means you have people sitting in the waiting room for 4, 5, or even 6 hours as they wait for treatment. And all of that was happening before you cut off the bonus money.

Now instead of 60% staffed, you are more like 45% staffed. Instead of 10 nurses, you only have 7. Now picture that across the entire hospital. A 600 bed hospital with a 50 bed ED requires 100 nurses or more each shift. You only have 50 or 60. Now what do you do? There aren’t enough foreign workers to fill that many spots.

My hospital can’t be alone in this. Here is the warning: there is a potential collapse of health care coming. It takes 3 to 4 years to train a nurse to the point where they are licensed, and another 2 years or so for that nurse to be proficient enough in their job to staff an ED, even longer for places like the ICU.

By Divemedic, ago

Airplane Medical Kit

Because of the comments to the post about the doctor on the airplane, I wanted to do a follow up. So let’s first talk about what is in the medical kit on a commercial aircraft. The FAA requires an AED, and a medical kit that contains the following items:

The most common inflight medical events are:

  • Gastrointestinal/Nausea (31%)
  • Neurological, such as fainting or seizures (26%)
  • Respiratory (7%)
  • Cardiovascular (5%)
  • Dermatological (5%)

My wife was on an aircraft flying from JFK to Heathrow where there was a death in flight. The flight attendants cleared out the back row of the plane and put the body on the seats, covering him with a blanket. That is where he stayed for the remainder of the flight.

I myself have been on two flights were there were medical issues. In both cases, the flight crew called for medical personnel. I wasn’t going to volunteer, but no one else did, so I raised my hand. The FA brought me a radio headset that was connected to the airline’s on call doctor, who consulted with me and we agreed upon a course of action.

The first was a moderate allergic reaction (urticaria, wheezes, pruritus) on a flight from Orlando to Boston. The passenger got himself 50mg of IV diphenhydramine and some inhaled albuterol. He was fine and slept the rest of the flight.

The second was on a flight from Las Vegas to Orlando. It was a guy who was having himself an anxiety attack. He was hyperventilating and complaining of shortness of breath, chest pain, along with numbness and tingling to his fingers and lips.

The reason for it was hilarious. He had gotten married to his fiancé (a white woman) while in Vegas. He was Puerto Rican, and was dreading his mother’s reaction when he told her that he had married a woman (who wasn’t Puerto Rican) that his mother hadn’t even met yet. If you know anything about Puerto Rican mothers, you would know that they are much like Italian mothers. He had every right to be afraid.

Anyway, I told the doctor that his vitals looked good and I felt like it was an anxiety attack. The doctor agreed. I traded seats with his wife for about half an hour and talked him down. Once he felt better, I went back to my seat. An hour later, his wife came and got me a second time. During that second visit, his wife told mine that I was a very patient and nice man.

That’s it for my aircraft stories.

By Divemedic, ago

Stop

I don’t feel sorry for this guy.

To the press: stop whitewashing this:

Matt Ford, who goes back and forth between both New York City and Los Angeles, had been exposed via a friend in LA through skin-to-skin contact. 

If you don’t want monkeypox, you should stop sticking your penis in the rectums of other, random men.

By Divemedic, ago

Monkeypox

So I am just now hearing about this. People are worried because, at most, 130 people have this, with two of the in the US? Your odds of being attacked and killed by a rabid squirrel are higher than getting monkeypox.

According to WHO estimates, monkeypox could be fatal for up to one-in-ten people, though its similarity to the smallpox virus allows smallpox vaccinations to provide some protection.

So that means worldwide, this disease is currently projected to kill one person, and it likely won’t be anyone who is immunized for smallpox, meaning any military veteran or over the age of 50. Monkeypox isn’t even anything new. The US had an outbreak in 2003, with 71 Americans getting it. The smallpox vaccine, JYNNEOS is at least 85% effective in preventing monkeypox. It is a traditional vaccine (not RNA like the COVID vaccines) made from an attenuated virus.

If it comes down to it, I will get this one, but I don’t think I will need to, since I have already been vaccinated against smallpox from my time in the service.

JFC. Can we stop obsessing over every little thing?

By Divemedic, ago

Again

I haven’t posted in a couple of days. After managing to make it two years without COVID, I have managed to catch it twice in as many months. The odd part is that the two episodes have differed in symptoms.

The first time consisted of large amounts of congestion and coughing that lasted eleven days. I had no fever and COVID tests came up negative, but I lost my sense of taste and smell.

This latest bout had me with a mild stuffy nose and cough, no fever, and only lasted four days. I was so tired, I couldn’t stay awake. I wasn’t sure that I had COVID until my wife got sick, took a test, and it was positive. So I took one too, and what do you know, it was positive. Then yesterday morning, I woke up without a sense of smell or taste. This second bout with COVID has been MUCH milder than the first. The only other symptom is copious amounts of sweating.

I have no idea how we caught it. With my wife being a teacher and me working in a busy emergency room with daily contact with COVID patients, who knows?

By Divemedic, ago

Math, it’s a thing

Moderna claims that its COVID vaccine is 44% effective on young children who are 6 months to 2 years old. Doesn’t that mean that it failed 56 percent of the time? Even worse, it was only 38% effective on children aged 2 to 6 years. How can you call a vaccine that fails to work more that half of the time a “success?”

Moderna said the vaccine effectiveness for children under 6 years old against omicron was consistent with the currently approved vaccine for adults 18 and older.

So you are telling me that the vaccine fails to work 62 percent of the time on adults as well? That’s a far cry from the 95% success rate that was sold to us back in 2020.

By Divemedic, ago