Tuesday, April 14, 2015

SEPSIS is the new black

All of a sudden sepsis has become the IT thing in the ER. We have had septic patients for a long time and have treated them with fluid, antibiotics, sometimes pressors, etc.  We aren't really treating them any differently now, its just that now someone with sepsis has become

       ******THE SEPTIC PATIENT!!!*****

Now..if you have a fever you are possibly septic and we treat you as such.  The whole world has become
possibly septic and all that entails: fluids, blood cultures, lactates, etc. Sniffles with fever - SEPTIC!  Sore throat with fever - SEPTIC!! Everyone is septic until proven otherwise dammit!

We are getting new machinery around this that has us tilting the patients legs up at a 45 degree angle for a few minutes to determine where they are with their fluid status involving CO, SV and all those other letter things that they understand on CCU and I never wanted to understand. Its too complicated for my feeble brain. Another machine to hook up to the patient.  Its getting to the point where we won't be able to see the patient because of all the cables going from them to the machines. 

Of course we had an inservice which went in one ear and out the other.  

It is admirable that attention is being put on sepsis and trying to decrease the mortality rate that goes with it. Why does it seem like whenever a something like this starts, they go overboard? **

**I know the picture has little to do with this content but I thought it was sue me.

Tuesday, April 07, 2015

it ain't rocket science folks

Good luck to hospitals in the almighty patient satisfaction sweepstakes. They are approaching it all wrong.  They are approaching it from the top down, instead of the bottom up.

I used to be on a committee addressing this.  I once sat for an hour and a half at a
meeting listening to a "performance improvement specialist" talk about what we say to patients.  What do we say to them when they present at the window?  Do we say: Can I help you? What can I help you with? How do we acknowledge them?  I mean seriously....

It seems the triage area is a place where people don't "feel welcome".  Could that be because the staff appears stressed out? THEY ARE STRESSED OUT.  Here is a list of what the two nurses at the triage desk deal with:

1) Answer phones:
     - from ambulances coming in, place those ambulances in the ER (if there is a bed available)
     -from idiot doctors offices, nursing homes, therapists, etc. who call to tell us their patients are coming in.
WE DON'T CARE.  We will deal with them when they get here.
     -calls from information desk about patients they can't find
     -random other calls

2) Let people in the door to main ER a thousand times a day. Deal with frantic relatives.

3) Give directions to people to inpatient rooms,  the cafeteria, coffee shop, pop machine, admitting, etc. etc. etc.

4)  Deal with people who have to be transferred to labor and delivery.

5)  Go outside to help people out of cars.

6)  Check people in.

7) Triage people.  WOW, yes we actually have to do this in the middle of everything else.

8) Take people to rooms.

All of this is really great, especially when there are 10 people at the window, 20 people in the lobby.

In the middle of all this we are expected to smile like a frickin' idiot.  Let me ask you, could you smile like a frickin' idiot in the middle of all this?  I don't think so.

Here is what will help patient satisfaction in triage:


No doctor office, etc. calls

Security handles traffic in and out.

Charge nurse gets ambulance calls.

Come up with the money to have someone at the desk which allows nurses to actually TRIAGE (what a concept).

If you take some of the  stressors in triage away, staff will be happier, less stressed and they will be able to welcome patients as they should.  Patient satisfaction improves. This ain't rocket science folks.

Here's a clue: Maybe you could ask the staff who works in triage what they see could help the situation.  What a radical idea.