Sunday, February 10, 2008

We Have Met the Enemy...and We Don't Like Him (Part 2)

Noun 1. bean counter - an accountant or bureaucrat who is believed to place undue emphasis on the control of expenditures

Usually, the last thing in the world the bean counters want is for the ER to go on diversion- it's a money thing, or course. It always is. They will micromanage the hell out of what is going on in the ER to the point of silliness. The latest silly thing is "the Huddle". What is the Huddle, you ask? Simply stated, it is a meeting of the minds--the ER doc, charge nurse, admission nurse (reluctantly), and a couple of useless bean counters to "look at the board", or as I like to call it the ER scoreboard. How many patients, how many admissions, how many potential admits/transfers/discharges, where in the process are the docs/hospitalists on dispo's. Instead of asking "what can we do to help you", we get "what are YOU doing to get these 40 people out of here so we don't have to divert. It's all pretty senseless, because it's all just math; too many patients + not enough beds = diversion, a monkey could do it.
On Fridays, when the bean counters and managers go home, there seems to be an assumption that nothing happens in the hospital, that life goes smoothly on, and it is a happy little utopia for patients, nurses, docs and everyone. I humbly say this is complete bullshit, and Friday was business as usual. I am trying to get these people out of the ER, I really am. I have beds for everyone, including the suicidal 1:1. I am finding the charts for the hospitalist. I am communicating my ass off to the ER docs, admitting, and at the same time addressing the 5PM direct admit requests (you couldn't do this at 2PM when the patient saw you? Yes, I know about that). But I am only one person. The ER charge nurse is panicked and won't be talked out of the tree. We are on a help alert (does no good if you don't have orders). I get a call from the medical director who grills me on what the hospitalist is doing, how many admits he has (um, 6), why hasn't he called for a backup hospitalist--I simply hand to phone to the hospitalist who happens to be the only one in the whole hospital, not good. The medical director calls me back to let me know that she is flabbergasted that he is all alone, and it will be addressed on Monday, "in the meantime, there is nothing I can do about it", NO SHIT. And for the record, I didn't ask. It's Friday, inexperienced ER charge nurse, no techs, no volunteers, no paramedics, no LNA'a. Guess what? We are on diversion. Monday morning there will be an Ambush Debriefing: a surprise meeting, complete with white board, QM, and whoever was working on Friday to figure out how it all could have gone so wrong. Since everyone else worsk 3-11 and the meeting will probably be at 8:30AM, looks like I will be the only one there; I worked 4 hours past time to leave to try to straighten things out, but they don't care about that. Want to know how it could have been fixed?
1. More than one hospitalist. The floors were ready, willing and able to take their admissions, they just won't do it without orders. Can't blame them, why should they hang their butts out on a line?
2. Full nursing staff--it still is NOT OK to leave at 3 PM if you are a manager, without appropriate staffing levels. Come on, people, the same thing happens every week!
3. How about a little support for the nursing staff? LNA's, techs or paramedics to assist us in getting patients out of the ER and into their cozy floor beds. It's a no brainer- if the nurse is doing an EKG and mixing critical drugs, do you think she is going to transport the patient? Ridiculous!

Want to know what doesn't help? Constantly talking about the same damn thing over and over!!! I guess I can look forward to a heaping helping of bullshit tomorrow. Maybe I'll just call in sick.