Friday, December 24, 2010

Adding Levels of Ineffeciency to reduce the cost of care

It was one of those meetings where logic just seemed to fly out the window and minutia took control and strangled what little common sense was left in the room. It is bad enough that the nurses don't have the time to take care of patients because they are so busy having to chart everything, and that the real care is being done by lpns. Well, here come the next level of making sure the paperwork is better cared for than the patient. The hospital is having to hire even more nurse practitioners. The reason? Since there is so much more time spent doing paperwork, well entering everything into the Federally Mandated EMR, the docs who used to see the patients and manage their care don't have time to actually see the patients. So, you have to hire a bunch of nurse practitioners to do yet a whole second level of paperwork, to free up the docs to be able to actually see the patients.

So, it used to be a nurse took care of the patients and a doctor managed their care. Now it is lpn who actually sees the patients, a nurse and a arnp who spend all the time documenting on the patient, and a doc who tries to see the patient and has to manage all the others paperwork.

I had to open my mouth. I asked if the nurse practitioners where going to actually see patients and write orders. I got the of course from the nursing supervisor. I asked what training do they have. She gave me a look like she wanted to kill me. She said, "well, they are BSRNs and then have their nurse practitioner's degree". I asked again, what again is their training. Before she could answer, I said, "if a patient is admitted by infectious disease, does the anrp have an infectious disease fellowship?, what about cardiology?" She said that some of the nurse practitioner's have been cardiac nurses. I said, "so she does cardiac patients only?" Of course the answer was no. I looked at the applicants for the nurse practitioner position. All of them had gone straight through school, there was no clinical experience at all. I told her. If your mother is admitted to the hospital with a pe and right heart failure, how do you want her care managed? You can have an experienced nurse watching her and taking care of her, or you can have a lpn and a arnp who doesn't have a singe ounce of clinical experience charting away to make sure JACHO and CMS are happy while the doc is getting pummeled by all the other anrps that are in way over their head.

About that time the hospital head administrator said something that made me like him a lot, he said "look, our job is to try to find out how to take care of patients and stay in business while the government tries to do the opposite."


Andrew_M_Garland said...

Fred:  I'm so sick. I need a doctor.

MedClerk:  I will be your clerk today. Here is an aspirin, and a thermometer for you to take your temperature. Don't lose it. There are no doctors here.

Fred:  I really need a doctor.

MedClerk:  Don't worry. I will record your symptoms and look up your treatment in the book. We find that this resolves over 40% of client needs at little public expense.

Fred:  I was looking for a doctor.

MedClerk:  Stop complaining. This is all free.

SeaSpray said...

I feel like we've crossed over to the dark side ...into some parallel universe that seems so foreign to what we've known for so long.

From a patient's perspective ...I loathe the idea of anyone but the best trained med professional ..a physician ..I would think ..being responsible to monitor and make decisions based on their years of training. And unless there is an intervention will get worse. Alarming!

I just think this is an awful way to practice medicine.

rnraquel said...

Aw, Throckmorton. You are so logical. I wish you practiced at my hospital.