Wednesday, June 25, 2008

Changing Attitudes

Copied below is an e-mail message I recently received from long-time friend Bill Busby, who now lives in Albuquerque.

Discounting the iconoclasm for which he has long been known, I take Bill’s comments to be another sign of changing public attitudes towards the health care establishment.

Take, for example, his statement that the administrator “gave orders” on where children arriving at the emergency room would be cared for. In my day, no administrator would presume to “give orders” on any matter involving the care of patients. Although I doubt it happened exactly that way at Presbyterian either (I suspect the matter was negotiated with the doctors and nurses), I find it interesting that Bill – and, quite possibly, others - thinks it did.

The same holds true of his remarks about getting hospitalists to sign discharge orders in a more timely way. If you were to ask Presbyterian’s hospitalists to describe the chain of command over them, I’d be surprised if any of them named the administrator. However, Bill – and, again, I suspect others – thinks that the executive head of the hospital ought to be able to define and require certain standards of performance from the hospital’s professional employees.

While I agree that ought to be the case, it hasn’t been and to a considerable extent still isn’t.

But things are changing.

Here is Bill’s message:

“Our Saturday morning Albuquerque Journal had an article about Presbyterian Hospital's efforts to reduce the wait times in their emergency rooms. The administrator made a quick survey which showed that their Albuquerque hospitals (two) ranked second in the state ("losing out" only to the New Mexico University Hospital which is the state-designated trauma center).

When analysis showed that a large percentage of the admissions were children, he gave orders for them to be sent to the new pediatric wing upon arrival. A large percentage of the adults shouldn't be in the hospital at all -- people with colds, for example. The real emergencies, he determined, were dealt with within minutes of entry into the hospital.

The larger problem was finding a bed to put them in. The problem, it seems, is that doctors (hospitalists all) want to wait until the end of the day to sign the dismissal orders. The administrator's problem, it seems, is to get them to spend a few minutes at the beginning of their shifts to sign the papers, thus making rooms available for new patients. Well, duh, aren't they employed to take care of their patients? One way to do that is to see that a bed is ready for them on entry and that they can get out of the hospital on a timely basis when they leave.”

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