Sunday, February 20, 2011

An open letter to all the doctors I know:

You guys are going to cost me my job, my sanity, and my freedom, not necessarily in that order. What's going to happen is a mass slaughter of people I normally like and respect and depend upon, and then I'll get arrested and from then on things will suck.

But! There's a chance to turn this boat around, to make sure that you all keep your collective and individual lives and that I keep my happy-go-lucky personality. Everything rests on these four littleish words:

Neuro Critical Care Unit.

That's where I work (and what I kind of by default, without really wanting to, find myself running sometimes).

In order for you, beloved Medicos, to admit a patient to the NCCU, they have to meet two criteria: they have to have a Neurological Problem and need Critical Care.

That means that the dude who's been stable neurologically for two weeks but who needs frequent suctioning does not qualify. Frequent suctioning is not a Critical Care Function. Likewise, if you feel like your completely intact, rock-stable patient doesn't get enough attention (I wish I were making this up) on the acute-care floor, you can't just transfer them to the NCCU so that they'll get their little paddy-paw held.

I know that seems unfair. After all, we have three whole beds in our NCCU, and you want your patient to be taken care of! The thing is, though, that those beds are generally reserved for people who need




For instance, if somebody has a stroke as a complication of surgery, that person would be transferred to the NCCU. If somebody else had a dimunition of mental status after anesthesia, off they'd go to the NCCU for observation. If a third person had an aneurysm coiled or glued or otherwise dealt with in a minimally-invasive manner, they'd come to us. Most of all, if some poor sot came into the emergency department at Holy Kamole with an occlusive stroke, they'd be transferred, hospital to hospital, for what's known as "definitive management".

"Definitive management" means that we do Neurological Critical Care.

And Neurological Critical Care does not mean--and I want to stress this again--scheduled, every-three-hour nasal-tracheal suctioning for somebody who's otherwise a candidate for a floor bed. It does not mean transferring a walkie-talkie patient to the unit because you felt the nurses on another floor "weren't seeing him enough". Level of care is not an indication for our unit. Level of acuity is.

Unfortunately, and I'm looking at you, Medicos, anybody who needs Neuro Critical Care this weekend and into the start of next week will be, in the words of Queen Victoria, shit out of luck. Because you've filled my three! whole! beds! with your personal pets, thus leaving no




beds for people who might actually need them. Yeah, I suppose we could send people to the surgical critical care unit, but they're not specialists on strokes. We are.

And we can't exactly do a whole lot of transfers in and out, to the floor or the SCCU, because there are no open beds in the hospital.

I explained this all to you, and even got a little short-tempered (and I normally love you guys and gals, really). The house manager explained it to you. The charge nurses of at least two units explained it to you. And still, when I left yesterday, I had a unit full of people who did not need




Poor Jo (Der Alter Jo) had her dinner interrupted last night when I called her from the car to vent. Doctors mine, the first words out of my mouth at the end of the day should not ever have to include reflections on your personality or your parentage, followed by the phrase "Good holy God I need a new job."

Please do not do this any more. Admit the people to the Neuro Critical Care Unit who are both Neuro and Critical. Do not admit the people who are not. I don't know how to make that any simpler for you. Please do not make me try; "simpler" at this point might include "pounding it into your head with a half-roasted ham."

Hugs and Kisses,




Enfermero said...

Yesterday we had a rapid response on a lady who needed Narcan. Initially the surgeon (she had an extremity fracture) said send her to ICU. After the Narcan she was totally fine. He still said send to ICU, even after the nursing supervisor said, Really? Dumb because you know she's just coming back to the floor this morning.

messymimi said...

If the docs want better nursing care for their patients, maybe they better convince the hospital to hire more nurses and pay them enough to want to stay.

Moose said...

Wait, I think I read this story. "Ham to the Slaughter," by Shirley PissedOff.

woolywoman said...

been there. done that. got the new job. Our neurosurgeon DISCHARGED from the neuro ICU. Uhm, no. Hint: if you write an order to not wake patient for vitals and neuro checks, the are not critical.

Geens said...

Take a page from Star Trek and "sour the milk."

When something is sucking your resources, make that resource unenticing.

Patient needs more attention? Give it - and give the doc frequent updates on their stable condition.

Do whatever your NCC's version of calling at 2am for Milk of Mag is.

inkgrrl said...

I'd use an unroasted ham, just so it makes a splooshy splatty sound and gets all in their hair. Plus that way you haven't used energy by having the oven turned on for any length of time, so it's environmentally friendly. And cheaper.

Anonymous said...

or frozen

Amelia said...

Ohhhh, so so good! I so very much want to link this to my facebook! I work in Neuro Trauma ICU. We now have Admission Criteria...however, saline locked, no monitor, neurologically intacted pts still find their way to our floor. Love, love, love your blog!

Exergen Corporation said...

I am sorry to hear about your frustrations. I am sure there are many people out there who are grateful for what you do.