Where is money wasted in healthcare?

[country mom]

Some time ago, I took a week-long class in a process called "Six Sigma", which began in industry and has now migrated over to health care. Officially, it is known as a "process improvement" effort, but long story short it's about cutting costs and saving money. The Six Sigma process was designed by engineers, so it takes months and months of measuring, graphing and data collection to get the end result. I'm a "cut to the chase" kinda girl, so would love to hear where other nurses are seeing wastefullneess in health care. Big things, small things, whatever.

[ethangram]

It seems we always talk about the direct care costs of healthcare when it is time to start cost cutting but there are other ways to address our costs. It makes me crazy whenever I open packages of supplies that are boxed, double wrapped and then boxed again. Or those that have special packaging designed to do something I can't fathom (is it really necessary to hold that tubing in that position?) but certainly does increase the amount of packaging. This must increase the direct cost of the supply. In addition, it increases the time it takes to unpackage it (time for the nurse is money to the organization) as well as increasing disposal costs to the community. I know this has been addressed but nothing seems to really change. And are those expiration dates really reasonable or does it just increase the profit for the supplier when we must order new ones?

These are huge costs that affect every patient from physician office to the ICU. Changes here could make a big difference.

[Pepper The Cat, BSN, RN]

Concentration camp survivors existed. Would you have preferred them all to have died? Are you going to decide who is "living" and who is "existing"? How about a 32 year old who works 3 jobs and no time to pay the bills? Are they living? Or just existing? Hell, most people are just existing!

I believe the original statement referred to people who refuse to let their elderly relatives die - forcing them so linger on vents or with feeding tubes. Walk through a chronic care ward and you`ll see being existing on feeding tubes with trachs and stage 4 ulcers from being in bed forever. We had a long-term vent in our ICU. Pt was brain dead. Family refused to let the vent be disconnected because they thoug that he `might get better` This cost the healthcare system thousands of dollars not to mention tieing up an ICU bed for months.

[ShayRN]

Its also a matter of the doctors on the case just being honest. How many times have you had a patient's family member say "they never said he could die!"

Also, how many drugs get wasted because they are narcs? We have had entire bottles of Roxanol wasted because a patient dies before it is opened and you cannot reissue a narc. Other scripts can be sent back for credit, but not narcs, its stupid.

[Pierrette]

Way, way too much money is spent on patient who only have a very short time to live. Rather than enroll grandma or grandpa in a comapssionate hospice program, they are placed in an expensive ICU where they are subjected to many expensive tests and procedures -- when everyone with any common sense knows they are going to die anyway within days or weeks. Hospitals should be set up so that such patients are guided toward cheaper hospice care instead -- but short-sited hospitals see those patients as revenue generating and encourage such expense, not seeing that it is bankrupting the entire system of health care, which is bad for everyone in the long run.

... Letting nature take its course with a 95 year old...

What would be the cutoff age for aggressively trying to save a life rather than letting nature take its course? Have we not seen miracle patients come back from what we thought were impossible odds?

[ShayRN]

What would be the cutoff age for aggressively trying to save a life rather than letting nature take its course? Have we not seen miracle patients come back from what we thought were impossible odds?

Sure, but how often. No cut off age. But when there are no brain waves and a person is not able to breath on their own for 10 weeks, it is time to be realistic. Do you really want to live that way? I know I sure don't. Listen, I am NOT afraid to die. I am terrified, however, of living in a bed, on a vent, with tube feed going into a hole in my stomach. I say it again, that IS NOT LIVING.

[Katnip, RN]

What would be the cutoff age for aggressively trying to save a life rather than letting nature take its course? Have we not seen miracle patients come back from what we thought were impossible odds?

Those "miracle" patients are miracles because they are extremely rare. We're not talking about patients of a particular age. We're talking about people who are brain dead or so far gone they just can't return and those who have specified that they do not want these measures getting them because family just can't let go. Not only does it cost a tremendous amount of money that could be used to actually help someone, but it's taking up a bed that could be used by someone who may actually be helped.

We do not have unlimited resources, and when that happens someone has to make decisions on who has the best odds of survival with those resources. If there's ever a mass disaster, you'll see those folks pulled off their vents right quick.

[Katnip, RN]

Sure, but how often. No cut off age. But when there are no brain waves and a person is not able to breath on their own for 10 weeks, it is time to be realistic. Do you really want to live that way? I know I sure don't. Listen, I am NOT afraid to die. I am terrified, however, of living in a bed, on a vent, with tube feed going into a hole in my stomach. I say it again, that IS NOT LIVING.

I agree here. All we're doing is torturing what's left. And when their kidneys fail. Yeesh. Not for me. No vents, no feeding tubes. Just give me my morphine and let me go already.

[llg, PhD, RN]

Concentration camp survivors existed. Would you have preferred them all to have died?

Your comparing apples to oranges and I am offended you would compare my words with what I consider one of the worst things done to a human. What was done to the Jews in Nazi German was pure evil. Letting nature take its course with a 95 year old who is dying isn't.

Great response! Sometimes, it is fully appropriate to be offended -- and I think you expressed yourself quite eloquently.

Good for you!

[country mom]

I agree here. All we're doing is torturing what's left. And when their kidneys fail. Yeesh. Not for me. No vents, no feeding tubes. Just give me my morphine and let me go already.

You make a good case for advance directives. And I never thought of advance directives as being a potential cost-saving measure, but I wonder how much the healthcare system could save if every patient had put their wishes in writing as to the initiation or continuation of life support.

[country mom]

It seems we always talk about the direct care costs of healthcare when it is time to start cost cutting but there are other ways to address our costs. It makes me crazy whenever I open packages of supplies that are boxed, double wrapped and then boxed again. Or those that have special packaging designed to do something I can't fathom (is it really necessary to hold that tubing in that position?) but certainly does increase the amount of packaging. This must increase the direct cost of the supply. In addition, it increases the time it takes to unpackage it (time for the nurse is money to the organization) as well as increasing disposal costs to the community. I know this has been addressed but nothing seems to really change. And are those expiration dates really reasonable or does it just increase the profit for the supplier when we must order new ones?

These are huge costs that affect every patient from physician office to the ICU. Changes here could make a big difference.

Not to mention that better packaging could potentially mean less solid waste ending up in landfills. Some other posters mentioned pre-packaged kits. I know they can be handy in some cases, but take a suture removal kit for instance- those metal scissors going into the sharps waste, when they could be sterilized and used again. I've always wondered about those expiration dates too- maybe a scam so facilities have to buy more supplies?

[llg, PhD, RN]

What would be the cutoff age for aggressively trying to save a life rather than letting nature take its course? Have we not seen miracle patients come back from what we thought were impossible odds?

I wouldn't make the decision based on age -- but on the person's history, current condition, and prognosis. Just 2 years ago, my step-father's kidneys failed and he needed dialysis for a few weeks. He was in his early 80's ... and prior to that bout of pneumonia and sepsis, he was fully alert and physically active. Even during the height of his infection, he was fully alert, oriented, etc. Within 24 hours of being on anit-biotics, his condition began to significantly improve. He was discharged to home in approximately 10 days and off dialysis in 1 month. Within 3 months, he was playing a little golf again.

So ... yes ... in his case, dialysis was worth it. He had an acute illness that interrupted an active life. Anyone with any common sense can see the difference between such a scenario and one in which the patient has had severe dementia for a couple of years, unable to care for themselves, not enjoying life, etc. -- patients for whom their current organ failure is NOT the result of an acute and curable illness, but rather the current stage of their of the death process.

...And no one in this thread has suggested that there be some mandatory age at which further health care would be denied with no regards for the specific circumstances. To suggest such is to put words in our mouths. What we are suggesting is that a whole lot of money is spent on people (usually elderly) who have no chance of returning to a meaningful, happy life. We should develop a culture and systems whereby such cases are guided to services more appropriate to their situations and not waste scarce, valuable resources on false hopes and unrealistic expectations. If God is going to intervene and make a miricle, he/she doesn't need us to waste our resources to get it done.

[Moogie]

A couple of tangible items---small and big---that make me go "Hmmmmmmmm" regarding health care costs.

Small: I know of a LTC facility that has two common rooms, one for each wing. Each common room has a gas fireplace going 24 hours a day, 365 days a year. Even during the summer when it's over 90 outside. Sure it adds to ambiance in the facility, but is it necessary to keep it running all the time? Isn't that a waste of gas----and money?

Big: How many times have we all seen facilities that claim they can't hire more nurses yet they're doing some sort of major building projects? I agree that facilities need to be aesthetically pleasing, but is it necessary to have a two-story atrium with fine art, plants and a grand piano that's programmed to play all day long? I've also seen institutions build incredible new units and then, a year or so later, close those units because they want to reallocate the space or there was a merger or something happened. I remember two institutions that merged and it was decided that psychiatric services and most ICUs would be at the one facility. The other facility had recently renovated wasted space into a beautiful psych unit and built a state-of-the-art ICU. Come on----don't tell me they didn't have some INKLING about the merger? Why did they waste the money on these renovations when they probably knew that these services would be redundant after the merger?

I also remember being very angry as a staff nurse at a large hospital when we were told we had to work short---and that very night there was a huge banquet in the staff cafeteria honoring the bigwigs in administration. :angryfire

A little common sense here, people! Wait a second----can we call the sentient beings who make these bad decisions people?