Where is money wasted in healthcare?

country mom · Jul 3, 2009

Thank you to all those who have posted for your thoughtful responses. It's the wastefullness that really gets to me. And the thoughts posted about the lavish furnishings seen in many facilities, a few nice pictures are okay, but some of these places just really go over the top. When did hospitals have to start competing with luxury hotels?

The whole end-of-life scenario is a dicey one, at best. Surely that debate needs it's own thread. I wonder how much the family's perception of death and beliefs about death affect the decisions that are made when faced with catastrophic conditions. But that's another thread for another time.

Pediatric Critical Care Columnist · Jul 4, 2009

Here's an example of ridiculous waste that happened to me just last night. I admitted a neonate from the CV-OR right after my shift started. It had been a long procedure and the kid was sick-ish. He had a significant hyperglycemia and so I started an insulin infusion. Because of his age and size, that meant hourly glucose monitoring. I went and got our glucometer and discovered that the responsible party had not uploaded the information to our main lab's database as required by policy, and it had not had any QC done in months. It wouldn't let me do anything with it. (I could have done the QC but not the uploading.) So instead of doing hourly bedside chem-strips I had to do hourly ABGs all night. Don't think that didn't waste a few hundred bucks in supplies, to say nothing of all the extra time and needing to have the RT involved.

wildlaurel · Jul 8, 2009

I am a new nurse, but I am now working in an ER and I totally agree with the abuse of ER services for everyday problems. My first day in the ED we had 2 people with tooth aches and a couple of ear aches! Having worked as a CNA I also agree with the palliative care comments. I encourage everyone I know to have a living will and make decisions about that kind of thing in advance so their children and family aren't left with the guilt of deciding to opt of ICU and extraordinary treatments.

I also think we waste a lot of money in small things...I don't know how other healthcare systems do it, but where I work if someone comes in for surgery, KNOWING they're going to stay overnight in the hospital, we still provide them with everything they need for grooming. And if a patient does happen to bring their own things, most of the time the CNA's have already brought a basin full of stuff into the room and left it there - so it can't go back into supply. That is also a problem with nursing staff and their supplies. I can't tell you how many extra bottles of sterile saline or Kerlex (sp?) and 4X4's are left and thrown out in a room because the nurse didn't see what was there before she went in to do a dressing change. Or laundry costs - we had a patient leave after several weeks in the hospital and when housekeeping went to clean the room, they found 3 linen bags worth of clean laundry stored in the cabinets because it was brought in and never used and the patient stored it. Not only was it a pain for the housekeeper, but what a waste in laundry costs. :twocents:

silmas RN · Jul 8, 2009

When I was an agency nurse, I worked in the NICU of a large children's hospital. Half the electrical outlets were broken and most of the charger cords were frayed just to name a few problems. This hospital benefitted from the Children's Miracle Network, but the staff nurses told me that any money they received went for cosmetic improvements to the building, like new statues for the outside. It's disgusting.

zuzi · Jul 8, 2009

Because majority of nurses here was worked and lived JUST in US, well is hard to belive how the helath care function and in other countries.

Trying to apply in US the healthcare model from another countries will not work at one point, because their model was adapted for their own needs and US is US!

The problem here in US are insurance companies beetwen patients and providers, is the huge mistake ever.

As soon you have the second part involved in healthcare "ring of fire", they are second part who make money for NOTHING, always the cost will be high and much more you will NEVER know who is a REALLY good provider and who not, because all will be the same. Because of insuarnce companies we developed here in US a lot ot 10000 employes who suck a lot of money also, 10000 services also sucking money, insurance companies here is what a italien movie named "La piovra". You could not doing nothing againt it!

In a really free healthcare, the providers are free to setup the fees and patients free to go or not to providers. IF YOU hospital doctor, facility if you are REALLY good, people will come and will pay as much as you ask for it, if not ....you could enroll your self and your hospital facility on comunitar programs and you will be paid from social funds, and you will be the one like many others.

I know insurrance companies work for them self but not just only for them self, loooooool, is a big huge mistake. America is country for investitors for bussiness... but as good as you know ...I know also that...the best bussines is the bussines with.....insurance companies, lol

In my past I worked for a insurance company over the ocean, I had friends working there still...you really don't want to know how the thinks work from the insiede out, .... .

But still , I know how is to be in "for all the same" health care", at one point will be a mistake... but when money are involved.... you know always need to keep the balance beetwen money and helathcare...damn it I learnt good my US lessons, lol.

I belive in US stakeholders and I am sure that whatever they will decide they will balance both visions, and they will not let Zuzi and many others to live again what she lived one time ago... "for all the same, but for us a little different" is a a so tricky vision, ONLY you you lived it, you know it!

Health care money are wasted by insurance companies!

Nurses who come in nursing for money and just for money they need to go there, they will like it!

reiver71 · Jul 8, 2009

I think spending resource $$ to try to adapt the latest industrial trend to a healthcare model is wasteful. Hospitals I've worked in have tried to incorporate these types of programs since it became popular to do so and have usually failed....Why? Because we deal with people and not commodities on an assembly line. We're anxious to get people trained at the various belt color levels so they can engage in busy work projects to save the parent company money. But what's the effect on patient outcomes/satisfaction? What's the effect on the staff that has to work short? Or without tangible resources? Our supply room was "leaned", and the result was that we are often out of the basic necessities required for patient care. That's efficient. Our break room is going to be "leaned" soon.....a project that I'm pretty certain that the patients I care for could care less about.

I don't believe patients care how many "black belts" are on the staff; they just want to know that they will receive appropriate, competent and empathetic care. We can become so focused on the process that we forget about the person.

rph3664 · Jul 8, 2009

I agree with the time it takes to do redundant paperwork.
Enormous numbers of dollars are spent on futile care because a family member doesn't want to let go. Hospital admins need to grow a pair and say we've done all we can, try to sue us. I recently saw a case in New England somewhere where a family sued because the hospital refused to override a patient's advance directive. Judge wouldn't even look at the case saying the advance directive was a legitimate, legal document and they had no right to override it. We need to see more of that.
And speaking of lawsuits...they need to stop or drastically cut back. Greedy lawyers go after scared, grieving or greedy families. Yes, there are some cases of malpractice or negligence where compensation should be awarded. But things go too far. Even if a hospital or other defendent wins, it can cost a huge amoount of money and time to defend the case.
Also the quick readiness to sue leads to more and more unecessary tests so doctors can cover themselves.
Spending money on cosmetic items rather than patient care. Will that grand piano in the lobby actually help a patient get well? How about the marble tiles, the original paintings, etc? Put money where it can help.

My hospital has two grand pianos in it. Both were donated by people in the community, and volunteers come in to play them. One of them at my hospital is the father of a co-worker who did it several times a week until he recently had a stroke at age 92. :cry: The artwork in the lobby and both pediatric wards (regular and psychiatric) was donated as well.

Our hospital has spent millions of dollars over the past few years on a computer system that has probably caused way more problems than it has solved. :angryfire

One of my co-workers refers to the aforementioned program as "Six Sigmoid." :lol2:

rph3664 · Jul 8, 2009

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?

I think it's more about rotating stock. Did you know that paper products in grocery stores now have expiration dates? :confused:

rph3664 · Jul 8, 2009

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.
Our hospital's cardiac surgeon has done CABGs on people in their 80s. Some people might find that unethical, but if the person was active and otherwise healthy before, I don't have a problem with it.
Some people who are not in health care think we should do away with life support. Good heavens, if you have had general anesthesia, you have been on life support! The overwhelming majority of people who go on it, come off it within a matter of hours or maybe a few days, and recover completely or nearly so. That's why it exists in the first place.

irisorchid · Jul 8, 2009

Poorly organized units and supplies, filing systems, etc. The places I worked recently seemed to stock and file things for the convenience of the stocker, not the nurses who are using the supplies. In one place, the Pharmacy dumped a pile of IVs in a box and the nurses had to sort them out and put them on shelves (over some nurse's heads) and you had to handle several IVs to find the one that you needed. I think a new person on the floor should be able to find what they need in less than a minute. When a nurse makes $45-$55/hr on the the floor, they are paid $0.75-$0.95/min. If each nurse is spending excess time trying to locate the supplies that they need every shift that really adds up over a year, not to mention the daily stress and frustration and overtime at the end of the shift trying to get charting done. This is time better spent doing pt care or charting.

muffylpn · Jul 8, 2009

its labs oh my God its the labs-I work on a Geri-Med-Pysch Unit (GMPU) so u need 2 have 2 conditions

to get on my unit; which also means 2 different doctors. 1 of which is a hospitalist who changes every

12 hrs. Constant repeat of labs and even when u see that the same labe was done yesterday and it

was normal u would have to call a different doctor to get it d/c and they never d/c them.

irisorchid · Jul 8, 2009

Hospitals need to solicit input from nurses and ancillary help before they design a floor or new wing. I think we have all worked in places that were designed poorly. Example: A floor was redesigned in a local hospital recently. My friend who worked there asked me--"What would you do with the rooms nearest to the nsg desk?" "I'd put the sickest or confused pts there so I could watch they better." Of course, but the architect/hospital admin decided to put a visitor waiting room across from the nurse's station! No place to put those confused pts, not to mention trying to communicate at the nurse's station without violating HIPPA. Millions of dollars spent on a remodel that is going to cause all kinds of problems for the staff who has to work there 24/7 for years and years.