How much waste do you see?

Published

So after the MM 'sicko' thread, me and some of my co-workers got to talking last night about the whole univ health care issue and what's best. We all agreed that, on our unit esp, we see a lot of dollars that could go elsewhere and we see a lot of wasteful spending in our system. We basically take patients that are dead or near death. We save patients that are homeless and leave them on vents for months at a time where we know we will never get that money back when they die. We also see the same with illegals. About 1/2 of our patients do not have any form of insurance (so they wont be paying) and they still get to sit on the vent and rot until they die for thousands of dollars a day. This is a huge waste to me. In other units perspectively, how much wasting of healthcare dollars do you see?

Specializes in Cardiac.
...yes, infection control, a biggie to be sure. It may also cut down on narcotics being "diverted" to staff.

I don't do that with narcs either, but I do it with the big 100mg vials of lasix.

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A life is a life and you chose nursing to save/preserve life, right?

Apparently not the unborn in an emergency

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Specializes in Education and oncology.

PiPhi2004 ((thank you))) for a sensible reply. As an educator, I believe that we (collective Americans) watch too much ER, Grey's etc tv. We are shown that anybody, no matter how poor shape they're in, can be hauled to an intensive care unit and saved to walk out in good condition. We (collectively) don't want to believe that yes, we ALL are going to die. Hopefully not today (grin) but no one gets off this planet "alive". As a society, we are a death defying one. It really gets me when the family says, "Oh no! Don't use that "h" word with us!" Hospice. It really is an incredible philosophy. Also glad that the "palliative care team" is beginning, just beginning to roll off of some health care professional's lips.

To the family of the 91 year old terminally ill grandpa, there should be a film of a real life code. Complete with rib fractures and zaps that lift his shoulders off the bed. Real life codes are often horrific as all who have witnessed or been a part of one.

I am **not** for Kevorkian, but there's some value in a opoid drip when air hunger sets in and the family is at peace. Just my venting again.

Oh- I don't care if my patient is a millionare or an illegal immigrant. They deserve the best, compassionate and professional care that can be delivered. Period. :twocents:

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Specializes in Hospice, Palliative Care, Gero, dementia.

People have mentioned ethics committees several times, but there's another approach -- well-integrated palliative care teams.

I say well-integrated b/c they need to be seen as part of the larger healthcare setting who are there to work with and for the ward/unit providers.

Doc not comfortable having that "quality of life vs. prolonging death" conversation? Bring in palliative care to talk prognosis and values. They have the time, the knowledge and expertise.

Of course, not every hospital has a PCT, and not every PCT is seen as the asset they can be. One palliative care doc, when describing how we got palliative care accepted into his (large, teaching) hospital said that "the patients and their families are not my clients, the staff are my clients." This team is liked, appreciated and the rest of the hospital see how their practice helps and supports them in doing their jobs.

This doesn't mean that the regular floor/unit staff can't and don't do this work, but sometimes having someone else come in helps -- especially, as I said b/c PCT usually have a lot more time to spend w/patients and families than the docs or even the nurses. I just wish that nurses could initiate PCT consults.

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Specializes in Pediatrics.

I haven't read all eight pages, so please excuse me if I am being redundant. I will read them when I am done.

Personally, I think it is wasteful for someone to sit through an Ethics class that they very likely paid upwards of $300 for and received nothing from. Hmmm...waste of time and money if you ask me.

I mean, far be it for me to pass judgement on another's POV, but OP, seriously? Who are you to judge how much a life is worth? How can anyone judge the value of another? A worthless, homeless life to you (or others who share your sentiment) is someone's mother, father, sister, and brother. And even if their relatives NEVER come to see them, somewhere they have people who love them and value their lives. I don't know about your finances, but truthfully I am but three paychecks away from being virtually homeless myself; and I'll be damned if my husband, mother, father, sisters, brothers, or children would call my life worthless. :nono::nono:

That said, I do believe the healthcare system as a whole is a fraud. The wastefulness is shameful. Insurance companies and vendors are making a killing off of $55 per case Pediasure for tube fed patients and $40 bags of briefs. Lights are always on, TVs blare in empty rooms in under census units, and really...how fancy does an elevator really have to be? This is a hospital people, not the Hyatt. But I digress...(I guess...)

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.
People have mentioned ethics committees several times, but there's another approach -- well-integrated palliative care teams.

I say well-integrated b/c they need to be seen as part of the larger healthcare setting who are there to work with and for the ward/unit providers.

Doc not comfortable having that "quality of life vs. prolonging death" conversation? Bring in palliative care to talk prognosis and values. They have the time, the knowledge and expertise.

Of course, not every hospital has a PCT, and not every PCT is seen as the asset they can be. One palliative care doc, when describing how we got palliative care accepted into his (large, teaching) hospital said that "the patients and their families are not my clients, the staff are my clients." This team is liked, appreciated and the rest of the hospital see how their practice helps and supports them in doing their jobs.

This doesn't mean that the regular floor/unit staff can't and don't do this work, but sometimes having someone else come in helps -- especially, as I said b/c PCT usually have a lot more time to spend w/patients and families than the docs or even the nurses. I just wish that nurses could initiate PCT consults.

This would be a wonderful idea. Honestly I have no idea if we have a PCT but I am guessing not since our unit has the most deaths than any other and most of them are long term chronic illnesses that die of sepsis. I have only seen 2 ethics consults ever done and nothing happened. We do have one doc, however, that will refuse to escalate any form of care if he determines it is futile and has been to court many times over this issue. He has never lost a case. I wish more docs would be willing to do this as, to me, it shows who REALLY cares about their patients.

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Specializes in NICU.
Somehow working with adults is more difficult than children- most parents don't sit by and watch as their kids suffer. Not the same with adults- if the doc says "oh, we'll try something else," the patient and family members often say Ok. Denial is a huge defense mechanism.

You should come visit my unit. 95% of the parents of the critically ill babies are in denial. They just want their child to live, they will do anything. Of course it doesn't help that some of our doctors paint a nice pretty picture and anybody who is REALISTIC is considered "Dr. doom and gloom" and not listened to anyway. These parents latch onto someone who tells them what they want to hear. I am always appreciative of the parents who are at least thoughtful enough to make their kid a DNR. I have seen way too much suffering secondary to parents not being able to let go and I've only been doing this for 9 months.

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Specializes in LTC,Hospice/palliative care,acute care.
So after the MM 'sicko' thread, me and some of my co-workers got to talking last night about the whole univ health care issue and what's best. We all agreed that, on our unit esp, we see a lot of dollars that could go elsewhere and we see a lot of wasteful spending in our system. We basically take patients that are dead or near death. We save patients that are homeless and leave them on vents for months at a time where we know we will never get that money back when they die. We also see the same with illegals. About 1/2 of our patients do not have any form of insurance (so they wont be paying) and they still get to sit on the vent and rot until they die for thousands of dollars a day. This is a huge waste to me. In other units perspectively, how much wasting of healthcare dollars do you see?

I have to agree-usually the street people have neglected themselves for years so they are true train wrecks.Once they get into the system the fun really begins.I've seen several live for many,many years in the LTC on medicaid with enteral feedings,trachs,etc. As far as the illegals go I live in an area with a large population of Mexican workers-most do not have insurance but I have seen how they will pay their bills $20 or $50 per month but I have also seen many who have neglected themselves,run up a massive bill during a lengthy hospitilization and then go back to Mexico. What would happen if I fell out on a vacation in say, Japan? Maybe I get mugged and am found with no ID,unconscious,head injury...What kind of care would I get? Every day I care for elderly patients with NO quality of life-how many times do you treat aspiration pmeumonia in a patient with an advance directive that states "no artificial feeding"? How many millions of dollars are spent on micro preemies? Why can't our society accept death?

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Specializes in MICU, SICU, PACU, Travel nursing.

Lately working with people whose extensive end of life care is completely painful and futile has been getting to me as well as some other posters here. I am glad this issue seems to be coming to life more and more. I think that maybe public education of some sort could help, as the families who are desperate for you to do WHATEVER you have to do to keep their inevitably dying family members alive seem to have little understanding of the natural dying process and about how they are not only robbing these patients of dignity but also robbing themselves of the memories they will have of the patient passing. They will not remember a peaceful passing, but a horrible pointless code with gowns open under fluorescent lights with ribs breaking and electricity coursing through their dead veins and various body fluids coming out.

I could NEVER do that to someone I loved.

Its all so very sad.

The fact that waste occurs with this is not necessarily my primary concern with this process, but it is a waste, yes. :(

But its the futility and the lack of dignity that really get to me....

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Specializes in School Nursing.

not quite sure that waste is the appropriate word for this. :no:

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Specializes in vascular, med surg, home health , rehab,.

I had an 80 year old nursing home pt, CVA, whose daughter insisted on a PEG replacement, despite the dangers of any kind of procedure on her already frail mother. They couldn't get her off the vent post op. She was paced, vented and just kept literally rotting away. Huge abdominal abscesses, the daughter, in her 50's divorced and estranged from other family just would not let this end. I swear, the women started to look like Shrek, her edema was so bad. No quality of life at all. She exhausted her Medicare Benefits at over 1 million plus. It was only when a nurse actually took down a dressing in front of the daughter, and pressed on the side of her wound and a flood of pus came out that the daughter finally gave in. I can sympathize with the daughter, but this was her psychological issue, it had nothing to do with her with her mother who was to all intents and purposes dead. The suffering to her mother, the affect on the staff dealing with this and the sheer phenomenal cost of this care, which the hospital, a non profit, take anything kind of place, took the hit. This must be occurring nationwide daily. So, I guess the culture is too blame, that death is considered defeatable if you throw enough money at it. I think a national ethics committee for these cases. A fair, unbiased hearing that while considering the concerns of the next of kin, also considers the futility of ongoing treatment for those who are already beyond help. This isn't playing god. Who lives, who dies, I think playing god arises when we keep these people alive artificially. And as a result what suffers? The care we can give to people who have a shot. And maybe an end to this horrible situation that wastes so much. Financially and emotionally for all concerned.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
not quite sure that waste is the appropriate word for this. :no:

i agree. i can understand where the op is coming from--sustaining lives on a vent for a long time while they are suffering and have no hope of recovery is not a pretty picture. unfortunately family members are often uninformed and uneducated about their options. doctors need to have those necessary discussions with families sooner rather than later. i think it is difficult for some physicians to be realistic with families and that is why so many families don't opt for comfort measures sooner. it is very sad to see patients that are suffering for weeks before being placed on comfort care and finally given the narcotics that they needed the whole time.

i think what got everyone riled up was the term waste associated with "illegals" and non-paying patients. i really don't think that the op meant to compartmentalize patients into paying or nonpaying categories.

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