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.

[southernbeegirl, BSN, RN]

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.

I was lying in the bed this morning thinking about this very same thing. (for what reason i dont know but this is what i was thinking of, lol).

what i was thinking was how if a patient is discharged from LTC, their unit dose packed regular meds go back to the pharmacy. yet the narcotics, which are NOT unit dose and are packaged in little plastic boxes, have to be destroyed. why not just package the suckers in unit dose so they can be sent back and credited so there is little waste??

[MedSurgeMess]

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!

But, unfortunately, it is a waste of precious resources just the same, when you have someone whose outcome is not going to be a positive one

[southernbeegirl, BSN, RN]

Tests, tests, tests for someone with a hangnail (I am oversimplifying)-- all to appease the lawyers and their litigious clients......

i could only thank your post once but i wish i could have a thousand times!!

the number of xrays alone that i have to order in LTC just because someone falls is outrageous! if someone trips and complains of pain in their ear, i have to get an xray just so i can CYA and not get sued. it. is. outrageous.

[southernbeegirl, BSN, RN]

And while we are at it,..Medicaid should never and I mean NEVER pay for a pregnancy test at 0200 when that is the only reason a pt checks in to the ER. Medicaid shouldn't pay for the visits when Mom brings in her 18 mo old who's had a fever of 102 for an hour, she didn't give Tylenol and "while your at it,..I want the doc to see my other three kids because when one gets sick they all get sick"!

If you have 37 ER visits in the last 90 days, with no emergent dx, you should be told to stop going to the ER! We shouldn't have to pay for that! I checked in a 20 yr old female,.at 0300 a couple of days ago,...here with her grown mother,...7wks pregnant,.."I can't feel the baby move, something must be wrong",....she waited 4hrs to be seen and our tax dollars paid for it,...talk about waste!

AARRGGHHHH,......people need to start taking some personal responsibility over their own health!

i wish that ERs could refuse to treat nonemergent patients and refer them to the urgent care clinic.

i have seen so many CNAs i work with go to the ER just to get an excuse NOT to work. they couldnt care less about the costs because THEY dont have to pay the bill because they are on medicaid. all that, just to get out of work.

i wish people could be penalized for abusing the ER!

[MedSurgeMess]

If God is going to intervene and make a miricle, he/she doesn't need us to waste our resources to get it done.

You took the words right outta my mouth!

[NotReady4PrimeTime, RN]

CEOs making 7 figure salaries......

Managers and directors making 6 figure salaries.....

These people are NOT saving lives or saving $$$ at our hospital, yet the administration deems it fit to cut costs in nursing and ancillary care, AND demand that we do more to improve patient satisfaction scores!

Go figure!:angryfire

Our health care system in Alberta is undergoing yet another reorganization. We went from every community for itself to 17 health regions in the early '90s, then to to 9 regions in 2005. Now "We Are One", a single health care system for the whole province. Severance for the ousted CEOs, directors and other administrators for just this current round of changes has cost our system $22.5 MILLION dollars (Calgary Herald, July 1, 2009). A single person, Paddy Meade, who was deputy health minister in the provincial government before the fall and who became interim "super-board" chair for a total of 9 months after the fall, received $1.3 million and Jack Davis, the CEO of the former Calgary Health Region $1.7 million. Not one patient has benefited in any way from the actions of either. But we have to keep reinventing the wheel.

"Penny-wise, pound foolish" thinking among administrators who "save money" by cutting ancillary staff -- thus dumping their work onto higher paid RN's -- who then struggle to provide high quality care -- which results in major financial loss through expensive errors, inefficiency in patient flow, etc. as well as in increased VERY expensive staff turnover. Other "cost-cutting" measures often have the same effect of saving a little money up front, but causing big expense down the road. If the focus were on quality and "doing things right the first time," it might cost a little more up front but save money in the long. But such thinking is often not allowed because of the up front costs.

We nurses seem to be the jacks-of-all-trades of the health care system, and have additional tasks heaped upon us at every possible occasion. But of course we have no lessening of our workload to accommodate these additional tasks. "It's only going to take you 2 minutes to fill out this flowsheet." "It's not a big deal, you can do this at the same time you do that." "Computerized charting will be more efficient and legible" but it'll take you three times as long and when someone else is using your terminal, you're just going to have to wait... Our unit is currently being studied to assess the effets on workflow of the introduction of a computerized chart. So far the results are that the nurses spend far more time "nursing" the computer than they do the patient.

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.

I totally agree. Overpackaging makes me insane!! Never mind how much time it takes to get into the package to access the urgently needed item... I then have to go back later and clean up all the debris! And since one of the areas our hospital has chosen to cut back on is facilities management, our waste collection has fallen off to the point that we have forty full bags sitting in our dirty utility room for the whole night.

Then there's our practice of running all of our pressure lines for children under 10 kg on an infusion pump. They come from the OR with those lines infusing from a pressure bag. But we have to mix heparin into a 500 mL bag of IV fluid (D10W for CVP and LAP, NS for arts) and attach a buretrol so that it can infuse through a pump. Most of our nurses will automatically discard ANYTHING mixed int he OR and start their own infusions.

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.

We can return unopened narcs to our return bin in Pyxis, but we waste a LOT of leftover narcs (peds, you know... 0.2 mg of hydromorph means 1.8 mg wasted...) and a lot of other drugs as well. Our pharmacy is very inefficient, and because of that our PICU is only supplied with a few drugs in unit doses, mostly antibiotics that are stable for at least 24 hours out of the vial. Our policy is that the initial dose of an antibiotic must be given within one hour of the order being written, so most of our initial doses are prepared on the unit. This means that the remainder of the drug is discarded (a single dose of 90 mg of pip-tazo from a 2.25 gram vial... the rest is tossed). Often pharmacy doesn't send up the doses as expected, for whatever reason, and then we have to open another vial. Sheesh.

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've worked at my current job for 7 years. In that time there has not been a second that there hasn't been something under construction. (No additional staff or visitor parking added though!) Most notable is our cardiac sciences "institute", first promised to open in 2005 and still under construction today. It has a healing garden that was completed for the "official grand opening" on May 1, 2008 and has been looked after ever since, even though the only part of the building in use is in the basement. Cost overruns are astronomical and when they do open, only about 2/3 of the beds will be open because we've got an external hiring freeze on. Oh, and many of the highly-respected (and very well-paid) surgeons and researchers hired for the programme have already moved on rather than sit idly waiting for the place to be finished. I don't know how they're going to replace them since we aren't hiring externally!!

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?

We were having such staffing shrotages in the last year that anyone working more than 4 hours of overtime was given a meal voucher. That stopped on April 1. As a little perk, staff members wearing their staff ID were given a 10% discount on purchases from hospital food services (nothing prepared freshly, mind you) and that stopped as of today in an effort to save money. I'm quite sure that the practice of catering any meeting attended by anyone in a management role will not have ceased though.

Another thing that is really wasteful is the continual ordering of labs in the absence of any changes in treatment that could need monitoring. Do I really need to run ABGs and mixed venous BGs every hour even though we've made ZERO changes to our ventilation, preload or afterload? Is it really necessary to send off a lab CBC every 4 hours when we're doing ABGs at the same time and get our Hgb and Hct at that time? Is the WBC oging to change that much in 4 hours? Are the platelets going to fall enough in that time in a patient who isn't septc or actively bleeding? And why are we using 5% albumin for fluid boluses all the time?

There are so many small things that, multiplied by the number of patient days, add up to a LOT of money!

[nerdtonurse?, BSN, RN]

When you've been a nurse, and had a pt who's 103 (no lie, 103) with necrotic feet, a PEG, aspiration pneumonia so bad you can hear them breathing from the hallway, multiple CVAs to the point where the only thing functioning in that brain is the brainstem, and the family's wanting them to have yet ANOTHER colon resection so they can reverse the colostomy so great-grandma can get "better..."...then you have experience to make an informed decision. Until you've seen just how bad it can be, you don't. I wish to god we made every admission to the hospital watch a video of a code, and say, "okay, now see the teeth flying and the ribs cracking? That's what you're signing you 95 year old brain dead, end stage COPD/CHF parent for." And if they made the person a full code anyway, then we should have the right to call adult protective services, because all they are doing is torturing their family member.

[DolceVita, ADN, BSN, RN]

Less artwork, fountains, pretty gardens. No one is in hospital long enough to appreciate these anymore.

How about a parking lot that someone other than a doctor can use?

Or new flooring on a couple of wards (I swear something is gonna jump out or the carpet pile and kill me)?

New equipment?

More staff?

How about not having exclusive doctors/surgeons lounges? How much does that cost? By the way have you seen them...I used to clean one as a volunteer. High end coffee machine with the little single serving coffee pods (Keurig I think), subscriptions to at least 11 professional journals (just for the lounge) -- that is some serious dosh right there every month.

[Ruby Vee, BSN]

stop wasting tons of money trying to keep someone alive at all costs for another week or month. if an octogenerian doesn't do well after heart surgery, suggest to his family that you've done all you can, then let them die peacefully. ditto someone with multiple other organ systems failing.

anyone who has demonstrated noncompliance by failing to show up for their clinic appointments or refusing to take their prescribed meds should not be given a ventricular assist device or considered for transplant. if that's too hard-hearted, give them one second chance. but i hate seeing someone who has fifteen no call/no show clinic appointments over the past three years, multiple notes about how they "refuse to take" this med or that and a note about how they have sleep apnea and don't use cpap because they "don't like wearing it" get a heart transplant or a vad -- especially when it invariably seems that the taxpayers are picking up the tab.

if, despite a demonstrated history of noncompliance and no history of ever working, you decide to give someone a ventricular assist device, when it becomes infected because the patient "ignores advice and does whatever they want," don't give them a second device. yes, they'll die. but i'd rather vaccinate every school child in the county than pay for another device (or even a first one) for someone with a well-documented hisotry of noncompliance.

if you're in this country illegally, you are welcome to basic healthcare even if you can't pay for it. but heart surgery, transplants of any kind, dialysis and insulin pumps are well above the basics. so either pay for them up front or get your country of origin to cough up the cash.

[DolceVita, ADN, BSN, RN]

stop wasting tons of money trying to keep someone alive at all costs for another week or month. if an octogenerian doesn't do well after heart surgery, suggest to his family that you've done all you can, then let them die peacefully. ditto someone with multiple other organ systems failing.

anyone who has demonstrated noncompliance by failing to show up for their clinic appointments or refusing to take their prescribed meds should not be given a ventricular assist device or considered for transplant. if that's too hard-hearted, give them one second chance. but i hate seeing someone who has fifteen no call/no show clinic appointments over the past three years, multiple notes about how they "refuse to take" this med or that and a note about how they have sleep apnea and don't use cpap because they "don't like wearing it" get a heart transplant or a vad -- especially when it invariably seems that the taxpayers are picking up the tab.

if, despite a demonstrated history of noncompliance and no history of ever working, you decide to give someone a ventricular assist device, when it becomes infected because the patient "ignores advice and does whatever they want," don't give them a second device. yes, they'll die. but i'd rather vaccinate every school child in the county than pay for another device (or even a first one) for someone with a well-documented hisotry of noncompliance.

if you're in this country illegally, you are welcome to basic healthcare even if you can't pay for it. but heart surgery, transplants of any kind, dialysis and insulin pumps are well above the basics. so either pay for them up front or get your country of origin to cough up the cash.

gosh it would be interesting if health insurance companies yanked coverage for conditions where the patient was non-compliant -- of course they probably do.

[MedSurgeMess]

Sorry- the real crux of my argument with you is your arbitrary decision of basing someones LIFE on whether they are "existing" vs "living". There are many ways to justify this "saving of money", and each one is as zany as the last. Should we select people who don't contribute to society? Should we pick people who are going to die anyway? Should we pick people who have serious diseases? Should we only pick the poor people?

Please don't fall into the thinking that money is more important than life itself. What benefits a person if they gain the world, but lose their soul? The money you save anyway will not go toward anything good; it will simply make rich people richer. Which doesn't include you or me.

We are talking about waste to the system. I know that you truly care for those that you take care of by your statements. But when talking about waste of resources, many times these cases are viewed as such. To the family it is not a waste, but to resource managers, it is. In the case of disaster, these cases would be passed over for those who showed the most promise of return to health with the least amount of resources used, so that many could be cared for, as opposed for just a few that used much resource allocation. I know it's sad, but it's how it is....

[DolceVita, ADN, BSN, RN]

Put a lock on the fridges that get emptied by visitors on a daily basis.