Lost on the Floor

I saw this story titled: "Hospitals Designed to Heal" on line this morning as I awoke from the slumber of a man exhausted (this is the last time I stay up all-day after the night shift...family first though). While I agree in concept that hospitals are places to heal and that they should provide a healing environment, there are limits to that.

"Southwest Washington Medical Center in Vancouver built its new hospital tower with many design features as comforting as you'd find at a resort hotel." I found the words "resort hotel" particularly ominous. In creating a resort, you place in the patient mind set that this is a vacation, thus they should be served hand and foot, as if they were on vacation. Granted, not all patients will feel this way, but many, and their families will. I am a believer in the active participation of the patient in their health care, if able. That's why I will try to get patients to do things for themselves. Yes, I will be by their side every step of the way, but I will make them do it themselves, again, if able. As an example: we post-CABG patients 2-3 days our of surgery on our floor. These folks need to start moving soon after surgery to reduce any number of complications. We push them, yes, but when they go home, we will not be there to do everything for them. We want to get them out quickly to reduce the risk of obtaining a nosocomial infection or other nosocomial complication. Coddle we don't do. Nurse them, we do. We encourage active participation. If you're on vacation, do you really want to work?

I do understand the importance of quality design and eye-pleasing decor especially when faced with research like that done by Roger Ulrich where he "compared abdominal surgery patients assigned to rooms identical except for the window view: Half overlooked a grove of trees; the other half faced a brick wall. Patients with the tree view recovered sooner, suffered fewer complications and needed less pain medication than wall-view patients." There should be limits though. Do we need to spend millions and millions of dollars to draw patients to one particular hospital? How about when that money is at the expense of current facilities? One colleague related to me a story of the expansion of the Legacy system in Portland into nearby Vancouver, WA. He related how the project for the Salmon Creek hospital went way over budget and how the system diverted money from where it could to make up the shortfall. It meant no extra shifts, reduced staffing, no sitters unless absolutely needed, no new equipment, reduced availability of working equipment, all to create this Valhalla-esque hospital with Italian tile floors in the main lobby. Sure, they operated within acceptable limits, but bare-bones. While he may have had an axe to grind, it made a point to me.

One thing I do believe a great deal in is private rooms. At one point during my time in Arizona, my wife ended up in a hospital and there shared a room with 3 other women. Yes, 4 post-partum women per room. Not cool. Not even close to peaceful, much less anywhere near private. HIPAA was non-existent on this ward. We heard all about how one roommate had Hepatitis C and gang bangers coming after her. A private room would have solved this problem. Semi-privates do work, but still you have to basically live with someone else while in the hospital. What if the roommate has an overbearing or overly large family? Or is a moaner/groaner/screamer/yeller? Not exactly a peaceful healing environment.

Finally though, it comes down to money. Like so many things in life. If the hospital presents a pleasing face, more people will choose to have care there, which equals more money for the hospital. Elective surgeries are where the money is in our health care environment. If you don't get that business, you don't stay in business. Considering that one drug-eluting stent costs around $4,500 not to mention the cath lab, the post-procedure room, nursing and ancillary staff and of course the doc, you can see how it can add up quickly. And this is a simple stent. What about a total hip or knee? Yep, big money.

Contained in the article, although along a different train of thought, was this gem of a thought:

"A study last year by Randall Pozdena, an economist with consulting firm EcoNorthwest, estimated that the metro area has about 1,500 surplus beds. Considering projects planned or under way, the economist projected that unused capacity will expand to 2,208 beds by 2025. That's assuming the addition of 2.2 million residents and a doubling of residents older than 65."

I'd love to know how they figured this one. When we're full nearly every night, it is hard to fathom. I know that is metro wide and that we're not the only floor at my hospital, but it seems very often we have the last bed in the joint and it gets filled quick. Maybe it's all about location, but I don't know. It's an interesting idea to chew on.

Is there an answer? Not really. What would I love to see? Let me show you:
I see a place where it is nice, but not like a resort hotel, more like a 2-star one. Nice, with the necessary amenities, good TVs, internet, decent food. We have plenty of staff and working modern equipment. The patients are polite and pleasant as are the families. We don't have to fluff pillows or pick things off the floor for capable patients. The nurses have a 3:1 patient to nurse ratio, CNAs that do their jobs, colleagues that don't call off for no reason, plenty of staff parking and a coffee cart open all night.

A guy can dream can't he?