Flattery?--5/1

I've had several blogs send for links to them and my policy is this: I'll put in a link, but if it is not reciprocated within a reasonable period, it gets scratched off.

The last two have been Citizens for Paris, and Paris Needs A Super Hero. Powerline 195 was promoted via email by a reader of both. (Heck, maybe Powerline won't be around all that long--if they win.) It has a single issue: Keeping the transmission lines out of Paris. The other two are more generalized.

I would imagine that this is about the only thing that E$$ent and I agree on: If it's bad for Paris, it's bad for both of us. The only thing that the Paris City Council has agreed on in my memory is the unanimous approval of the resolution against the transmission lines. Too bad they couldn't do the same with E$$ent! Wonder if Andrew will move if they put a 150 ft electric power transmission tower in his backyard?

Maybe if we all teamed up, we could get rid of Essent, the City Council deadlocks, and the powerlines. For the person with the "tunes that drive her crazy": "What a wonderfull world it could be...."

Oh yeah, the flattery question: How many blogs have started up in Paris since I started the-paris-site?

Note:
The caption might be: "The E$$ent Administrative Organizational Chart"!

Monster Mash--4/29

The annual Gala--A chance to be "seen" in one's finery with Hud and his bud.... Just what I want to do. On the surface, it looks great...charitable donation, mixing with the 'society' of Paris...who either don't have a clue, or don't care...because they're going to Baylor.

"But", you say, "it's going to a good cause...." Yep, one of them is: Nursing scholarships.

Paris healthcare? Maybe, but isn't that their code words for PRMC? Remember, they don't do anything for free. Make it a donation to the Agape Clinic, and maybe I would be less cynical...nah!

Grants are available for diabetes research, but, they are done on two criterias: who you know, or what you produce.

The Annual Golf tournament sort of fizzled: Who wants to buddy up to the E$$ent boys? Apparently not enough for a foursome. No, I can't say that, the board would make a foursome, and they're in bed with E$$ent, so I guess it would just be a case of rolling over one more time.

Speaking of the board, Gene is the one that's pushing the Gala. After all the history, it would seem like he's still right at the forefront.

If you really want to help a student nurse, there are probably scholarships that could use funding. If not, start one. Call it the "Paris for Excellence in Healthcare". Slap conditions on it that they'll have to pull a 3.0 minimum, and that they can prove financial need...I'll contribute. Heck, I'd put a link for a PayPal contribution.


Just say NO! to Hud and his bud.

Code Blue??? or is it?--4/24

This is a long post, but important. Bear with it and realize this is a game stopper. This was another email that I bounced off a couple folks and then decided to publish in its entirety.

PRMC has to install new portable telemetry monitors. When the employees ask, no one seems to know what kind of heart monitors the hospital has bought, nor when they are going to be installed, or where they're going to install them. Rumors abound, of course, but no one seems to actually know. Of course, biomed and the former assistant CNO and director of goodness knows how many departments went somewhere to learn about the monitors, but, of course, one of those two people has now left PRMC.

The general plan seems to be to install these monitors that only one person in biomed knows how to work on (which is also something that currently happens, even with a system that's been installed for quite some time), remove the telemetry technician from ICU, and consolidate all telemetry monitoring in one place with two telemetry techs. Currently, ICU has a telemetry tech to watch only the ICU patients, and the other telemetry tech monitors all other telemetry monitors throughout the hospital (excluding the emergency room), as well as the cameras for the stepdown beds.

IF all of the portable monitors were all present, this would have the hospital telemetry technician watching approximately 55 heart rhythms, 13 cameras, and the 13 stepdown monitor's blood pressure and oxygen saturation readings. (But about 20 portable units have gone missing.) This is, of course, too much, so it would SEEM to make sense to combine the ICU telemetry and all other hospital telemetry and split the number of monitors between two technicians. The problems that this consolidation would create are actually numerous, and affect patient care.

At this point in time, the hospital has already acknowledge that there is a large communication problem that affects the efficacy of the hospital telemetry tech. The hospital telemetry tech sits in a small room (affectionately termed "the hole") and has the un-enviable task of sitting in a chair for 12 hours, begging the 3rd floor or ICU nurses for breaks, and having no way of effectively communicating with any other floor than 3A. Of course, currently, the only other floor that is allowed telemetry monitoring is 7A, as telemetry overflow. This is exists for a couple of reasons. 6th floor doesn't monitor telemetry because there's been something wrong with the telemetry system for that floor every since it was installed on the re-model. 4th floor doesn't monitor telemetry for a reason that the telemetry techs were never told of, but it may have something to do with a delayed Code Blue on a patient due to poor communication between telemetry and the other hospital floors.


The OTHER reason that telemetry monitoring has been reduced to only 3A and 7A is because there is a serious lack of nurses who actually know how to read a heart rhythm. Apparently, this is not a requirement of nurses who have to take telemetry patients. It is not an uncommon occurence for 7A to have no one who knows how to read telemetry, and only one or two nurses on 3A (the cardiac floor) who know how to read it. Add to all of this, the fact that the currently telemetry tech staff (both hospital and ICU) have very little training beyond the heart rhythms themselves. The telemetry techs are all perfectly capable of reading the heart rhythms, and identifying problems, but they have very little idea of what to tell a nurse is the biological reason behind a reported change.

So, the telemetry tech doesn't know, the nurse doesn't know, so somebody needs to pray that there's an experienced cardiac nurse to ask readily available. If the nurse doesn't understand that there is an importance behind the telemetry changes reported to them, then they are unlikely to follow an appropriate course of action. And, quite frankly, there are few of the staff nurses left who are going to take the time to search out someone who would know what to do.

Also, the proposed change would lead to problems for ICU and the patients there. The ICU telemetry tech would no longer be "on-site" with the patients. The ICU tech monitors rhythm, blood pressure, and oxygen saturation on all the ICU patients, but there are also other invasive lines/readings to monitor, such as arterial lines and Swan-Ganz readings. The hospital telemetry tech has never monitored these, except for a few arterial lines that are quickly discontinued on stepdown, and has no training on what they do and/or should read. Also, except for a few stable or non-titrated (which mean the medicine is not supposed to be increased or decreased), the hospital telemetry technician has very little experience with the common IV drips used in ICU. Dopamine affects blood pressure and heart rate, Cordarone affects rhythm, Cardizen affects rhythm, Natrecor is for CHF but can have a bad blood pressure side effect, and Nipride affects blood pressure. These are the most commond drips used, and if the person monitoring the patient doesn't know what they are, what to watch for, and what they do, the patient isn't being monitored properly.

If the ICU telemetry tech is removed from the ICU setting, then they will more than likely be unaware of what drips the patient is on, or how they are being titrated, so they will not know what to look for. The ICU nurses monitor their patients very closely, but they do have at least 2 patients usually. As happened when the telemetry was combined before, no one calls the techs to tell them about admits, drips, or patient changes. And how is the tech going to contact them in an emergency? Usually the nurses are on top of the situation, and gathered in the patient's room. So, that leaves the tech on the phone, no one answering it, and the tech having no clue if the nurses are in the room.

It's not a good move for the patients, it's been tried before, and failed before. If the problem is that the hospital telemetry technician is watching too many monitors, then, why not, when installing the new system, portion some into the ICU where they can be watched by that technician. Something like, ICU would watch ICU and 7th floor, and the hospital tech would watch 7A. Maybe not very cost effective, maybe not even feasable, but better for patient care than effectively ham-stringing the techs.

Casa Rio Rojo? 7/29--New Pic

Guess it's official, Red River Valley Radiology is moving...to the Loop! Despite being one of the most consistent customers of the hospital, the hospital (Essent, PRMC, or the powers that be...) have determined that they need the space...in a building that has noticeable vacancies.

Shame that the convenience of their location to the various medical offices (notably the old Sears and Brookshires buildings) was lost, but if you notice, most of the newer medical offices are moving to the Loop/195 area. In the long run, this will probably benefit the group, but time will tell.

It is amazing that the push to depose the family/locally owned business coincides with the arrival of a new PACs system, which will allow the hospital to farm out the readings to radiologists...in say India, Ireland, or wherever. It's also a shame that the convenience of comparing films brought from outside sources will be lost, or the ability for the physician to review those outside films with a local radiologist (which was a non-charged service.)

Renovation of the former Casa Ole is on-going, and by the looks of things, should meet the May 15th deadline. All they have to do is pick a name for the building...and keep up the service that garnered their move.

Okay, I had to change the date, since the move date changed. Besides, this one is going to go gold by June, I have a feeling....and you know, that lot next-door would make a heck of an outpatient facility.

Looks like they're going to make the deadline!

Boutique Hospitals--the Hows...Tax Day

Article excerpted from USA Weekend:

People often assume this 12-bed nest is only for the rich, says Jack Sternlieb, M.D., the boyish founder and director of The Heart Hospital. In truth 80% of his patients are on Medicare. "Full service hospitals are big white elephants," he says, "bogged down in administrative costs."

Specialty Hospitals:

Proponents of physician ownership of niche, or specialty hospitals, argue that it is a model that encourages innovation, which can lead to reduced costs and increased quality of care. Opponents argue that specialty hospitals take away profitable business from community hospitals necessary to service low-income patients, leaving general hospitals the poorest and sickest patients.

Legislation:

On June 8, 2005, with the expiration of the federal moratorium, a number of specialty hospital bills were filed to be considered by the Texas Legislature. SB 872 directs the Texas Department of State Health Services (DSHS) to study the impact of niche hospitals on the State’s health care delivery system. The law prohibits providers from recommending patients to a niche hospital (generally defined as surgical, cardiac, orthopedic, or women’s hospitals) when the provider (or immediate family) has a financial interest in that hospital. An exception applies if the physician discloses that interest to the patient in writing and informs the patient that alternative choices are available. The physician is also required to notify DSHS of any ownership in niche hospitals. The bill directs DSHS to conduct a study regarding the impact of niche hospitals on the financial viability of other general hospitals in the state. In addition, the bill establishes an Advisory Panel on Health Care Associated Infections to collect and report data on infection rates and process measures, effective September 1, 2005. HB 3357 requires an application for a hospital license to include the name and social security number of any individual (including physicians) who has an ownership interest of more than 25 percent in the hospital, or is a General Partner. The bill also directs DSHS to post the names of all the individuals named in the applications to its website.

The moratorium extension into 2007 for specialty hospitals slows the progress, but an outpatient surgical center that grows...has possibilities....

Whatever is going to happen better be planned now. I would estimate that a window of opportunity will exist briefly, and that those that submit immediately after the expiration of the extension will have the best chance of approval. I can forsee as well, additional stipulations and restrictions being added in the ensuing months.

Who can put it together?

I feel that it should be a consortium of local physicians, possibly with additional capital backing. Christus did it once, however badly it turned out:

If you will remember, Christus built the Outpatient Surgical Center as a for-profit enterprise, soliciting investment from the physicians, in an effort to garner revenues from the outpatient side of healthcare. The enterprise failed, more from billing problems and management than a lack of need. The buyout, by the non-profit side, was pennies on the dollar to the physicians, and Christus ended up with a surgical center at a discounted price, with no interest. Whoever said that incompetence didn't have its rewards....

I think we can do better! Possibly with the support, if not the help of the Texas Medical Association and the AMA. A TMA article sets the 2006 goals, including:

"Strongly oppose efforts to limit investment opportunities for physicians such as limiting ownership of facilities, equipment, and services to certain types of providers."

I guess it depends on your definition of strongly....Even Baylor has gotten into the act: "Even though Baylor and THR officials want the ability to partner with physicians and construct joint ventures, not all hospital representatives share that opinion."

Boutique Hospitals--the Whys...Easter

The "boutique" hospitals provide several benefits as indicated by the article that this was excerpted from:

Major motivators
Physicians seeking to build such a facility typically have two major motivators—control and economics, comments Ted Schwab, president of Sokolov, Schwtiqueab, Bennett, Los Angeles,a consulting firm that specializes in joint ventures and other arrangements with physicians.

Physicians want control over their work lives—where and how they perform their procedures and the staff and equipment they have available.

“If you talk to physicians who work in hospitals, one of their perceptions is that they are unlistened to,” he comments.

Boutique hospitals are profitable because they concentrate on “hearts, brains, and bones,” the most lucrative specialties....

Why should that matter here? Because not only is the mix poor, but the hospital treats physicians the same as the regular staff....ignoring or worse....

In some cases, boutiques provide resources that wouldn't be available in other circumstances. Lap-bands, plastic surgery, as well as the afore mentioned specialties. But, the patients are creating the market.

“The public wants and is demanding a friendlier, healthier, more comfortable environment.
We are basically bringing the concept of personalized care from the outpatient surgery center into the surgical specialty arena.”

And, with the current staffing problems, personal care is something that Paris has a lack of.... Next, the "Hows."
NOTE: More pulled from comments. They even included some of the references!

Joint Council on Accreditation of Healthcare Organizations (JCAHO)--4/28

Someone came up with an idea for a JCAHO post: where you can comment on any violations. Actually, it would help keep the hospital honest, and it would help the patients, and isn't that the whole idea of healthcare?

Rather than just cleaning up messes, and pencil-whipping the forms at the last minute, wouldn't it be novel to be doing it right all the time?

Keep your letters and postcards coming, folks!

The Board--4/22

I don't know exactly where to post this - but it must be said:
We are giving E$$ent all the credit for the straight running crap that has and is taking place since "Hud" came to Lamar county.

One wonders - what about Hud's "Board of Directors?" Are these not local "folks" with a sincere interest in our community?

I am led to believe one of two things: they are either blind - or integrity is a word with which they are unfamiliar. Does any one else have any thoughts on this?

That was from an email, but I had thoughts when they recommended Essent over HCA, and the recommendation apparently was on the basis of two things:

1. HCA wanted to disband the board.
2. The board membership is now 'compensated.'

I really feel better knowing that a retired football coach is on the board that determines my healthcare alternatives. Are the others equally as qualified? One only wonders....

Corporations have been jumping on the board of directors bandwagon for years--that's how the executives get the exorbitant salaries, and how board members get paid...despite not attending meetings.

Where is the outrage? Isn't there plenty when Congress votes itself a pay raise?

Hospital boards should be representing the community. When was the last time you saw a solicitation from a board member for input from the community? Probably the last time you saw a suggestion box in the hospital....