Monday, January 14, 2008

Back to the Obvious....2/4

They are no longer just looking at the heart hospital but moving the whole shabang to the north campus. They finally realize the logistics and the PR of the community [needs] a new fresh start.
According to the Essent, they're going ahead with the heart hospital...and possibly a new facility at the north campus location. Where is this influx of cash coming from? Probably the investors, who realize that unless they fund this properly, the whole ball of wax might melt. (Besides, no offers to buy.)
My question is will they actually try to get input from the people who will have to work there to make it a user friendly building or will they just go ahead and plow on thru with no clue to what a hospital is really for??
So, what should they consider when building this medical Mecca? Functional proximity, for one thing. Room size, equipment staging and storage areas, and planning for future technology/expansion (what hospital hasn't had to expand?) HIPPA requirements (avoiding the viewing of patient records at nursing stations). Flexible tasking of rooms and floors (being able to ramp up acuity levels as needed with appropriate plumbing [O2, suction, and monitoring] in place.)

Possibly even on-floor waiting areas, which while adding to the cost, are less costly per square foot than patient areas, and can be designed with an eye towards that inevitable expansion (if they are in it for the long term.)

Let's do it right, this time. Just please: Not another naming contest!


Anonymous said...

So are they going to move pedi's icu, gero-psych, skilled nursing facility, rehab, and debri to the south campus? Just curious?

HIPPA said...

Heard that some doctors,(3) of them are leaving PRMC? Any truth to this.

Anonymous said...

I am afraid that you dont understand what was really said at the town hall meeting.Basically it was stated that Essent is going to install a new cath lab at the SOUTH CAMPUS, a 64 slice CT will also be added to the SOUTH CAMPUS.The only moving that is going to occur is that Essent is hiring a company to STUDY the methodology and logistics of moving to the NORTH CAMPUS.They just dont get it! The little bounce that occurred in the community after the initial announcement was predicated on the belief that , finally the hospial would be located in its entirety at the north campus. Putting a CT and new cath lab at the south campus will do nothing to stem the hemmorrhage of insured patients (and primary care M.D.'s)leavig Paris.By the time Essent finishes studying the move there will be no reason to move.
Someone on the medical staff said it best "If you polish a turd , it's still a turd".

fac_p said...

Two, possibly three...

I was kind of wondering as well. Did seem a bit different than my take. But, I was willing to be suprised.

A new CT, and Cath lab at South doesn't really indicate that they're committing to moving. As a matter of fact, more the opposite.

They've got the rock-and-the-hard-place problem: As time goes on, they have more immediate update needs. At what point do you go past the "We've invested so much that we can't move?" I think they've already hit that point and the study is just window dressing....frank

X-Ray boy said...

If the CT at North is the slowest, and you are going to build a 'heart hospital' there, wouldn't the scanner that you were replacing be that one? If they move the scanner from the South to the North, my bullsh_t meter will peg.

Anonymous said...

Why the 64 slice ct? Does this have anything to do with the deep bronc issue they recently blew? Just curious.

fac_p said...

It was explained to me this way: The 64-slice CT is good for cardiac studies because it's fast enough to stop the heart wall motion, reducing the reliance on cardiac cath. 16-slice and higher are fine for bronch.

The North has a single slice and the South has a 4-slice, from what I gather.

The higher the slice count, the faster the study. So, an accident victim would be in the CT for one sixteenth the time?

Makes sense to me...and to any trauma patient. It would seem that they need the 64-slice CTs at both campuses.

Woot said...

No no-the 64 slice scanner is going to NORTH campus in anticipation of the Heart Hospital. I've read the specs and it will produce some awesome detail for heart patients--practically won't need heart caths any more!

My suggestion for making the New Building That May Be Coming: design the ER/Xray areas with MAJOR inpute from the people who work there!!! Make it functional first THEN make it pretty to look at.

Anonymous said...

Duh.... get a 64 slice to keep up with the competition!!! Doesn't take a rocket scientist to figure that one out. Besides, that's why they have Nuc Med as a modality b4 sending a pt for an unnecessary Cath..

Anonymous said...

The 64 is nice, for those patients that you can get the heart rate down on. the 128s are making their appearance and that would do almost any patient.

Now the problem is the over-use of CT, and the dangers of radiation exposure. The patients that are routinely given a scan for 'headaches' on a weekly/monthly basis are probably the most likely to sue for long-term damage from over-exposure to radiation.

Had an article from the NEJM (I think or JAMA)sent to me that echoed the concerns for pediatric patients....frank

Anonymous said...

Great, now you will have a choice:
1. Allow the cardiologists to burn up your kidneys with IV contrast, or
2. Fry them with radiation from the CT.

Anonymous said...

The 64-slice scanners make nice cardiac pictures...if your cardiac rate is below 60. This either takes a healthy patient (who doesn't need a cath), or beta-blockers. Most of the people who need a cath are already on beta-blockers, and past a point you're 100% beta-blockaded and the extra metoprolol or whatever else you're using isn't having an effect. I've seen a patient with a HR of 70 laugh off a 10mg IV bolus of Lopressor, with no change in HR or BP. Had a cardiologist try to get the heart rate down -- nothing. As expected, his scan was loaded with artifact and the predicted lesions were nothing more than motion.

Don't believe the hype about the 64 eliminating the need for caths. Maybe a 256 or 320 (both debuted at RSNA) can do that for HR>60, but I'd like to see the data on that.

For trauma, the 64 is good but a 16 is just fine. For either scanner, it takes far longer to position the patient and protocol the study than to scan them. The rate-limiting step is the ability of the heart to push contrast, and the 64s have to slow down so they don't outrun the bolus.

In the middle of the night, I'm curious as to who a patient expects to be reading their "Triple Rule-Out" 64-slice CT (PE, CAD, dissection). I have a couple of years' experience and with a dedicated workstation it takes me at least 20-30 minutes to reconstruct even a normal CT coronary angio, review the cardiac-echo type motion reconstruction and evaluate everything outside the heart as well. If you're thinking a locums doctor or a telerad doc is going to be doing that, you're in for a disappointment. And if you're planning to wait to send 1500 slices to an outside reader, go get a cup of coffee and a magazine to go with your disappointment.

McCuistion was always laid out better than St. Joe's. The ER, OR, cath lab and ICU were all on the same floor, no elevators to deal with. Christus had an edifice complex about the South Campus, and Essent followed them down the same landlocked path. They've only wasted six years between them now, maybe Essent's advisors, with fresh eyes, will tip to the acres of unused space at the North Campus.

When I was there, the town was about a third McC, a third St. Joe, and a third agnostic. I'm pretty sure the third McC people were the first to head over the horizon for care, followed by a sizable percentage of the agnostics. Getting them back will be a trick.

The good/sad news is that the North Campus facility can probably house all the inpatients that want/have to get care in Paris. The rest are already getting care elsewhere.

Anonymous said...

I saw TJ in the hospital the other day and was curious. Has Essent/PRMC finally come to their senses and let him back in?

Anonymous said...

Just for a FYI, Medicare is pulling reimbursement for cardiac CT.

Anonymous said...

hey 7:35
You get their heart rate down with labetelol. It's a beta blocker and it works. Must be a new drug that you have never heard of. LOL. For your other concern if you are having "EMERGENCY" headaches that cause you to go to the ER on a "weekly/monthly" basis then you should actually follow up with a neurologist; as directed by the er physician and staff in your discharge instructions; to find out why you are having "weekly/monthly"; "EMERGENCY" headaches and stop coming to the ER where we have to CT scan you to make sure that you are not having a bleed. If you can't do that then you must be worried more about getting your lortab than you are about fixing your headache problem. Basically we scan you to make sure you aren't having a bleed AGAIN or we can just assume you arent and get sued if you are. Damned if we do damned if we dont. Yeah thats just about right.

Anonymous said...

1:21 PM
If you had a clue about what you were talking about you would be dangerous. What exactly are you saying? You don't want to CT or cath anybody? Sounds good to me let's let em all die and not try to help. You are truely a f'ing moron.

Anonymous said...

and to 4:09 PM
AMEN BROTHER/SISTER whichever it may be. The only comment with any realism that I have responded to
(see the two before this they are mine too). Good to know at least someone has a brain and can actually reason things out for themselves. Thank you for the good post.

Anonymous said...

The answer that the 'frequent fliers' (those that hit the ER time after time) give to the question about regular physician is telling: The ER physician.

They are the non-compliant patients, the ones that never follow-up with a physician, and are most likely to sue.

They are also those that are the most likely to be self-pay/no-pay.

You'll see them listed as weekly, or monthly returnees, with the same orders, the same complaint.

Follow-up with neuro? Give me a break.

Anonymous said...


I've actually heard of labetolol, it was my first choice for a beta-blocker for this application. The feedback I got from people who aren't anonymous posters on a moderately obscure website, but who are board-certified anesthesiologists and cardiologists is that it's not the magic bullet you seem to think it is.

The short answer is that nobody has a good handle on rate control, at least not for 100% of patients. You're welcome to try labetolol at high enough doses to break someone who's already on Coreg chronically, but if their BP bottoms out and they have a cardiac event or CVA on your scanner, you will have a no doubt pleasant deposition experience in which you explain how you turned an asymptomatic patient into a symptomatic one, with a deficit. And kindly remember, I was talking about people ALREADY ON A BETA BLOCKER.

The short answer is to wait for a higher-slice scanner that can better capture cardiac images almost regardless of rate. Cardiac CT does NOT replace catheterization for most patients, and definitely not for those with a rate >60 bpm. Period. Anyone who tells you different is a GE/Toshiba/Siemens/Philips vendor.

Anonymous said...

Labetalol is not the best choice for cardiac rate control. It is a combination drug and has an alpha-blocker as well as a beta-blocker which will likely result in more hypotension than a beta-blocker alone. A better choice would be an infusion of a very short acting beta-blocker like Esmolol.

fac_p said...

I heard (second or third hand) that he was to work for St Jude's and that he had a meeting with Dux. "We'll get back to you"...which was a call to St Jude's saying he was denied access to the hospital.

Lying to his face, as it were, seemingly is the public persona presented by this administration. They had no intention of letting him in. Probably didn't even warrant a phone call to Nashville, nor to him, in their eyes.

Anonymous said...

Who is TJ?

Anonymous said...

"If you polish a turd , it's still a turd".
Bet I can guess which doc said my day!!