AHS/healthcare system debacles

[R154]

Speaking strictly from an outside consultant/supplier, I have built a pile of equipment for AHS and it is always the very best options/most expensive they can option. They have a budget for upgrades and retrofits, it never stays on budget. Ever.

With that said, I'm sure that no one wants life safety equipment not working properly because a second rate or poorly constructed item is sourced. With that said, my word. The private sector never buys like the city or ahs.

[R-Audi]

One interesting thing I found out regarding drug companies/pharmacists and Doctors... (in clinics)

While drug companies and pharmacists arent allowed to outright pay Doctors for using certain items/brands they have a unique work around. While partnering with a doctor for a new building/clinic, the drug companies via the pharmacy will pay for the doctors build out and in come cases subsidize their rent!!
I was completely shocked when I found this out, but apparently its pretty standard practice to work around the rules..

[TurboMedic]

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Thats my point - we WERENT CTAS 2 by any stretch, perhaps 4 or 5. All vitals were normal at that point. There was no urgency.

However, straight in from the ambulance area into the Dr. exam room.

The need to even go to the hospital was questioned at the time and we went because the paramedics suggested a ride.

Without seeing the actual chart its hard to speculate what the score was. Its not a rigid system where the computer spits out the CTAS once info is entered, its selected and thats based on the guidelines but ultimately is at the nurse discretion. FWIW, rightly or wrongly the policy with EMS was always every call gets transported, the assumption being that 911 was called so people want to go to the hospital. We are obviously not all in agreement on that, but its a physician driven system and they don't get $$ if we aren't bringing everyone in to them. We circumvent that quite often, we don't kidnap people and many many times we are propping up the system by keeping people out of the hospitals for minor complaints. This means that many times you will encounter varying experience levels of practitioners who will have differing comfort levels of leaving patients at home. I have some colleagues who absolutely won't, I have others who try more often than not to avoid transport. The issue with non transport is it exposes us to liability, moreso than people think, remember we all carry that insurance, and some people are just not comfortable with that exposure. Its "easier" to transport, than to not. It will never get you in trouble with your bosses, it will never get you in trouble from a patient care perspective, its just CYA.

[revelations]

So back then to my original point - had I brought my son in through the regular admitting processes at the Emerg, I would have had to line up with the rest and wait hours.

By going in the ambulance, even as non-urgent CTAS 4-5, we definitely skipped the admitting line up.

Therefore, there are cases where you can get in faster with the ambulance, vs an equal CTAS score through regular admitting processes.

Im not saying this was appropriate and that there might have been some 'fast tracking' done somehow (maybe he was tagged CTAS2 when he really wasnt??), but thats what happened.

As someone else mentioned, Childrens Hospital might have something a little different??

[ExtraSlow]

Probably this is what happened:
1) your wife is hot, and you weren't in the ambulance
2) the paramedic was trying to impress her
3) they pulled strings, or exaggerated the situation to get you in faster.

I've heard paramedics get all sorts of laid, so why not use that to your advantage?

[BigDL]

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So back then to my original point - had I brought my son in through the regular admitting processes at the Emerg, I would have had to line up with the rest and wait hours.

By going in the ambulance, even as non-urgent CTAS 4-5, we definitely skipped the admitting line up.

Therefore, there are cases where you can get in faster with the ambulance, vs an equal CTAS score through regular admitting processes.

Im not saying this was appropriate and that there might have been some 'fast tracking' done somehow (maybe he was tagged CTAS2 when he really wasnt??), but thats what happened.

As someone else mentioned, Childrens Hospital might have something a little different??

From my experience taking our baby in to the Childrens, the triage nurse said they wanted my little guy (5 days old) in a room as soon as possible to get him away from all the other sick people because he was so young and they don't really have an immune system yet. At the time he had a very quite very strained cry which was very different from what his normal cries were.

We also went back at 5 weeks with a similar choking incident where he turned blue, went limp and started to get cold. SIL jumped into nurse mode and did black slaps and chest compressions. He was better when EMS came around and accessed him but also suggested to take him down to get looked at. He got seen by a triage nurse way sooner than if he had to wait in line if we walked in as I followed the Ambulance down. There was no volunteers around and there was a decent line at the triage, just based on how long it took me to hook back up with my family while waiting to talk to someone to let me in there was a large difference in time, especially if it was all the way out the door like when you went in.

[TurboMedic]

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So back then to my original point - had I brought my son in through the regular admitting processes at the Emerg, I would have had to line up with the rest and wait hours.

By going in the ambulance, even as non-urgent CTAS 4-5, we definitely skipped the admitting line up.

Therefore, there are cases where you can get in faster with the ambulance, vs an equal CTAS score through regular admitting processes.

Im not saying this was appropriate and that there might have been some 'fast tracking' done somehow (maybe he was tagged CTAS2 when he really wasnt??), but thats what happened.

As someone else mentioned, Childrens Hospital might have something a little different??

Ok so you didn't have to wait at triage behind 4-5 other people waiting to talk to them. That's not hours, and your CTAS does not get inflated because you came in an ambulance, its complaint and judgement based only. That's the point I'm trying to make. So your little guy didn't get triaged to the waiting room, that's fine but that's a factor of illness (combination of what is already waiting and what your kid had) and not a factor of arriving via ambulance, I have placed many patients at the childrens in the waiting room after arrival. That's also the point I'm trying to make. EMS is strained beyond capacity most of the time, I can illustrate that daily, I'm saying wanting to bypass 5 people in a lineup to speak to triage does not make an EMS trip valid, and we get told that all the time by people who have called. And just because that happened to you, just means the crew had a nurse that was available to do that at that time. I've been at the rockyview and foothills countless times where they deliberately take 4-5 people from the waiting room lineup before they talk to me, like I indicated earlier (30 min to even give a triage report). You have to understand I have 20 years of experience doing this every singe day, and while I understand what happened to you is what is in your mind, that is far more anecdotal than what I'm saying is the actual experience and why, backed by hundreds and hundreds of repeats. I know how the system works, I live it as a career.

Tangent time....

I've had people arrive at the hospital on their own, leave because the line is too big, return home and call EMS on the way and an ambulance is waiting when they get back, insist on being transported only to have nothing but a $585 bill and a seat in the waiting room or in the hallway almost an hour after they would have had they just stayed in the lineup.....When asked why they didn't stay, "I'd get in faster if I took and ambulance, I didn't want to wait". Well you were wrong.

Was there a time that EMS was given preference? Absolutely. Hospitals weren't as busy, and the average acuity of the patients was higher, EMS call volumes (and therefore resources) were lower. So it wasn't a burden on the system to move an EMS patient into the department to clear up that crew to be available. That just isn't an option anymore. People are calling EMS for the flu, aches and pains, nosebleeds for 10 minutes, nausea and vomiting, a month of back pain, toenails being clipped too short and causing pain, plain headaches, etc. People have lost the ability to self manage, nobody seems to know what OTC medications are anymore and people don't keep things like Gravol or Robaxacet or Tylenol around, and if they do they just don't think to take it. The system is backed up by people calling EMS and going to hospitals for things they should be utilizing walk in clinics or family doctors for. But people don't want to wait, they don't want requisitions for lab work, they want it done now. People don't want to wait til the next morning to see their doctor, they want to right now. As a result, the hospitals and ED's which should be dealing with legitimate emergent life threatening conditions become places where people get symptom relief, rehydration, constipation relief, pain management for their flu symptoms. Family doctors are equally guilty, they call for patients that arrive in their office just based on a complaint, without even assessing the patient.

I could talk, rant, discuss, clarify or whatever for hours. I can speak of the merits of the system, and the downfalls of it. For sure there are individual experiences and some are right and some are wrong. People have died and will continue to when triaged incorrectly, some people who are experiencing relatively minor problems will at times be prioritized too high. That happens and will always happen, stuff changes, conditions change, and each practitioner (Paramedics and Nurses alike) handle every single patient differently. I don't doubt that what you state happened happened, not in the least. I'm just saying that is not how the system works, and that's not the norm. Unless I see your kid, see the report, see what was presented, see what the circumstances are its all speculation from me, but chances are your child was triaged higher and nothing more, that would have happened either way you went about it

- - - Updated - - -

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Probably this is what happened:
1) your wife is hot, and you weren't in the ambulance
2) the paramedic was trying to impress her
3) they pulled strings, or exaggerated the situation to get you in faster.

I've heard paramedics get all sorts of laid, so why not use that to your advantage?

Its funny, but we do conduct ourselves a bit more professional than that

[ExtraSlow]

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Its funny, but we do conduct ourselves a bit more professional than that

You haven't seen his wife.....

[ExtraSlow]

Although to be clear, I am joking.

[vengie]

There is only one way to settle this. @revelations you can PM me pics of your wife and I will vouch for you one way or the other.

[revelations]

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You haven't seen his wife.....

you had to go there didnt you .... LOL

[ExtraSlow]

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you had go there didnt you .... LOL

I truly did. I guess I'll awe you a NICE bottle of vodka next time.

[revelations]

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From my experience taking our baby in to the Childrens, the triage nurse said they wanted my little guy (5 days old) in a room as soon as possible to get him away from all the other sick people because he was so young and they don't really have an immune system yet. At the time he had a very quite very strained cry which was very different from what his normal cries were.

We also went back at 5 weeks with a similar choking incident where he turned blue, went limp and started to get cold. SIL jumped into nurse mode and did black slaps and chest compressions. He was better when EMS came around and accessed him but also suggested to take him down to get looked at. He got seen by a triage nurse way sooner than if he had to wait in line if we walked in as I followed the Ambulance down. There was no volunteers around and there was a decent line at the triage, just based on how long it took me to hook back up with my family while waiting to talk to someone to let me in there was a large difference in time, especially if it was all the way out the door like when you went in.

Yea this - I wonder if there is something for very young where the CTAS is always considered higher ? Maybe a Childrens Hospital thing?

I have no clue as to how the system works but I know we saved prob an hour with the ambulance.

It was not a 4-5 person lineup, it was a 14-15 person lineup plus a full waiting room.

[Maxt]

Without getting into the deep gory detail of my person health file, I'll just offer a brief summary and comment.
I've had 5 real health issues in occur in my early mid life years that I went to the Gp for, then through referrals to specialists.
The wait time from referral to visit, is so long, the imaging they send you for is often out of date, then they send you for more imaging. I've had some serious injuries that I had to just keep working
through, because I am self employed. When I sought treatment, the wait and lag in the system has been so long, that by the time I get to the specialist, my body has learned to ignore a certain pain, healed itself, or I found a treatment that I could do myself that more or less had taken care of 95% of the injury. Because this happens, most of the worst symptoms are gone when I get there, or the self healing is now preventing the medical treatment from being done.
The worst part, is if a doctor doesn't look at the dates from first complaint to specialist work finale and map it out, it makes me look like a hypochondriac. Whats missing in those nearly 3/4 year spans, is that the patient ate 3 costco sized bottles of ibuprofen and naproxen to go to work, or patient learned to become left handed for 4 months, or patient was filled up to the ying yang with cortisone instead of fixing the knee while it could still be fixed, now its in the beyond screwed for restorative surgery realm and patient is too young to be considered for joint replacement.
I could list 4 or 5 specialists that should be charged back for their inability to diagnose, their total lack of follow up and having staff that couldn't organize a two car funeral. Googling symptoms and trying the search results actually fixed more than the specialists ever did, as dangerous as that sounds, but I found things that worked, mostly physiotherapy type stuff or tips for making certain medications more effective.
I never went down the hardcore homeopathic route, but I can totally understand how people give up on the system and jump down that pseudoscience hole.

[94boosted]

My opinion may be a bit contradictory but I guess I just don't see all these inefficiencies at AHS that everyone keeps talking about. I've had fairly limited interactions with hospital staff and such until recently (we've had a baby in the NICU for the past couple weeks so I've spent a lot of time at FMC and Rocky). And I must say that I think they run a pretty tight ship, in those units at least. There's no surfing of the net from work computers, there's no water-cooler chats, there's nobody glued to their cell phone looking at social media. The nurses, clerks, techs and doctors I've seen are constantly doing something, that from my perspective at least, appears to be work related.

This is almost the exact opposite of what I see in the O&G industry were coffee breaks, surfing the net and browsing ones phone is very commonplace. Same thing for management, in the larger corporations it's not uncommon to have a Worker->Lead->Manager->Senior Manager->Director->VP->Sr./Exec VP->CEO, that's a lot of rungs on the ladder.

I'm not saying AHS is perfect, I'm sure there are some efficiencies at all levels that could be found but maybe it's not as bad as this thread makes it out to be.

Flame suit on I guess. Oh and for reference I work in O&G and have a doctor and a nurse in my immediate family.

[Mitsu3000gt]

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The ER docs don’t get paid for the imaging or labs that they order. Diagnostic imaging done in hospital is contracted to the radiology group(s) interpreting those exams. There is typically a professional fee negotiated for each exam performed and paid to the radiology group.

Same is true in the community. There is a fee code for every imaging exam performed, which is billed by the interpreting radiologist as the service provider.

Or is your comment directed at the ordering of tests to avoid liability?

I asked again yesterday because I was curious, l and I was told there is a literally a sheet that spells out the fee charged when an ER doc does something. For example if they put in stitches, they get paid for that separately. So I don't know what to tell you or why we seem to have different info. Are you an ER doc?

And yes my comments were more towards avoiding liability as well as increasing the chance of an accurate diagnosis - it's not a bad thing IMO. If I was a patient, I would certainly appreciate the docs airing on the side of caution.

[JfuckinC]

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My opinion may be a bit contradictory but I guess I just don't see all these inefficiencies at AHS that everyone keeps talking about. I've had fairly limited interactions with hospital staff and such until recently (we've had a baby in the NICU for the past couple weeks so I've spent a lot of time at FMC and Rocky). And I must say that I think they run a pretty tight ship, in those units at least. There's no surfing of the net from work computers, there's no water-cooler chats, there's nobody glued to their cell phone looking at social media. The nurses, clerks, techs and doctors I've seen are constantly doing something, that from my perspective at least, appears to be work related.

This is almost the exact opposite of what I see in the O&G industry were coffee breaks, surfing the net and browsing ones phone is very commonplace. Same thing for management, in the larger corporations it's not uncommon to have a Worker->Lead->Manager->Senior Manager->Director->VP->Sr./Exec VP->CEO, that's a lot of rungs on the ladder.

I'm not saying AHS is perfect, I'm sure there are some efficiencies at all levels that could be found but maybe it's not as bad as this thread makes it out to be.

Flame suit on I guess. Oh and for reference I work in O&G and have a doctor and a nurse in my immediate family.

I think a lot of nurses are worked hard, and most people know that, they're saying the inefficiencies lie in other areas.. Ie Managment/Construction etc

[ExtraSlow]

More structural issues with how the system operates than inefficiency with the actions of the front line workers.

[Mitsu3000gt]

One of the biggest issues is that 90+% of the people who come to the Emergency room shouldn't be there, but they have to get seen if they show up. Lots of people don't even have a GP because they just come to the ER with everything from a dry mouth to a sore throat.

[dirtsniffer]

On one hand public workers work hard. On the other, that take 12 sick days a year