Monday, 1 February 2010

Pick up thy bed and walk

More than 500,000 hospital patients are sent home from their sick beds each year before they’re ready to leave hospital, according to figures released today.

About 1500 patients are readmitted to A&E department each day having been sent home too soon. Now, to be fair, I’m not putting all the blame on the doctors. If you’re a medic and you have some humourless automaton with a clipboard breathing down your neck every hour of the day, you will make mistakes, panic and mess up. Seeing patients in pain on long waiting lists must contribute to doctors’ understandable wishes to push more people through the healthcare sausage machine.

And before some smart arse asks me how I know this to be true, allow me to recount my own experience. Last year I was fitted to with an external fixator to my left femur in order to help my fracture to heal. After four months the doctors decided to take it off and insisted that it could be done with day surgery. The operation was carried out under general anaesthetic but I had to stay in overnight because the blood loss was too great for me to go home. However, I was packed off the next day even though I didn’t feel too great. Three days later my leg had bent like a banana and the fracture clearly hadn’t even started to heal despite my leg having been x-rayed and manipulated. I was then readmitted as an emergency and spent ten long weeks in traction.

So, I think I can claim that I’m one of last year’s 500,000 who suffered the fate of being pushed out of their hospital bed too soon. Come to think of it, my leg broke in the first place because I was sent home too soon after my attack of osteomyelitis. I really needed a month or two more of complete bed rest and monitoring to be certain my leg was more stable. As a result of that blunder, I have one leg that’s now 4cm shorter than the other.

The figures for emergency readmissions have been rising for the past ten years, and this is the direct collateral damage from reducing waiting lists. Also, during this time, 20,000 beds have been taken out of the healthcare system, about 10% of the total beds available.

For those of us who’ve witnessed the NHS close up, it’s clear that the bed capacity is too low. During my stays in hospital I never saw a bed that was empty for more than an hour or two. Nurses were run ragged cleaning and changing beds as more and more patients turned up on the NHS conveyor belt of care. Surely, there must be a better way than this ‘just in time’ system of medical care.

7 comments:

  1. Chris of Melbourne1 February 2010 at 10:29

    Hi XTM.
    That's a chronic stat.
    Over here the actual figures are very elusive, but I think it's quite a few, 'tho per capita I don't know how it would line up.
    Similar 'hurry up' and get out scenarios abound here also. One of the family had a gall bladder removal, went in on the day and the Hospital were ringing early the next day organising a pickup at lunchtime. I'd been in the afternoon and evening of the operation and the 'patient' didn't look that flash to my eye, a bit of a concern as an older person.
    However, at home we could organise the Royal District Nursing people, and the 'Hospital in the Home' nurses to call, so possibly being in your own bed with the family around aided recovery. Do you have that sort of thing there?
    Conversely, I went into one of my Ports of Call
    for tests that were going to take 3 days max and ended up being incarcerated for 3 weeks instead. But normally they try and eject one asap, even with the musical trolley game in the A & E. to keep from admission to the Hospital proper.
    I don't think it's the same everywhere in OZ, but here in Victoria there is a mandated nurse to patient ratio, 5 nurses per 20 patients.
    Not all Florence Nightingales, some of them the 'Mortar Board' type, too posh to wash types,you called it I think,in one of your much earlier posts and wow do they grizzle if an admission to the ward is in the early hours!
    The wages here at face value don't seem to bad; in the term of the current agreement the basic reaches $48.000 odd for a graduate to $56.000 for a year 4 RN.
    The admissions seem to be regulated to allow for the ratio, so often there are empty beds in the major Hospitals, whilst the clipboards
    are saying we're full. Doesn't help the waiting lists for elective surgery which is ballooning quite nastily. But by ejecting patients too soon it seems to me that they are creating a rod for their own backs which I guess is the same as your NHS.
    Keep well!

    Chris, Melbourne

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  2. I've heard of a nursing ration of one nurse to 16 patients. Anyone care to comment? As far as home nurses go, I'd have more chance of seeing the Loch Ness Monster than having a district nurse visit me in my home. Sounds as if it's more organised in Oz.

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  3. Well, the ratio of qualified and experienced nurses to patients has always been pretty bad at times. I can remember being the only registered nurse on a 30 bed trauma ward with 2 agency nurses who didn't even know the hospital! Try getting patients to and from theatre safely that way! Funnily the ward sister had been on the previous shift with about 5 qualified staff who were permenant on the ward! It is not always a nursing shortage it can often be a bitch of a sister doing the off duty!

    That said, people have been getting sent home quicker from hospital all the time. One doctor wanted to send my son home a few hours after needing IV fluid and meds following a collapse due to a life threatening medical condition!!! ARGH!

    IT is very hard being a nurse. As an A&E nurse we used to get all the flak for patients not getting 'seen' and admitted but most of the time patients who required hospital admission were seen speedily and then we had to wait for our colleagues to find a bed for them! Leaving us with even longer waiting times as we were backlogged with patients waiting for beds!

    The answer has to be to stop closing beds to save money and stop employing idiots to sort out efficiency! What does a business man know about patient care?

    Sorry to rant but I get so fed up of seeing the NHS being undermined by short sighted policies!

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  4. We're all with you, Nurse. I've seen how hard nurses work and it's not a job I could do. I get really angry when our local hospital charges nurses to park their cars when they come to work at a time when there is little or no public transport. Then they pay them a pittance (except to the management nurses) and expect the moon on a stick. Nurses have my total support.

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  5. As an allied health worker who supposedly helps facilitate a safe discharge from the hospital to home it makes it difficult to do so when you only get the referral just before or even after the patient has already the hospital!
    I'm sick of having to argue with doctors and patient flow management about peoples safe discharges.. i.e. no that patient cannot go home as they cannot walk up the 30 stairs to their front door so if there is an emergency they are stuck.... no this patient isn't able to go home as they cannot shower themselves and since they have an open ulcer/wound surely being able to manage their own personal hygiene at home is a priority... no that patient is not cleared for discharge as they currently can't physically get themselves out of bed and they live alone, how do you propose they look after themselves once they are home... the list is endless and it's not just the nurses who are fed up with seeing the same patients return to hospital on failed discharges!

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  6. The fact is that people die for very petty inexpensive reasons whilst money is thrown away elsewhere. This is unacceptable.

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  7. i now work in primary care, thank goodness, can't say much but none of this surprises me, unfortunately quick savings are very short sighted and usually cost money, and more importantly cost patients health and unnecessary pain and distress

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