Current Events > I literally can't transfer critical patients to ICUs

(+) Yeah! (+)

thronedfire2 posted...

you don't get more staff and then fill more beds. you fill beds and then bring more staff in to care for the extra patients

the problem is there's literally no room in the hospitals to put more beds

Yeah, this is the 1st time in my lifetime where I've seen hospitals have to build overflow tents.

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"The pandemic has killed less than 1% of the world population!"

Ok, it and almost every pandemic in history. We try to stop a lot of preventable bad things that kill a small minority of the overall population. Machinery accidents don't kill hundreds of millions a year, but we still force companies to observe safety standards.

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CableZL posted...

Yeah, this is the 1st time in my lifetime where I've seen hospitals have to build overflow tents.

That's mismanagement! Every hospital should have 2000 beds in case bubonic plague makes a comeback! It's basic preparedness.

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Time to manage DKAs on the floor now. Feels great man

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RenescoStCewl posted...

At this point anti vaxxers shouldn't be getting hospital beds even if they are available.

This. It's time to stop squandering resources on these people.

OrangeWizard posted...

Are we talking about physical space, and physical ICU beds?
Or are we talking about having staff available to care for patients?

Both. When we say there is a shortage of ICU beds we dont mean that we literally need beds. We mean a shortage of resources like space, ventilators, staff, etc... and any combination of those things.

Because my argument has been, better hospital management = more staff = more beds.
As was said, there already was a nursing shortage prior to the pandemic.

This is insane.

Better middle management isn't the solution to a pandemic. It was always understood that hospitals can reach capacity in this pandemic.

The plan was to mitigate as best we can and hang on until vaccines were available.

We did that. Hopsital staff did their jobs and bought us enough time. They succeeded in exactly what they were supposed to do.

The problem now is that redcaps have decided to make the covid pandemic permanent and its simply not sustainable to do this indefinitely.

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Shadow Don posted...

Better middle management isn't the solution to a pandemic.

Have you considered that instead of flattening the curve we could simply raise the threshold at which the hospital systems fail? That instead of running out of hospital beds and rooms and ventilators, we simply manage them better? Have you not considered this? Im very smart.

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Our beds are all full

Weve been told that if people dial for an ambulance and it's not life threatening, that we cant take them to the hospital because beds are full

Me and my partners get cursed out so many times because of this, shit is insane

I'm am emt basic for reference

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coolpal23 posted...

Our beds are all full

Weve been told that if people dial for an ambulance and it's not life threatening, that we cant take them to the hospital because beds are full

Me and my partners get cursed out so many times because of this, shit is insane

I'm am emt basic for reference

The transfer centers for us aren't telling us what their criteria are, but as best as I can tell they are rationing care based on patient comorbidities and likelihood of success. Which is pretty terrifying.

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Tyranthraxus posted...

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metallica846 posted...

This type of shit never stops being hilarious. These amazing tough guy warrior-monks that they fancy themselves as are so mentally incompetent that they can be accidentally manipulated into killing themselves en masse via their own playground-esque team politics.

Don't forget though, they're the last firewall to socialism. Without them, we're FUCKED

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In my large city, all of last years pandemic phased covid plans (of shutdowns, business closures and opening percentage, masking requirements, etc) took percentage of ICU beds available into account. If hospitals looked like they may start to get overrun, you go back a phase. If trends went up for more than 10 days or whathaveyou, we went back a phase. It has ALWAYS been understood that the biggest goal is to not let hospitals get overrun, because then people even other than covid patients suffer preventable deaths. Thats why government/state interference was necessary, because we couldnt all just be trusted to be good little boys and girls that did the necessary things to starve the virus before it got such a huge foothold.
The shining beacon in the night was the vaccine. Hospital employees were put on mandatory overtime for OVER A YEAR, often without hazard pay, without being able to take PTO, with fear of catching the virus themselves, seeing death that didnt have to happen if people would have been diligent sure they may have had problems with their working conditions beforehand as everyone does, but that doesnt mean youre going to quit. The other factors do. It is an unsustainable quality of life for healthcare professionals, that couldnt get proper supplies for all this either. There is no just making beds appear. There is no just conjuring more staff out of thin air- these positions require years of schooling. If professionals are driven to leave specific hospitals due to pay or other job dissatisfaction, that'd be one thing, pointing to bad management. But ALL hospitals are short. I dont think Ive even seen anybody touch on the numbers of deaths (yes suicides but also from covid), or how many staff members are out from either covid or quarantined due to it. That also contributes to the shortage. There are simply not enough beds, supplies, people to help cover shifts and avoid burnout, time to rest, etc. They do the best they can. My hospital had supplies and drugs stockpiled that in any other circumstance, would take a few years to burn through, but tell me why we went without actual disposable lab coats, chemical resistant gloves, appropriate masks, etc. It was simply impossible to foresee how BADLY our nation would respond to a crisis and not take drastic measures necessary to keep it from getting so far.
why is there talk of hospital management failing when it was government at local and state levels that failed. Why did my city turn its back on its promise to revert to lockdowns if the hospital systems got too overwhelmed? To appease the people that didnt want to take all this seriously. And those are the people that caused this to drag on and on. That caused the small bad things in a job (like everybody has) to grow and grow to insufferable conditions where people literally have to move around and search for any type of benefit- whether it be financially or mental relief in diff positions or any kind of respite to keep them from leaving a career they put thousand of dollars and hours into. Because individuals couldnt look past themselves and see a bigger picture. Sorry not sorry, its the people who didnt care about other people enough to put their own happiness (not needs, but wants) on pause temporarily that are causing just about all of this.

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I dont just understand why the hospitals arent refusing COVID patients once they reach like 50% capacity. The vaccine is out there. Its free. Its not hard to get.

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I'm quitting my icu job this week for a dope part time procedural job. Kinda wish I would have picked up a big money travel contract instead but this position is pretty perfect and they don't come around often so I'm going to give it a shot and if there's another wave of covid morons next year and stupid money is still being given out for travel nursing I might have to snag one even though I don't really want to do it. Got a buddy who cleared $350k last year so.... O__O

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Lmao people harassing mods for "not doing anything" yet all I see tons of moderated messages.

You guys need to chill

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...yes... I didn't need to delete a post... /s
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whitelytning posted...

What would you recommend is done to solve the problem TC?

Vaccine mandates, or you don't get to use public services. Schools, businesses, and yes, healthcare. Unless you're immuno-compromised there isn't an excuse and a vaccine mandate would save lives. People still don't have to get it, but don't get to do everything anymore and don't get to clog up ICUs.

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metallica846 posted...

Big brain time.

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This is making me so glad I didn't do primary or critical care, but then again it's also a disaster with pregnant patients. I'm enjoying some time off after residency so I haven't been in a hospital for a few months now, but my friends are telling me how bad COVID-19 cases in their pregnant patients are now.

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matteus70 posted...

This is what people think a pandemic is when they hear about it.

If they don't see that they think everything is hunky-dory when it actually isn't.

This image is, presumably, what the hospital staff sees, right?

They're seeing people dying from covid, and lines out the door. They know who's unvaccinated and who isn't, and what the difference is. It can be said that they see the reality of the situation more than any of us.

So why are some staff still hesitant? They should be first in line, right?
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OrangeWizard posted...

This image is, presumably, what the hospital staff sees, right?

They're seeing people dying from covid, and lines out the door. They know who's unvaccinated and who isn't, and what the difference is. It can be said that they see the reality of the situation more than any of us.

So why are some staff still hesitant? They should be first in line, right?

Wait I thought you were arguing that most of the blame was on hospital management for not creating extra beds and nurses prepandemic?

Ruvan22 posted...

Wait I thought you were arguing that most of the blame was on hospital management for not creating extra beds and nurses prepandemic?

Yes. I don't what this has to do with the question of "why aren't hospital staff getting the vaccine"?
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OrangeWizard posted...

So why are some staff still hesitant? They should be first in line, right?

Not all staff see it. Some departments have been decreased to skeleton crews, and some specialties flat-out don't treat COVID patients. Most surgery centers and surgical wings of the hospital have stopped elective (non-life saving) surgeries because ICUs need the ventilators/intubating personnel.

This is why the occasional surgeon/surgery team will have some comment about COVID not being that bad. Yeah of course the plastic surgeon who will never treat COVID and had all of his money-generating cases cancelled thinks we need to get back to normal.

Most hospitals have created COVID wings in order to minimize spread, so only a section of the hospital is relegated to COVID patients. Some floor nurses don't deal at all with COVID patients, and the nursing field does not have the same academic barrier to entry or intellectual rigor as that of physicians. Unfortunately, most nurses are (even sometimes encouraged through training) intuition-based and there is a very concrete "out of sight, out of mind" approach to their care. So if they're on a med-surg floor and they don't have to rotate to the COVID wing, they don't see COVID and are convinced it's overblown or a lie.

And don't get me started about administration. They just want everything and everyone back to normal to generate money for them. Fuck them.

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MrPeppers posted...

Not all staff see it. Some departments have been decreased to skeleton crews, and some specialties flat-out don't treat COVID patients. Most surgery centers and surgical wings of the hospital have stopped elective (non-life saving) surgeries because ICUs need the ventilators/intubating personnel.

This is why the occasional surgeon/surgery team will have some comment about COVID not being that bad. Yeah of course the plastic surgeon who will never treat COVID and had all of his money-generating cases cancelled thinks we need to get back to normal.

Most hospitals have created COVID wings in order to minimize spread, so only a section of the hospital is relegated to COVID patients. Some floor nurses don't deal at all with COVID patients, and the nursing field does not have the same academic barrier to entry or intellectual rigor as that of physicians. Unfortunately, most nurses are (even sometimes encouraged through training) intuition-based and there is a very concrete "out of sight, out of mind" approach to their care. So if they're on a med-surg floor and they don't have to rotate to the COVID wing, they don't see COVID and are convinced it's overblown or a lie.

And don't get me started about administration. They just want everything and everyone back to normal to generate money for them. Fuck them.

Thank you.

I would have thought that people would have to, I don't know, wade through bodies in order to get to their wing of the hospital, so that they would at least have to see it, but I guess not.

I got lost inside a hospital once, and had to walk past a crying family several times.
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I'm sure it's like that at some hospitals. Where I trained, the emergency department was (and probably still is) a warzone and a nightmare with people on stretchers in the hallways. The women's center (labor and delivery unit) had to convert a recently constructed labor division into the "pregnant COVID" unit where anyone sick but not sick enough for a ventilator is placed. But the inpatient floors of the main hospital were still one patient one room.

The entire pandemic is interesting for many reasons. One talking point is the difficulty the healthcare system encountered with the initial virus and then a separate difficulty with the delta variant. When it first came stateside, the issues was equipment: not enough vents, ICU rooms, tubing, PPE. Now, the issue is staffing since nurses are leaving due to horrible compensation and working conditions. We definitely experienced that firsthand: 24 labor rooms but now we were only running about 10-12 at a time because too many nurses left due to crappy wages, hours, harassment, or for fear of contracting the virus. I imagine that (with the exception of ICU beds which probably are full nation-wide), most hospitals have all of these empty rooms because they simply cannot retain enough nurses to safely care for patients.

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OrangeWizard posted...

So why are some staff still hesitant? They should be first in line, right?

Doctors are almost universally vaccinated, I think by the end of June they were at something like a 96% vaccination rate.

Nurses, aids, etc. on the other hand, are often poorly educated by their programs (which often teach to the test instead of providing actual, thorough medical understanding). Nursing is also one of the few jobs deemed acceptable for women by right-wing evangelical Christian groups, which results in them being over-represented as a demographic within the nursing profession.

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DarkRoast posted...

The transfer centers for us aren't telling us what their criteria are, but as best as I can tell they are rationing care based on patient comorbidities and likelihood of success. Which is pretty terrifying.

being unvaccinated should be treated as a comorbidity

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We have individual units that are specifically for COVID patients. Our cancer nurses are having their first experiences with COVID as we tried to keep COVID patients out of the cancer building due to their immunocompromised systems during the first couple of waves. It was still difficult as a majority of our critical care units are located in the cancer hospital. Now we have a few cancer units dedicated to COVID. So many precautions need to be made to ensure that we aren't spreading the virus to the other patients.

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Once in a while I am reminded that the current state of things is basically optional. That's what's really sad about this.

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OrangeWizard posted...

Yes. I don't what this has to do with the question of "why aren't hospital staff getting the vaccine"?

So now that your second question has been answered, are you still arguing that the hospital management is primarily at fault?
@OrangeWizard

Ruvan22 posted...

So now that your second question has been answered, are you still arguing that the hospital management is primarily at fault?
@OrangeWizard

That is still my opinion yes.
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That's certainly a take.

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Try harder.

Please stop arguing with a sea lion. If you don't care about your sanity/time then at least consider everyone else's.

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