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No Room at the Inn: The Hospital Bed Crisis Nobody Sees · Banter At The Bedside

0:06
SPEAKER_05: Hi everyone and welcome back to Banter at the Bedside.
0:10
SPEAKER_05: We are here today with an exciting episode, one of our debriefs, where we take a topic and provide all different aspects from healthcare on that topic.
0:19
SPEAKER_05: Today we're talking about no room at the inn, meaning, what's it like when we don't have hospital beds or staff and there's still patients coming.
0:28
SPEAKER_05: There's still patients that need to come to the hospital.
0:31
SPEAKER_05: What are all those pressures like and what stories do we have for it?
0:35
SPEAKER_05: As always, I'm Abby.
0:36
SPEAKER_05: I'm a nurse practitioner of eight years, and I am one of your main co-hosts.
0:40
SPEAKER_05: We are joined by Kaylee, a nurse of 18 years in the ICU.
0:47
SPEAKER_05: Hey everybody.
0:47
SPEAKER_05: Next, we have Cody, who is a nurse of 11 years in the ICU, and he has done travel nursing.
0:54
SPEAKER_05: He's even been a manager for a little bit.
0:57
SPEAKER_05: So he proves provides that perspective for us.
1:00
SPEAKER_05: Hey y'all.
1:00
SPEAKER_05: We have Dr.
1:01
SPEAKER_05: Tyler with us today, a hospitalist of 12 years to provide the physician perspective.
1:07
SPEAKER_05: As always, this is for entertainment purposes only.
1:10
SPEAKER_05: This is not medical advice.
1:12
SPEAKER_05: Please seek the care of your own medical professional.
1:15
SPEAKER_05: We do not represent any entity at all.
1:18
SPEAKER_05: All of our thoughts and opinions are our own.
1:21
SPEAKER_05: So welcome back, everyone.
1:23
SPEAKER_05: How are you guys doing?
1:24
SPEAKER_05: Going good.
1:25
SPEAKER_01: I'm excited to come back.
1:26
SPEAKER_01: I enjoyed the first episode.
1:27
SPEAKER_05: Yeah, we enjoyed having you.
1:30
SPEAKER_05: And I feel like you're a great person to speak on this topic as a hospitalist because you have patients trying to come through to the hospital or needing to be admitted to the hospital from all different areas or just moved onto your service from different areas like us in the ICU.
1:50
SPEAKER_05: You want to speak on what that is a little bit like?
1:54
SPEAKER_01: I guess, yeah, to throw out the first line here.
1:57
SPEAKER_01: I guess um, you know, I I think hospital beds are a finite resource.
2:02
SPEAKER_01: And I think a lot of people who don't work in medicine don't quite see that.
2:06
SPEAKER_01: Um and I and I say that not to, you know, belittle them, of course, but just if you don't work in hospital, then you just kind of think, oh, there's a hospital.
2:13
SPEAKER_01: I'm sick, I'll go there and I'll be fine.
2:15
SPEAKER_01: But you know, we've got 400 million Americans, and um forgive me, I meant to look up the number for before and I forgot, but I think it's something like a hundred thousand hospital beds in the country or something like that.
2:27
SPEAKER_01: And you know, we we don't have the room for everyone to be in the hospital all the time.
2:31
SPEAKER_01: And so hospitals kind of work on this flow.
2:34
SPEAKER_01: It's the patient comes in, we fix them and we discharge them.
2:36
SPEAKER_01: They come in, we fix them, and we discharge them.
2:38
SPEAKER_01: And there are times that the the patient feels that the discharge was not ready or not right to say they have some more things they need to do, but we unfortunately kind of have to discharge them anyway, and because as I just said, hospital beds are a finite resource.
2:54
SPEAKER_01: There's more people who need that bed, and in addition to taking care of you, the patient in front of me, I also have to take care of all 18 patients on my rounding list.
3:05
SPEAKER_01: And to some extent, I owe a little bit of my my brain power to all 700 patients in the entire hospital because bed management is a big part of hospital medicine.
3:16
SPEAKER_01: And going even further, all 400 million Americans depend on how we use these hospital beds, and as such, might our consideration of a discharge order.
3:24
SPEAKER_01: I guess I wish that, like, you know, it's very common, every certainly every week and almost every day, that I'm discharging a patient who doesn't want to go, and they just don't understand.
3:34
SPEAKER_01: They think I'm just being a Grinch, they think I'm being tough, they think I'm just showing off how smart I am.
3:40
SPEAKER_01: But I wish I could relay to them, no, this isn't about those things.
3:42
SPEAKER_01: This is about I have a duty not only to you, but the other 18 patients on my rounding list, the other 700 patients in this hospital, and and and to everyone in the country, you know, the hospital beds are not infinite.
3:52
SPEAKER_01: And I'm I you you respectfully are at the point where you don't need this hospital bed, so I am taking it away from you.
3:59
SPEAKER_01: Don't take it personal.
4:00
SPEAKER_01: It's not because I'm mean, it's because someone else needs this hospital bed better than me.
4:03
SPEAKER_01: And so many people without a medical education, so many people who don't work in hospitals simply don't understand that.
4:08
SPEAKER_01: And and I would love for everyone to understand that.
4:11
SPEAKER_01: I would love for 400 million Americans to watch this episode so they could hear exactly what we're talking about.
4:16
SPEAKER_05: Yeah, it's I feel that a little bit too when we are like, okay, like you're going to leave the ICU.
4:22
SPEAKER_05: We're going to move you out to the floor, the hospitalist group, and patients are like, well, why can't I just stay here?
4:31
SPEAKER_05: I like it better here.
4:32
SPEAKER_05: And it's just like, you don't need to stay in the ICU.
4:38
SPEAKER_05: We have even less ICU beds than just general hospital beds.
4:43
SPEAKER_05: So you can't just stay here waiting because you like it better, because you like that your nurse only has one or two patients.
4:50
SPEAKER_05: Like, that's not a reason to stay here.
4:52
SPEAKER_05: But I also think that as you briefly kind of hinted at, like, we have a duty to that patient too.
4:59
SPEAKER_05: Like it costs you money.
5:01
SPEAKER_05: Like, it costs you money to stay in the hospital, whether you have insurance or not.
5:06
SPEAKER_05: Like, there's still money being billed.
5:09
SPEAKER_05: And I always just feel like an ethical responsibility to be like, I can't charge you for an ICU level of care when you're not needing an ICU level of care.
5:21
SPEAKER_05: Like, that's just not fair.
5:23
SPEAKER_05: It's not right.
5:24
SPEAKER_05: And I agree with you 100%.
5:26
SPEAKER_01: But the frustrating part about that discussion, even even though I'm agreeing with you, the frustrating part of that discussion is I I feel like I can't say that to a patient because if if those are mal, then the patient hears money is more important than your life, which of course that's not in any way, shape, or form saying, but that's what they're gonna hear and that's what they're gonna interpret.
5:46
SPEAKER_05: Yeah.
5:47
SPEAKER_05: I I do say it to patients, but I think that I have a little bit easier time because they're not leaving the hospital.
5:53
SPEAKER_05: Whereas for you, they are.
5:55
SPEAKER_05: I will say, like, I cannot charge you, I cannot ethically charge you for ICU level of care when you're not receiving ICU level of care, which is a great thing.
6:05
SPEAKER_05: It means you're not about to die.
6:08
SPEAKER_05: Like I can see how, yeah, patients could interpret it wrong.
6:12
SPEAKER_05: Thankfully, none of mine have, but I also do think working in such a rural area, it is a big thing that a lot of them worry about is the hospital bill.
6:25
SPEAKER_04: Yeah, I was about to say I think that's like a comforting thing for some of them or like a reassuring thing for a lot of the people where we work.
6:32
SPEAKER_04: But it would be to me.
6:34
SPEAKER_05: Yeah.
6:35
SPEAKER_05: I mean, I've had patients refuse Tylenol because they're like, it's too expensive from the hospital.
6:40
SPEAKER_05: And I'm like, well, this is a drop in your bucket while you're on you you had five days on ECMO.
6:46
SPEAKER_01: Like this ain't this ain't breaking your when I was a resident, I had someone tell me that um it costs about$4,500 per day.
6:55
SPEAKER_01: It costs someone$4,500 per day.
6:58
SPEAKER_01: Either if the patient has insurance, we're charging the patient.
7:01
SPEAKER_01: If the patient doesn't have insurance, we're charging good old Uncle Sam.
7:05
SPEAKER_01: And that that that's the cost of keeping one patient in the hospital for one night.
7:09
SPEAKER_01: Yeah.
7:10
SPEAKER_01: And um if so, let's say, for example, I show up to work tomorrow and I've got 18 patients on my list and I'm only discharging five of them.
7:18
SPEAKER_01: Well, it's by the way, that's that number 4,500 was back when I was a resident.
7:22
SPEAKER_01: So I mean, I it's easy to assume with inflation things got more expensive since then.
7:26
SPEAKER_05: Oh yeah.
7:27
SPEAKER_01: So if I'm only discharging five patients out of 18, which means I'm keeping 13 overnight, 13 times 5,000 mean by my not discharging anyone, I am charging the American taxpayer$65,000 that day.
7:41
SPEAKER_01: One day.
7:42
SPEAKER_01: One day I am charging the American taxpayer$65,000 by my lack of discharges.
7:48
SPEAKER_05: Um for one group, too, and then you multiply that by all the time.
7:53
SPEAKER_01: That's that's just me.
7:54
SPEAKER_01: And then so let's say there's you know 10 docs in my group, so that means just my group in my hospital, that's six hundred and fifty thousand dollars a day that we are spending by not discharging this patient.
8:07
SPEAKER_01: And then there's sixty one hundred in the hospitals in the country.
8:12
SPEAKER_01: I mean, you know, we have to make some tough decisions.
8:15
SPEAKER_01: We can't we can't just let everyone stay in the hospital as long as they want to because that would bankrupt our tax dollars.
8:21
SPEAKER_01: And I and and I'm gonna repeat what I said a few minutes ago.
8:24
SPEAKER_01: Like that that's a slippery slope towards, you know, money's more important than life saved.
8:27
SPEAKER_01: And I'm not, and that's not what I'm saying at all.
8:29
SPEAKER_01: No.
8:29
SPEAKER_01: So once we get past the point where we're not concerned about death anymore, you gotta get out of the hospital.
8:33
SPEAKER_01: We gotta save.
8:34
SPEAKER_01: Not only do we have to save taxpayer dollars, we gotta other people need those hospital beds.
8:38
SPEAKER_00: Mm-hmm.
8:39
SPEAKER_00: Yeah.
8:39
SPEAKER_04: Yeah.
8:40
SPEAKER_04: I mean, once you're admitted to the hospital, your your goal should be like, how quick can I get out of here?
8:45
SPEAKER_04: Because that's right.
8:46
SPEAKER_01: I did a reel, like I think like two months ago, and the reel was what's the most surprising thing you learned during education between med school and residency?
8:56
SPEAKER_01: What shocked me the most, and for that reel I talked about, the most shocking thing I learned about was how few patients want to leave the hospital.
9:03
SPEAKER_01: I never, when I was like a first-year med student, a second-year med student, I never dreamed in a million years that I would be convincing people to leave the hospital.
9:10
SPEAKER_01: But not only do I do that, it's extremely common.
9:14
SPEAKER_01: I mean, there are hospitals I work at that probably half of the discharges they don't want to go.
9:20
SPEAKER_01: So if I'm gonna try to discharge seven patients tomorrow, three or four of them are gonna argue with me because they want to stay.
9:25
SPEAKER_01: And like tell that to the version of me who had never done a clinical rotation yet, he'd be like, no way.
9:29
SPEAKER_01: Like, that's insane.
9:30
SPEAKER_01: There's there's no way that that's going to happen, but it is gonna happen.
9:33
SPEAKER_01: And then in that reel, I got a little bit of hate in the comments, which is fine.
9:37
SPEAKER_01: I mean, it's part of being on social media to begin with.
9:40
SPEAKER_01: But you know, people were replying that, you know, well, this patient has nowhere to go, they're homeless, they have no support, they have no funds.
9:46
SPEAKER_01: And yeah, that's certainly part of the discussion, but that doesn't change the fact that hospital beds are a finite resource and can't keep people in a hospital bed just because they have nowhere to go, just because they're homeless.
10:00
SPEAKER_01: Because there are a lot of homeless people in this country, and the more and more we start to do that, the less and less we'll have hospitals.
10:06
SPEAKER_05: Um, I I agree.
10:12
SPEAKER_05: And it's such it is such a finite resource.
10:16
SPEAKER_05: It is crazy that like the patients want to want to stay in the hospital, and all of us that work there are like, oh it's time.
10:24
SPEAKER_05: Like you see the nurses lining up at the clock out station, and like when the shift is done, like there's if you ask anyone that works at the hospital, the last place they want to be is at the hospital, they're like, Can I get discharge if we get admitted?
10:38
SPEAKER_05: It's like, can we get discharged?
10:40
SPEAKER_05: Like when I had dengue fever, they I asked, and I was allowed to go home every day because I lived with a very well-respected town healer.
10:53
SPEAKER_05: Um was it Luke?
10:55
SPEAKER_05: And it was not Luke.
10:57
SPEAKER_05: No, this was in Costa Rica.
10:58
SPEAKER_05: He didn't come with me there.
11:01
SPEAKER_05: Um, he did rant me out to my family though about how dangerous Stengate fever was.
11:06
SPEAKER_05: I kind of hit that from my parents.
11:11
SPEAKER_05: I mean, they can look it up, so they they could have.
11:15
SPEAKER_05: Uh, but like we just want to run out of the hospital and they want to stay.
11:20
SPEAKER_05: Did you see there was like someone that like refused to leave the hospital and they had to like open up like a court case to kick them out?
11:28
SPEAKER_01: And I've been looking for the outcome in that.
11:30
SPEAKER_01: Do you know the outcome?
11:31
SPEAKER_05: No, I think the the case is still pending in in the courts.
11:35
SPEAKER_05: Yeah, like a patient refused to leave the hospital and was like, what?
11:40
SPEAKER_02: And they were like this bed.
11:43
SPEAKER_05: They were claiming squatters' rights, yes, and they were discharged and they were like claiming squatters' rights.
11:48
SPEAKER_01: Squatters' rights and a home.
11:49
SPEAKER_05: Squatter's rights.
11:50
SPEAKER_04: That's private reason.
11:51
SPEAKER_04: That's what it is.
11:53
SPEAKER_04: Actually, I shouldn't say that.
11:54
SPEAKER_04: I don't know anything legal, but I've seen, I think I see more what I see is like people who don't want to be discharged from the emergency department.
12:00
SPEAKER_04: That's like the the stuff I see more or I hear more about because they don't feel like they got adequate care medication or whatever.
12:08
SPEAKER_04: But working in the ICU, I feel like when we're discharging people, they are all ready to go.
12:13
SPEAKER_04: I don't I most of our population, I think a small amount of them might be homeless or maybe don't want to go because they don't have uh that like you know, support.
12:22
SPEAKER_04: But I feel like most of the time when I'm discharging people, they're like, when?
12:24
SPEAKER_04: What time?
12:25
SPEAKER_04: The doctor said, have they put the order in?
12:27
SPEAKER_04: Where's my stuff?
12:27
SPEAKER_04: Hitting the call bell, I'm ready to go.
12:29
SPEAKER_04: And it's like, me too.
12:30
SPEAKER_02: This is so uncomfortable, but you want to stay.
12:34
SPEAKER_05: Yeah, I'm ready to go.
12:36
SPEAKER_05: I I'm ready to I did have one patient when I was a nurse that wanted to stay so bad, and then she took the pillow with her.
12:47
SPEAKER_05: The plastic pillow, the plastic pillows.
12:51
SPEAKER_05: I was actually on orientation.
12:53
SPEAKER_05: I was standing there with my preceptor.
12:55
SPEAKER_05: She's like, I just remember her being like, Fine, if you're gonna kick me out of the hospital, like I'm gonna make it worth it.
13:01
SPEAKER_05: And I I don't sleep as good anywhere else, so I'm I'm just taking these and took the plastic pillows, and I was like, should we stop her?
13:12
SPEAKER_05: My preceptor was like, It's not worth it, it's it's not worth the fight to keep those pillows.
13:17
SPEAKER_05: So she took two plastic pillows.
13:20
SPEAKER_05: I was like, Okay, all the things.
13:25
SPEAKER_05: She liked them.
13:26
SPEAKER_01: That seems that seems like a resource issue.
13:28
SPEAKER_01: Like, she just was looking for like, I don't know, a place to stay where she's taken care of.
13:32
SPEAKER_01: I guess I'm saying that respectfully, I'm just trying to observe here.
13:35
SPEAKER_04: I mean, I was scared to get discharged after I had my kids.
13:37
SPEAKER_04: I was like, I was ready.
13:39
SPEAKER_04: Then I was also scared, like, oh gosh, I really have to do this now, like by myself.
13:44
SPEAKER_04: So I get it.
13:45
SPEAKER_01: I mean, I get it.
13:46
SPEAKER_01: I I've seen I'll just say that I've seen some networks do programs like where the hospital will send paramedics.
13:53
SPEAKER_01: We'll send the patient to the house and then we'll send a paramedic to check on them up to twice a day.
13:57
SPEAKER_01: I'm not talking about home health.
13:59
SPEAKER_01: Home health is like, you know, a CNA comes in and checks vitals three times a week and does like IV three times a week.
14:05
SPEAKER_01: With some of these other programs, um, we'll literally send paramedics to the patient's house um and up to twice a day, and and they can do a nursing evaluation.
14:15
SPEAKER_01: They can even like bring a little iPad and talk to doctors and NPs and PAs.
14:19
SPEAKER_01: Those programs kind of started for like COVID because we needed to get people out of the hospital, but they still needed medical care.
14:25
SPEAKER_01: But they've they've proven useful and they persisted even past COVID because people just benefit from an extra set of eyes.
14:31
SPEAKER_01: I mean, there's a lot of fear, like Kayla, like you just said, there's a lot of fear with leaving the hospital.
14:35
SPEAKER_01: And it's a lot easier to shave off an extra day or two or three from the length of stay when I tell a patient, hey, there's this program we have where they'll send someone up to your out to your house and they can check on you up to twice a day.
14:48
SPEAKER_01: And they'll say, Well, how long?
14:49
SPEAKER_01: Oh, until you until you don't need it anymore.
14:51
SPEAKER_01: And that has really, really helped curb and expedite a lot of curb the fear and expedite expedite a lot of discharges.
14:58
SPEAKER_01: And I would love to see that happen for more networks because that's effectively increasing the number of hospital meds that are out there.
15:05
SPEAKER_04: I think a lot of times too that um the patients when they're getting ready to go, like they're they're nervous about a lot of stuff, right?
15:14
SPEAKER_04: Like they're meds, and am I actually like understanding what I'm when I was supposed to take what?
15:19
SPEAKER_04: And it can be daunting, I think, for a lot of people.
15:21
SPEAKER_04: They come in on maybe one or two medications, and sometimes they leave with 10 if they've just for example, if they've had a heart attack, because they might start on all this gold directed medical therapy, and you're gonna take an aspirin and a plavex or valentin, you're gonna take lip tort night, you're gonna take a total, and they're like, huh?
15:35
SPEAKER_04: So even in the ICU when they're here, like our job with getting them discharge starts then on education.
15:41
SPEAKER_04: That's why we're supposed to tell them every time, okay, this is this medication.
15:45
SPEAKER_04: Remember, this is for this.
15:46
SPEAKER_04: You're taking this now, you're gonna get it in the evening, and it's almost like they should hear it so many times that by the time you're doing their discharge network, it's redundant.
15:54
SPEAKER_04: And they're like, Oh, yeah, my nurses have been talking about that.
15:57
SPEAKER_04: I got that.
15:57
SPEAKER_04: Like, that makes sense.
15:59
SPEAKER_04: So they feel like confident that they actually like have already started like getting involved in like what it's gonna be like when they go home.
16:04
SPEAKER_01: Yeah, that absolutely helps.
16:05
SPEAKER_01: I think it also helps coming from the nurse too, because there's like a lot of things like at the at the like like hands-on micro level that I don't really know what it looks like or how it looks.
16:15
SPEAKER_01: And also, like I'm I think I said last time I've I've heard people trust nurses more than they trust doctors a lot of times.
16:20
SPEAKER_01: And so I think hearing that from the nursing definitely helps.
16:23
SPEAKER_01: Like, I don't even know how to do insulin, you know what I mean.
16:25
SPEAKER_01: I can I can order insulin with a computer all day long, but if you put like an insulin syringe and a vial next to me and told me to do active checks, like I wouldn't have a clue what to do that.
16:34
SPEAKER_01: And so I think having the nurses like uh like show that to the patients, I think that's extremely effective and and wonderful.
16:40
SPEAKER_04: Yeah.
16:41
SPEAKER_04: Plus now you get all your paperwork, but you can go in and look at a lot more things like in your charts and stuff like that.
16:49
SPEAKER_04: So um I try to remind people I'm like, it's all gonna be written down, you're gonna have a coffee, like it everything's there, but yeah, it's scary, I'm sure.
17:00
SPEAKER_02: I think when people get discharged, well, before they're discharged, is the fear of their medications and everything not being covered by insurance.
17:09
SPEAKER_02: That's another at least when they're in the hospital every we can't not give it to them because they don't have insurance or if they're insurance.
17:17
SPEAKER_02: We don't know if their insurance is being covered, if is covering the medication, so they get it scheduled like they're supposed to.
17:24
SPEAKER_01: And that's that right there might be my least favorite like uh reason that people don't want to go because I can't fix that, I'll never fix that.
17:32
SPEAKER_01: Yeah, no, it seems like every new pill that we see commercials for it's only five thousand dollars a pill, and your insurance will cover it if you got a white-collar CEO kind of executive level job.
17:46
SPEAKER_01: And then so if a patient needs anything beyond ACE beta, statin, aspirin, moxicillin, metformin, you know, the cheap stuff, then they just they can't afford their medications.
17:57
SPEAKER_01: Like there's there's no fixing that.
17:58
SPEAKER_01: I I mean we have we have programs, like we'll we'll give them a 30-day supply, we'll have we'll bring pills to the bedside and give them 30-day supply to go home with.
18:06
SPEAKER_01: But then they'll ask me, so what do I do when these 30 days run out?
18:09
SPEAKER_01: And I'm like, oh, I don't know.
18:12
SPEAKER_01: And I don't know.
18:13
SPEAKER_01: Um yeah.
18:14
SPEAKER_01: That doesn't change the fact that you have to get out of the hospital, but I don't know what to tell you.
18:19
SPEAKER_01: And and that that breaks my heart.
18:21
SPEAKER_01: And I I wish it were another way, but no matter what I wish, that is the way it is.
18:25
SPEAKER_01: You can't just stay in the hospital and take pills forever just because you can't afford a pillow on the outside.
18:31
SPEAKER_05: Yeah, it that is always hard.
18:34
SPEAKER_05: I just had one recently where I w I was actually doing a discharge from the ICU um to home, not to a celestial discharge.
18:44
SPEAKER_05: And everything was done, and they needed dual anti-platelet, and baby aspirin's cheap.
18:52
SPEAKER_05: The other drug that goes with that is not cheap at all.
18:57
SPEAKER_05: Uh Berlin is not cheap.
18:59
SPEAKER_01: And I'm gonna get Berlinta, yeah.
19:01
SPEAKER_05: Berlin is not cheap, and it is twice a day, and we can get you same, we can get you 30 days, but that's about all we can get you.
19:12
SPEAKER_05: And the patient didn't let us know until everything was done that they needed help.
19:20
SPEAKER_05: And it's just it it's so hard because it's like, you're right, you can't stay here because you can't afford the medicine.
19:27
SPEAKER_05: That it one doesn't make sense to you know rack up a hospital bill when you can't afford the medicine.
19:34
SPEAKER_05: But then it's also like on the other side, if you don't take this, you're going to come back to me.
19:40
SPEAKER_05: So how do I keep you out of the hospital safely?
19:45
SPEAKER_05: It it's so complicated and it it really does, it really sucks.
19:50
SPEAKER_05: I was at one system and they would do 90 days of medicines if you couldn't afford it, which was nice.
19:56
SPEAKER_05: But we did have, I remember this was when I was a charge nurse, we had one patient, he pretty much came back every 90 days.
20:04
SPEAKER_05: Because if you got admitted for a night because you couldn't afford your meds, they would give you a 90-day supply.
20:10
SPEAKER_05: So every 90 days he would come and be admitted.
20:16
SPEAKER_05: But as nurses, Kaylee and Cody, what does that pressure kind of feel like though?
20:22
SPEAKER_05: Because as providers, we're like putting the stuff in and we're doing the things, and then we're like, okay, well, we have this patient in the ED that needs to come, or I have this patient at this other hospital or in the clinic that needs to come.
20:35
SPEAKER_05: So get this patient out so I can get this other patient in.
20:38
SPEAKER_05: What's what's that pressure feel like?
20:40
SPEAKER_02: I feel like is it stressful because uh in my experience, when like our unit, like let's say you have a full unit and you have uh three or four vented patients in the ED, you have patients who are borderline could go out, probably could benefit from being in the ICU one more day.
21:05
SPEAKER_02: Do you transfer them out early?
21:08
SPEAKER_02: Do you how do you get the patients in the ED up sending the other ones out?
21:13
SPEAKER_02: It's like you don't want to do a disservice to the people who can go out but probably shouldn't go out.
21:19
SPEAKER_02: You also don't want to do a disservice to the ones in the ED because God forbid they're in the ED.
21:25
SPEAKER_03: So I don't know.
21:28
SPEAKER_04: I don't know that I feel that pressure as much.
21:32
SPEAKER_04: I guess it I want to make every patient feel like when I'm with them that my time is theirs.
21:37
SPEAKER_04: Now, you know, discharge instructions, we don't do a lot.
21:40
SPEAKER_04: Um I want I don't want them to feel rushed with that because after that they're on their own.
21:45
SPEAKER_04: If it's like transferring somebody out, I don't really feel bad at all.
21:48
SPEAKER_04: Cause I'm like, nope, you're going to another bed.
21:50
SPEAKER_04: Like you're fine.
21:51
SPEAKER_04: Like, I just need to get you out.
21:53
SPEAKER_04: Um, but as far as like the pressure to do that quickly so that another patient can come in, I think that depends.
21:58
SPEAKER_04: Like, yes, I don't.
22:00
SPEAKER_04: think a ICU level patient needs to sit in the ED for that long because that's a lot of different stuff they're not you know used to doing.
22:07
SPEAKER_04: But they are in a bed and they're being monitored and they have the physician, they have a nurse and they have an RT.
22:12
SPEAKER_04: So they're gonna be fine.
22:14
SPEAKER_04: If they're sitting in another hospital, you know, like outline, like I feel like that's more like let's get them over here.
22:20
SPEAKER_04: Like let's get them, you know, where they need to be.
22:24
SPEAKER_04: Um but we just do the best we can and try to make each patient that you're with feel like their time is like you know they're valuable to me too.
22:33
SPEAKER_04: But it's like also just being able to be like but but we're going, we're going.
22:36
SPEAKER_04: And like we can be like doing stuff we can be talking but I'm moving them.
22:40
SPEAKER_04: I'm like getting them ready to go.
22:41
SPEAKER_04: We can be talking at the same time it's like let's just get them out so this room can get turned over and then even if I have to hang with them for a few more minutes upstairs because they're still having some anxiety I can do that.
22:52
SPEAKER_04: But it is what it is.
23:00
SPEAKER_01: People could follow me for rounds and see.
23:03
SPEAKER_01: You know I'll have let's say I've got 18 patients tomorrow and there's like probably like probably 10 or 12 of them will be like in a room and they need that room and everything's fine.
23:14
SPEAKER_01: But then there's going to be four that should discharge but are arguing because they don't want to discharge.
23:19
SPEAKER_01: But then there's also four more who are stuck in the yard or stuck in like a PACU overflow unit where they have no privacy and no bathroom covered in curtains.
23:28
SPEAKER_01: And these four these last four are like when are you going to get me a real bed like I have I haven't been able to take a shower in four days.
23:34
SPEAKER_01: I'm I'm tired of pooping in a room where everyone can hear me and and they're begging to get them a real bed.
23:40
SPEAKER_01: And and I wish like that the for the for the four people who are like who need to go and are arguing me and refusing to go you know I I wish I could like have them hey all right why don't you come with me let me show you what's in the other half of my rounding list and we'll go to the I the ER overflow rooms and watch these poor people stuck in a broom closet for three days with no privacy and say that you know your refusal to leave your reluctance to leave is directly impacting this patient's care right here.
24:04
SPEAKER_01: And you know respectfully this patient is more acutely sick than you are.
24:07
SPEAKER_04: This patient still has acute pancreatitis you've been medically clear for two days and and I think that would go a long way if people could see that and and actually see it face to face and that's giving people too much credit honestly it's like when you're going out to eat and you are so hungry and you're sitting in the wait room or in the lobby and you can see all these people and you're like well they look like they're done they're not they're just talking they need to get up and it's like come on people like don't you see us sitting here and then as soon as you sit down you're like I'm gonna take my time and I'm gonna sit yeah yeah it's like that like yes but also once you're the person in the thing you're like I don't wow that is a really that is a good analogy but I will counter that people did it during COVID.
24:54
SPEAKER_05: Like we saw during COVID people understood and left the hospital quicker like especially at the start of the of COVID like we saw a lot of these people would discharge quicker people weren't utilizing the ED the way that they normally do you know utilizing things like urgent care PCP and so we we can do it like people can have that awareness it's just whether you choose to or not sure I do think people can be yeah more empathetic but I just think you know on the daily they be like well for them I I I just yeah it's interesting that that was your your COVID experience because like I saw that sometimes but also sometimes and maybe more often than that I saw the other side of that which is people refusing to leave the hospital because they turn on CNN and CNN said if you have COVID you're gonna die in three seconds and now they're like well wait a minute I have COVID and you're gonna discharge me but I'm gonna die in three seconds and and so I I felt that severe pushback from the patient themselves and then also from the family members would refuse to come get them.
26:12
SPEAKER_01: You know we'd had we'd say hey look we we finished the random we finished the dexamethasone you got to come get them all and and they said nope not coming to get her she's got COVID.
26:21
SPEAKER_01: I'm not coming to get her the thing we always heard was I'm not coming to get her until her test comes back negative.
26:26
SPEAKER_01: And that's never gonna actually test would stay positive for six weeks.
26:32
SPEAKER_01: We can't hold them here checking the COVID test every day for six weeks we have to do DC recommends which is get your grandma out of the hospital as soon as possible and they would they would absolutely refuse but we had to do really harsh things to clear up hospital beds during COVID.
26:46
SPEAKER_01: So yeah just maybe at my experience with COVID wasn't quite the same as yours.
26:50
SPEAKER_05: What Cody mine was pretty bad what do you mean maybe I was spoiled I'll I'll admit maybe I had some privilege.
26:57
SPEAKER_02: Yeah maybe you maybe you had a uh an unusual circumstance Cody what was your um what was your you said it was pretty bad it uh it was just death after death after death and then people just did it's like people just did not stop coming in it was like I know four people just died but there's five more events and there's five other people there's five um patients on the step down unit that's we've converted to ICU beds that they all need to be intubated.
27:31
SPEAKER_04: And it's like I don't even have and this is when I was in management so it's like I don't have physical bodies to manage all these people I got my nurses stretched three to three to one and they just kept rolling in day I've done like y'all are talking about discharged people during co during COVID to the house he's like who who got discharged at the house I mean they got discharged in the computer but I was like y'all are getting the people discharged what they're going home we didn't have as many COVID patients when it started though because they were trying to keep them all relegated to one ICU though.
28:08
SPEAKER_04: Yeah um so my experience is much different than Abby's even though we work at the same place because I as a nurse was going over there and staying on a COVID unit to work for a while or like we would have to go do that and we didn't get them for us as right what there was a while before we even started being able to get patient with COVID.
28:27
SPEAKER_05: I guess I'm privileged I'm sorry no you're you're don't be don't be sad you good for you but I do think it's different because it's like yeah going over to work in the COVID IC it's like yeah they're all they're all on the vent and they're not getting out for at least for a while until things got over I do think Cody brings up though another aspect of this like we're talking about patients that don't want to leave the hospital but another part that keeps the inability to bring people in or keeps the in full is staff like the in staffing and staffing models there are states that have patient to nurse ratios that no one can break you can't you can't break it some states don't some hospitals do like and there that state did not yeah a lot of them don't a lot of them don't but there are some that do and nurse to patient ratios what I think it's very important.
29:28
SPEAKER_05: Like you do have to have safe ratios but it also does impact how many patients you can bring in because it's like you you can only have so many patients you can only have so many ICU patients as a step down nurse like I would have sometimes two step down patients and two floor patients and that was the hardest assignment.
29:49
SPEAKER_05: So I had two pretty sick patients two not so sick but it was a lot of work to do to do that.
29:58
SPEAKER_04: When you said my room at the end I the first thing I didn't think was that there's no bed the first thing I think of is there's no staff but I do think that that is probably different in intensive care I don't I mean I mean different hospitals but you don't want I would assume as a hospital or whoever like you don't want people going around and saying like well we're staying in the ED for days or we can't get a bed because they don't have nurses.
30:27
SPEAKER_04: Like no beds okay physically that's like there is nothing you can do about that.
30:33
SPEAKER_04: There are things that can be done to staff the units that don't happen for whatever reason.
30:40
SPEAKER_04: So like for us sometimes like you're saying like we might have eight open beds empty beds we don't have any nurses and our charge might be in a pod and this is not all the time and it's it's not like it used to be but there's space there's just no nurses and I think that is a problem everywhere.
30:56
SPEAKER_04: There's so many nurses but there's a quote unquote nursing shortage well there's not they just don't want to work in certain conditions all the time.
31:05
SPEAKER_02: So we had no space everything it was like 17 vents we had to push our sister unit our which our was a step down we had the unit had just gotten like re um redesigned and we made sure we had six beds that mimicked our ICU bed so just in case something on that side we could house them over there.
31:33
SPEAKER_02: We would in have to increase their ratios over there to like five sometimes six to one when I say those patients in those six rooms it was like 60 liters 100% ice still max oxygen.
31:50
SPEAKER_04: But that's like crisis times you know like crisis times almost you can justify almost anything because it's like a disaster right like disaster staffing and disaster medicine it was on vacation so oh okay but I would say in general disaster medicine is much different than the everyday and even the everyday like you might have to say okay well there's a a STEMI or there's a stroke they're coming either way are we gonna have a nurse for them or are we gonna maybe push a borderline patient out so that we can have a nurse or are we going to you know change the ratio are we gonna pull somebody out of a management office to come help staff it's like you have to get creative a lot of the times you have to weigh the benefits and the risks to either the ratios or whatever however you want to say level of care to do what's best for you know the patients and it I I'm glad I don't have to make those decisions most of the time.
32:52
SPEAKER_04: Like I can get very creative with beds and assignments and like maybe moving certain people around sometimes we have to make intermediate pause to free up a nurse um but sometimes there's really nothing you can do and it sucks because we all I think we don't want to think about patients being left where they don't need to be and not getting the care that they yeah.
33:11
SPEAKER_01: Yeah that's that's that's that's another interesting aspect of this too it's like you know I talked about how hospital beds are a finite resource but another subchapter of that discussion is like there are good hospital beds and there are bad hospital beds and by that I mean like think about you know a pay if a patient's in the ICU their nurse probably has a two to one ratio and they have everything they need right there at the bedside.
33:33
SPEAKER_01: That's that's a good hospital bed.
33:34
SPEAKER_01: But then think about like the the broom closets and the overflow units where the patient has no privacy, no bathroom that's I can call easily call that a bad hospital bed.
33:43
SPEAKER_01: At my own hospital I can think of two overflow units that like I I I I if I were a patient I'll I'm just gonna say because this is on record here I if I were a patient I would not want to be stuck in that unit for three days.
33:56
SPEAKER_01: And so I and I think that's part of it too like even though we have so many hospital beds in the country how many of these hospital beds are actually going to provide optimal patient care I do think that's another really good part to this discussion.
34:07
SPEAKER_04: Yeah.
34:08
SPEAKER_04: Yeah and I mean I will say I understand the need for privacy and I'm really big on protecting our patients' privacies but if that's the worst thing that you have to deal with during your admission I do think there should be some perspective in that um they'll still complain though.
34:27
SPEAKER_04: Like they'll still get it I would too but if you got what you needed you got your medications you got your therapy you got your care and you're getting out like I I do I wish it wasn't that way but if you're at the if you're healthy enough to be complaining about only having a curtain versus a real room I think you're doing okay.
34:44
SPEAKER_04: Just just to say I agree.
34:46
SPEAKER_04: Not diminishing your feeling but in perspective but Dr.
34:53
SPEAKER_05: Tyler how does it feel you know if you're like I really need to get this patient up and the nurses are like I can't I don't have a bed like what is that feeling as a doctor?
35:06
SPEAKER_05: Because I kind of I've seen both sides.
35:08
SPEAKER_05: That question I I'm not sure I understood the question you said I need to get this patient up what do you mean by up like like sorry I need to get this patient admitted like they need to leave the ED like they're not getting what they need or they're sick enough to I I really need them in an inpatient bed where I can see them closer.
35:28
SPEAKER_05: What does I guess more so like what does it feel like when a charged nurse says I don't have a nurse for that bed or I can't I can't get that patient up here.
35:39
SPEAKER_01: I guess I don't feel I might need I might not be the best person to ask that question because I personally um I feel like I spend most of my day gradually nudging every 18 of my patients towards a discharge order anyway not that I'm a not that I'm a discharge machine not that it's the only thing I care about.
35:58
SPEAKER_01: I'm not like a numbers guy anything like that.
36:00
SPEAKER_01: But you know when I show up in the morning I and I'm pre-rounding I think how can I get this patient out of here 18 times and and so I feel and and the numbers like kind of support that if you look at like how we build and look at our venues you know I do a lot of discharges and I feel because of that when I get the messages from the charge nurse and from patient pace placement and and you know the admins saying hey we need some better why don't you discharge this patient to me it just that just rolls off the the the scan I don't really think anything about that anyway because I'm already doing that and it's like it just feels like they're like a step behind me because I've already thought about that extensively.
36:38
SPEAKER_01: So that that question doesn't bother me personally but I would love to hear I would love to see you ask that question to because I mean I mean let's just be frank there are a lot of hospitalists who disagree with me 20 minutes ago when I said I have a duty not only to the patient in front of me but to all 18 patients on my round list and in the entire hospital there are a lot of hospitals who disagree with me on that.
36:59
SPEAKER_01: There are a lot of patients who say like no no the only patients that concern me are the ones in front of me in the room.
37:05
SPEAKER_01: And I mean and I respect that argument I really do.
37:08
SPEAKER_01: Yeah.
37:08
SPEAKER_01: So then I'd like to see when you get a hospital like that now ask them that same question you asked me.
37:14
SPEAKER_01: So now when the when the hospital could who isn't quite thinking about the group census and isn't quite thinking about the number as a whole like now whenever in the charge nurse or patient placement or administration saying like hey we got we got to move here we got to get this patient out of the ER like what's their thought and and I I would be interested to see that conversation if that makes sense.
37:33
SPEAKER_05: Yeah there is some I think there's a couple I could I know personally I could ask moving from charge nurse to nurse practitioner I kind of see both signs.
37:43
SPEAKER_05: So some of my physicians that I have worked with in the past have uh gotten very frustrated when we can't land a patient and have a landing bed available.
37:57
SPEAKER_05: Sorry Kaylee triggering worms breathe through and yeah I'm a human landing pad by the way apparently yeah with a landing pad but I I understand as a provider the frustration sometimes when a patient is somewhere and they need to get to the main hospital or they need to get to a different unit where they can get the care that they need.
38:28
SPEAKER_05: I also understand the frustration as the charge nurse to get the phone call that's like hey you need to move this patient now because I have this other one coming so it's always interesting for me to see both of those play out and I have to tell the you know some of my physician colleagues like they're they're managing 24 beds like they're managing all of these patients like you gotta give them a minute and then even sometimes to the ICU charge nurses that complain about the floor charge nurses like they are man like as a former floor charge nurse like I have them texting me about patients from the clinic they want to directly admit.
39:09
SPEAKER_05: I have the ED messaging me.
39:11
SPEAKER_05: I worked on a post op unit so like I have the PACU messaging me.
39:15
SPEAKER_05: I have the ICU messaging me like I'm getting patients from four different areas and I have two discharges today.
39:22
SPEAKER_05: So like I cannot get all these patients out.
39:25
SPEAKER_05: I have to prioritize it who comes who's going to come to my unit first and sometimes management would tell me sometimes it was my own decision but it is interesting to now be kind of in the middle of that.
39:39
SPEAKER_05: So I was just wondering but you're probably along the same lines of me Dr.
39:43
SPEAKER_01: Tyler of like big picture thinker and not like I think of like I I I I think of big picture which occasionally will get me accused of being heartless.
39:54
SPEAKER_01: I agree I I I I semi di disagree sort of kind of agree with the heartlessness but you know for all for all the people who hate me for thinking of the big picture who hate me for for thinking at a you know a mass market level like that.
40:07
SPEAKER_05: Yeah.
40:08
SPEAKER_01: Like well if not me then who?
40:10
SPEAKER_01: If I'm not the one thinking of of everyone then then then who is like who spokes to and um and I think I I'm trying to agree with you.
40:18
SPEAKER_05: I hope that comes through yeah no I I I no I agree like there is a big picture like you have to think about the big picture and not just one individual sometimes and it can be hard and it can be hard if you're the only one.
40:35
SPEAKER_01: I do think I will and and I'm not just saying this because we're on record here but like I do think if I'm looking at the pie chart of everything that goes into a discharge everything that goes into a discharge the patient's desire to go is absolutely part of that pie.
40:49
SPEAKER_01: It absolutely is um and and I'll ask most patients most days I'll ask them do you want to leave?
40:55
SPEAKER_01: Do you want to go?
40:56
SPEAKER_01: Do you want to leave?
40:57
SPEAKER_01: And I do that partly to incorporate their thoughts and opinions into decision making sure but also partly just to kind of simply get them in the mindset that there's a discharge order coming within 24 to 36 hours whether you like it or not.
41:09
SPEAKER_01: Now of course it's different for every patient like you know if someone's obviously faking their symptoms for secondary gain then their dec their desire to go or save is a very very very small part of the pie chart.
41:22
SPEAKER_01: And if if they don't want to go out I just kind of push through it and discharge them anyway.
41:26
SPEAKER_01: But now think about the patient with metastatic lung cancer who has three months left to live their desire to go or save is a huge huge part of the pie chart.
41:35
SPEAKER_01: You know if this person's at the end of their life and they're suffering I don't want to be remembered as the Grinch who kicked them out to die alone in the streets.
41:40
SPEAKER_01: I'm not gonna do that.
41:41
SPEAKER_01: So I'll I'll be very very forgiving and very patient on letting that patient stay there almost as long as they'd like to I mean we can't just keep them here for all three months but like I'm I'm gonna be much more generous with them and I do think asking them what if they want to go is a big part of the picture too.
41:57
SPEAKER_03: Yeah.
41:58
SPEAKER_02: Have y'all ever been in a situation where like the house supervisor or beds or whatever like dictates what patient comes up like you've had the I wish.
42:09
SPEAKER_02: I wish somebody would like you have a a patient who is on death store all the things vented and somebody else is on Tuoleva Fed but they've been in the E D for two days.
42:22
SPEAKER_02: This patient needs to come up first when I was at that other hospital it was like a a battle and it's like that's you can't get them off that tualiva fed to send it to go to the intermediate floor and side.
42:41
SPEAKER_02: Not that I don't care that that I don't care about that patient on Tuoliva Fed but that patient on Tuoliva fed is less critical in my opinion than the vented patient on depth store.
42:51
SPEAKER_01: I'd have to defer to Abby I d I don't do much with ICU stuff.
42:54
SPEAKER_01: Yeah vented fed is a little over my jurisdiction there.
42:58
SPEAKER_04: I don't think patients sit in the EV for two days like an IC bed here.
43:02
SPEAKER_02: I don't think that is I we don't have that problem here.
43:04
SPEAKER_05: Okay yeah it's I was a floor charge as a as a floor charge nurse and I'm sure Dr.
43:11
SPEAKER_05: Tyler experiences this with the hospitalist group that there are sometimes ad administrator power set view that will dictate who needs to come when so and for me as a floor charge nurse it was more the ED's getting really full we need to decompress the ED so you need to move you need to accept the ED patients first or you know clinics about to close so they can't keep this patient in the clinic but they need to be admitted so you gotta take that one.
43:40
SPEAKER_05: Outside hospital transfers always kind of are they're in a hospital bed somewhere else so they're usually lower on the list which I think is sad sometimes but well it is sad but it goes back to like we have yeah you have finite beds.
43:57
SPEAKER_01: We we have finite beds and and the finite bed Leads lead to hard decisions, and someone has to make that hard decision.
44:04
SPEAKER_01: If that someone is not me, then who is?
44:06
SPEAKER_01: And yeah.
44:07
SPEAKER_01: I mean, maybe it can be a joint discussion.
44:09
SPEAKER_01: Me and the administrators and the chargers can all sit down and pow wow it out.
44:13
SPEAKER_01: Sure.
44:14
SPEAKER_01: But regardless, there has to be a hard decision.
44:16
SPEAKER_01: And when you make hard decisions, someone someone's at risk of getting hurt, and there's simply no way around it.
44:21
SPEAKER_01: And like I said, I wish it wasn't that way, but it is that way.
44:24
SPEAKER_01: So let's talk about it in the way we have to.
44:26
SPEAKER_05: Right.
44:27
SPEAKER_05: Exactly.
44:28
SPEAKER_05: It does remind me.
44:29
SPEAKER_05: Um, it was interesting because we I work very rural, and I was talking to a classmate of mine who lives in New York City.
44:40
SPEAKER_05: We were just talking about the differences in heart attack here.
44:43
SPEAKER_05: And I was like, Well, sometimes it can take, you know, I live so rural.
44:47
SPEAKER_05: Some of these people, it takes four hours in an ambulance to get to me.
44:51
SPEAKER_05: She's like, that doesn't that that's not what the guidelines say, but I can't I'm aware.
44:58
SPEAKER_05: I'm aware, but like the guidelines want to send a helicopter out there.
45:00
SPEAKER_05: Like, what I can't help where they live.
45:03
SPEAKER_05: And then I said, but and then it's even worse if we're full.
45:06
SPEAKER_05: If we don't have a bed, they're they're at these, they have to find other hospitals to send these heart attack patients to.
45:13
SPEAKER_05: If we don't have a bed, we're the nearest stem, we're the nearest heart attack center for them.
45:18
SPEAKER_05: So if we don't have a bed, they have to go somewhere else, and that's even further.
45:21
SPEAKER_05: She's like, Well, all the all the hospitals in your area don't do heart attacks.
45:26
SPEAKER_05: Like, if it's that far out, like why don't they treat there?
45:29
SPEAKER_05: I'm like, Girl, you you gonna get someone to go live in the middle of a cardiologist live in the middle of nowhere and do heart casts and with no CC surgery backup?
45:40
SPEAKER_05: Like, like no, they get lit us, they get lit us, yeah.
45:44
SPEAKER_04: Um they get moved, and th those are the patients, like you got it.
45:49
SPEAKER_04: But it's like I think I can remember twice the whole time I've worked there that I've had divert that we've had to divert a patient for us to be or something like that.
45:57
SPEAKER_04: And that's like what we do.
45:59
SPEAKER_04: That's supposed to be like our number one thing.
46:02
SPEAKER_04: We got the only unit in the hospital that takes a city, and we had to divert, but it was those extenuating crazy circumstances that hardly ever happened.
46:11
SPEAKER_04: And I I mean, I think that's a good if I can say in like the 16 years I've worked in that unit, I can only I only know a few times I'm sure it's happened more than that.
46:21
SPEAKER_04: I think I think that's pretty good.
46:24
SPEAKER_05: Yeah, you know, there's so much to patients coming to the hospital, patients leaving the hospital and keeping the beds open.
46:33
SPEAKER_05: And I just loved how you started it, Dr.
46:36
SPEAKER_05: Tyler, pointing out it is a finite resource, it is not infinite, like it's just not everyone organs and blood products.
46:43
SPEAKER_01: We don't have yeah, infinite transplanted organs, we don't have infinite blood products and staff, we don't have infinite staff.
46:50
SPEAKER_04: No, we don't even that, like the whole thing, like you can say like it's beds, it's narcissists, whatever.
46:56
SPEAKER_04: It's such a big problem.
46:58
SPEAKER_04: Like, I wouldn't even know how to begin to fix it because okay, well, maybe we can get you up and there's a nurse who can take care of you for the next two hours, but not the next shift.
47:06
SPEAKER_04: And so what are we gonna do then?
47:08
SPEAKER_04: Should we just keep you where you are?
47:10
SPEAKER_04: Um, so it's staffing, it's beds, it's you know, people going to the ED for their primary care because they can't afford to go to their regular doctor because they don't have insurance or you know, all of these things.
47:24
SPEAKER_04: And then if where we live, like you said, if you're in a really rural place, nobody wants to go work there.
47:29
SPEAKER_04: So that hospital might not even stay open.
47:31
SPEAKER_04: And if they do, they don't even have somebody in-house who can help you there or however they call them.
47:36
SPEAKER_04: So it's such a big problem.
47:38
SPEAKER_04: And then when I see people, you know, out in the world or social media, or you know, people who've had experiences and they're like, it took so long, and we had to sit there.
47:48
SPEAKER_04: And I'm like, and there's a hundred reasons for that, and I am in charge of none of them.
47:53
SPEAKER_04: I can only do this one thing to help.
47:55
SPEAKER_04: It's so frustrating, and it's just part of this like broken healthcare system that we have in the country.
48:00
SPEAKER_04: Yeah, you know, I I can say all that, but still if you're the one who's sitting there and like your luck ones had a stroke or a heart attack, like it doesn't make you all any better.
48:09
SPEAKER_04: And you know, if I can be as apologetic as I want to be, but I can't control any of it, and it's so frustrating, but you know, I don't that's such a big problem.
48:20
SPEAKER_04: I don't even know like where to start.
48:21
SPEAKER_04: And I think that's what people need to know.
48:24
SPEAKER_04: Like we could fix it, we would fix it if we could.
48:27
SPEAKER_05: Like we wouldn't.
48:28
SPEAKER_05: We're right there with it.
48:29
SPEAKER_05: And we do and we do care.
48:31
SPEAKER_05: That's the other part.
48:33
SPEAKER_05: We do care a lot.
48:34
SPEAKER_01: I do feel like there's a part of this too that like like when people see the word doctor floating over my head, they assume that I'm in charge of everything and I make every decision, and like the rest of the universe does whatever they tell them to.
48:47
SPEAKER_01: And and I want I want to be like, no, guys, I have a very, very, very thin sliver of control over you, and that's really the life-saving decisions that keep that make you your your heart beat or not be.
48:57
SPEAKER_01: That's really about it.
48:58
SPEAKER_01: Anything beyond that, like and and even that, even and even it within that fist thin sliver, it's like 80% of that the nurses do and help me with, you know, and and so like I I'm so minimally involved in your care.
49:10
SPEAKER_01: So when when your mad baby stuck in a holding bed for three days and you're mad at me because you know the ambulance took three hours to get there, like I guys, I'm sorry.
49:17
SPEAKER_01: I I'm just not the right person for the the the blame here.
49:20
SPEAKER_01: And you know, I think I could, but I can't.
49:23
SPEAKER_05: And yeah, it's all I do want to touch on one other part, and I do have a funny story that we could kind of close out.
49:32
SPEAKER_05: Sometimes it's not the hospital, sometimes it's not even the patients.
49:36
SPEAKER_05: If you are getting discharged to like a group home or a nursing home, they also have a bed space limited availability.
49:44
SPEAKER_05: So just a funny story around that.
49:48
SPEAKER_05: I had a patient when I was a nurse, he needed a group home bed and lived with us almost a year.
49:58
SPEAKER_05: And there was one night an ambulance uh paramedics with a patient showed up and they were like, I was like, who is this?
50:07
SPEAKER_05: I was charge nurse.
50:08
SPEAKER_05: I was like, who is this?
50:09
SPEAKER_05: Like, we don't have a patient coming.
50:10
SPEAKER_05: And they're like, Yeah, you do to, you know, room X.
50:12
SPEAKER_05: And I was like, no, definitely not room X.
50:16
SPEAKER_05: Like, I don't know what hospital you're supposed to be going to.
50:19
SPEAKER_05: They're like, this one.
50:20
SPEAKER_05: I was like, well, we have three.
50:21
SPEAKER_05: So are you sure it's this one?
50:23
SPEAKER_05: They're like, Yeah, this one and room X.
50:24
SPEAKER_05: I was like, Well, that patient's been living in that room for nine months now, so I can tell you that that is not it.
50:32
SPEAKER_05: And the paramedic was the EMS was like, You gave away this patient's bed, how inappropriate of you.
50:39
SPEAKER_05: They've been waiting days to come to this bed.
50:41
SPEAKER_05: I was like, I definitely didn't give this bed away because he has not left that room for nine months.
50:47
SPEAKER_05: He leaves it twice a day to come and tell us when he wants his medicines, and that's it.
50:53
SPEAKER_05: Like he come, he walks out to the nurse's usion, says, I'm ready, and walks back into his room.
50:59
SPEAKER_05: I was like, I did not give his bed away, but he was so mad he was like, You gave his bed away.
51:06
SPEAKER_05: And I was like, No, there is no giving of any beds away, but like that's also just like how tense some of the bed situations can get that they were like, You gave it away?
51:16
SPEAKER_05: No, he's lived here, yeah.
51:19
SPEAKER_01: Exactly.
51:19
SPEAKER_01: That's exactly what we have to uh wrestle with.
51:22
SPEAKER_05: Like, he's lived here.
51:25
SPEAKER_05: So well, I this is such a big topic.
51:29
SPEAKER_05: We could talk about this multiple times.
51:32
SPEAKER_05: Any final thoughts that anyone wants to get out as we close out?
51:37
SPEAKER_01: No, this is great.
51:38
SPEAKER_01: I know the topic I mean, I was stoked to see that offered as an option.
51:42
SPEAKER_01: And like you, I could we if you did a four-hour episode, I would sit there and talk about this for all four hours.
51:46
SPEAKER_01: And I'm I'm I'm glad you brought it up.
51:48
SPEAKER_01: And I I'm really excited to see how this comes out when when it gets through editing.
51:55
SPEAKER_04: A shout out.
51:58
SPEAKER_04: Um I would like to give a shout-out and a thank you to all of the EBS workers at the hospitals because like all of the stuff we're talking about, n none of it would happen because you it without you guys.
52:10
SPEAKER_04: And when they're short, everything is stalled.
52:14
SPEAKER_04: So I mean, I don't think they get enough recognition, but thank you for coming and cleaning the rooms and helping us get the patients in and out.
52:22
SPEAKER_04: Um you're not there, it it it's so much harder, it makes such a big difference.
52:27
SPEAKER_02: I think it really shuts us down.
52:30
SPEAKER_04: Yeah, literally.
52:33
SPEAKER_05: That's uh I'm so happy you brought that up, Kaylee, because that is a big piece and it's so important and they don't get the recognition that they deserve of how much they affect these beds and patients moving.
52:46
SPEAKER_05: Yeah.
52:46
SPEAKER_05: So well, we'll probably do a follow-up on this because this is a big topic.
52:52
SPEAKER_05: But do you have any hard discharge stories you want to share?
52:56
SPEAKER_05: What are your thoughts about no room at the inn?
53:00
SPEAKER_05: Do you think we should be building more hospitals?
53:03
SPEAKER_05: What about the staffing issue?
53:04
SPEAKER_05: Again, so much to talk about.
53:06
SPEAKER_05: Send it to us on our website at banter at the bedside.com, or you can follow us on all of our social media accounts, send us a DM, make sure you hit the like, follow, leave us a comment, we read them, and we will bring them back with Dr.
53:19
SPEAKER_05: Tyler for our next episode.
53:21
SPEAKER_05: Until then, from all of us shift talkers here at Banter at the Bedside.
53:26
SPEAKER_05: Bye.
53:27
SPEAKER_05: Bye.
53:27
SPEAKER_05: If this felt is your kind of conversation, make sure you're following, leave us a review, and we'll see you back here soon.
53:34
SPEAKER_05: Bye.
53:35
SPEAKER_00: Step into the live where the story is.