What do Emergiblog, Nurse Ratched’s Place and Kevin, MD all have in common?

We are all participants in Healthcare Today, the place for up-to-the-minute news on healthcare.

That news is as current as your latest blog post!

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The concept is simple.

By submitting snippets of your posts to Healthcare Today, links to your blog posts are posted on  Healthcare Today for others to read.

They see the snippet, click on the link and you have a new reader!

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But don’t be surprised if other people submit your links for you! You see, the key to Healthcare Today is to find the latest news on health anywhere on the internet!

See an interesting article on another site? Maybe FoxNews.com or the LA Times? You can then submit that post to Healthcare Today for all to see.

If you see a post with a Healthcare Today button at the bottom, simply click that button and you’ll be taken directly to the submission page, with the url already filled out for you. So, if I’m on your site, I can submit a post I find interesting. If it has already been submitted, I can vote for it! The more votes, the better!

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By promoting your blog on Healthcare Today, you become a part of healthcare news that people will be reading and talking about. Promoting your blog is easy:

• You add your blog to the Healthcare Today roster and add the html to your site.

• You will then see a button under every post, like the one you see right here on Emergiblog.

• After you write a post, submit it to Healthcare Today with a brief snippet of what it’s about.

It’s that simple.

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Ah, but don’t say I didn’t warn you! Once you are on the site you will find so many interesting topics, you may find yourself clicking away for some time.

I’m having a blast with it, I bet you will, too!

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An original post from www.emergiblog.com.

Many thanks to those who have signed up to host CoS - the page is updated, as is Blog Carnival . If you’d like to host (don’t be shy, it isn’t hard!), drop me an email (Contact button is up top).

A very fast two weeks has passed since the last edition and many contributions have been received, so let’s dive in!

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Keith at Digital Doorway submits the first post of his Value Care, Value Nurses nurse blogger scholarship series with a look at The Nursing Shortage: A Global Crisis, Close to Home. Sobering statistics, and a great overview of the contribution of nurses to health care systems everywhere. Is there hope? Also, if you haven’t done so already, check out NurseLinkUp - Keith is a major part of the new networking site and you can read more of his work over there!

The award for best blog name (I just made that up) goes this week to goes to The Loco Days of Locolorenzo. Mr. “Lorenzo” , self described male nurse, performance poet and a bit of crazy-old-man, submits his first post to CoS in which he thoughtfully looks at why a nurse should NEVER Forget Where You Come From.

Why does this not surprise me one bit? ERMurse submits a provocative post noting: Spike in medication deaths. Could it beeeeeee ……. Satan – or perhaps “The Fifth Vital Sign” . I know I am giving more and more narcotics than I ever used to give, both in frequency and in higher doses. I wonder if the pendulum is starting to swing the other way now. You can find this interesting look at pain control at ER Murse.

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It appears our colleague Disappearing John RN has discovered the joys of blogging at Starbucks! His submission this week deals with something none of us want to face, let alone confront. Find out what that is in A Painful Choice…

I thought I knew most of the networking sites in the medical blogosphere, but I discovered some new ones in 50 Social Media and Networking Sites for the Medically Minded posted by Sally Thompson at Nursing School Search Blog.

Glenna Murdock writes a blog for NurseZone.com called the Nursing Diary. She writes a chilling post detailing just what can be heard (and by whom!) in a hospital setting. Next time you say anything at work Think About Who Might Be Listening.

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Sometimes it’s the little things that count, particularly if you are dealing with a bedridden patient. Nurse practitioner Heather Johnson gives a thorough overview of what to provide in Caring for the Bedridden posted at Nursepractitionerblog’s Weblog

Just when you think you have heard it all…Maha assures us that This Really Happened posted at Call bells Make Me Nervous - Nursing Insights from a Student Perspective. You might need Kleenex, but only because you will be laughing so hard you’ll tear up!

Just when you think you’ve heard it all part deux: it seems the powers-that-be who run Mother Jones’ place of employment are upset. What do they have against diaper wipes, of all things? Find out at Nurse Ratched’s Place as you read about Potty Problems. Seriously.

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The Nurse Connect bloggers are present and accounted for! Laura wonders if we are ever really off-duty as she cares for a family member in A Nurse’s Work is Never Done: Caring for Our Own. Kathy looks at the practice of starting IVs by premedicating with an anesthetic in IV Starts. This is something I have never done, but the research is making me rethink my practice

Nurse Connect is also unveiling their new Guest Blogger Column! Every month there will be a new blogger and a new column! Check out this month’s guest blogger; the topic is the nursing shortage. I would comment on how handsome the guest blogger is, but I’ll refrain as that would not be professional!

Dean of The Back Pain Blog is back (no pun intended) with a look at herniated discs. With the aging of the nursing profession, are we more prone to herniate than someone who is younger? Dean checks out some research and discusses the issue in Are Herniated Discs Caused by Age?

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Just for fun: Therapy Doc tells a great story about why it’s cool to have your kids around (very timely just as my youngest heads for college in two weeks!). Check out Why It’s Good to Enmesh Your Children over at Everyone Needs Therapy. I wonder if they make sippy cups for adults <ducking!>

Alvaro at Sharp Brains weighs in this week with a look at the Top Ten Brain Training Future Trends. The one I see being used the most are Brain training podcasts! I had a chance to see some computerized brain training programs at BlogHer08 - very intriguing!

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Thanks to all who have submitted to CoS this week. The next edition will be right here at Emergiblog on August 24th. Submissions can be sent to me directly or through blog carnival.

I’ve seen some fun Grand Rounds themes over the last few years, but this one takes the cake…or the cheesy poofs!

In honor of the theme chosen by Jake at Pure Pedantry , I’ve co-opted the South Park theme (with apologies in advance to Matt and Trey…)

I’m goin’ down to Grand Rounds
gonna have myself a time.

Friendly bloggers everywhere
posting perfect posts on health care.

Grand Rounds read at Starbucks,
gonna leave my housework woes behind.

Ample parking day or night,
people shouting GIVE ME LATTES!

Clicking links at Grand Rounds
gonna see if I can’t find,

Funny, poignant, information - add my share of commentation

So come on down to Grand Rounds
and meet some friends of mine!

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Okay! I have put up the Change of Shift schedule through the new year on both Emergiblog and Blog Carnival, so if you see a date that works for you and you would like to host, shoot me an email.

The next edition will be here, and I’m taking submissions until tomorrow night at 5 pm PDT so there is still time to send in your best posts!

I don’t think I’ve ever had a patient plead for coffee.

Back in the old days (pardon me, sonny, while I put my teeth in…), patients in the Coronary Care Unit were not allowed to have caffeinated coffee.

No stimulating cardiac muscle in my department!

All we could give them was Sanka.

Freeze-dried Sanka.

It would be a cold day in Hades before I’d be pleading with anyone for coffee, leaded or unleaded. I’d get it one way or another!

Even if it meant my husband had to sneak it in under his coat!

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While at the BlogHer08 conference a few weeks ago, I had the pleasure of meeting Emily Post’s great-great granddaughter, Anna Post. (Yep, THE Emily Post!). Anna writes a blog entitled What Would Emily Post Do? , focusing on modern etiquette and, along with other members of the Post family, contributes to The Emily Post Institute.

Our conversation turned to etiquette in the emergency department, something that was not covered in any of the great books on etiquette available that day.

I remembered writing a post on ER etiquette, and a quick search of the archives turned up “Mind Your Manners and Call Me in the Morning”, first posted back in 2005.

It holds up pretty well, but I thought it could use a bit of refining. So, here it is, The 2008 Emergiblog Guide to Emergency Department Etiquette.

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The easiest way to understand emergency department etiquette is to realize that the majority of the issues revolve around privacy and confidentiality, both yours and that of other patients.

Therefore:

• Don’t ask about the condition or status of other patients in the department. Staff can not and will not discuss another patient with you.

• Stay in your room. Don’t congregate in areas where patient information can be overheard, including hallways or the nursing station. Use the nurse’s bell to summon staff for questions or requests.

• Limit your visitors. Ideally, bring no more than two with you to the ER. However, if you do have more than two with you, the others need to wait in the waiting room.

• Don’t stare into other patients’ rooms or at other patients as they go past on gurneys or in wheelchairs. Staring is just rude, period.

• Keep it to yourself. Don’t repeat what you do hear. Sometimes it’s impossible not to hear what is going on in another cubicle, especially when separated by only a curtain.

• If you are dealing with a very personal issue/condition yourself, it is perfectly okay to ask the staff to conduct your interview in a private area.

The next area of etiquette would revolve around cell phones. Cell phones are now permitted in some hospitals (in all areas except the intensive care unit), so it is important to discuss their use.

• Before you enter the emergency department, tell your family/friends that you will call them once you have been seen at triage. It’s easier on you to have them wait for your call than to have to ignore multiple incoming calls. Because…………

• Answering a ringing cell phone at any time while you are being examined or treated, either at triage or in the treatment room is a major breach of etiquette.

A major source of frustration in the emergency department is waiting. It’s inevitable. You will be waiting. You will wait to be triaged, wait to be treated, wait for test results and wait to be discharged.

• Asking for a time frame, or an update on where you are concerning test results is perfectly reasonable. A specific time can not always be given, but staff is happy to give you an update on your progress.

• Expressing frustration with the process can be therapeutic. Chances are the staff is just as frustrated as you are with any delays. Yelling, screaming and cussing at the staff is inappropriate and will not get you seen/treated/discharged any faster.

Etiquette in the ER is really no different than etiquette anywhere else. “Please” and “Thank you” go a long way. Treat others with the same respect with which you expect to be treated, and remember that the need to be polite does not end at the doors of the emergency department.

A visit to the ER is never easy. Observing etiquette in the ER makes your visit a more pleasant experience, not only for you, but for those around you.

Oh, I don’t even know where to start with this one!

Seriously.

The caps are beyond the pale.

The one on the right is shaped like an envelope, the one in the middle I’ve seen on many a waitress and the one on the left…

…what the heck is that? It looks like she stood under a soft-serve machine.

The Emergiblog Cap Rating Scale may have to go to negative numbers for these specimens!

And is it just me, or does it look like the building on the left is buckling?

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Wow! Emergiblog was listed in the LA Times as one of the best known health care blogs! Many thanks to Melissa Healy, Staff Writer. Check out the list - and congratuations to all the bloggers included!

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Dear Patient Family Member,

Thank you for choosing Superior Medical Center’s Emergency Department for your health care. We appreciate the fact that you trust us to care for your child. We are here to serve.

We would also like to politely inform you that yelling at the nurses because there are “sick people everywhere around here” is, well, confusing.

You see, you chose to bring in your Precious Polly Pumpkin with her baby boo-boo to our nasty, infested “icky” place of care.

Then again, perhaps you did not know that the emergency department is a hotbed of illness.

Let us tell you about the sick patients, as you seem most concerned with their presence.

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We have patients who are febrile, vomiting and having diarrhea in the next room. You say you saw a patient walk by with their official Tupperware vomit holder. They walked by your door on their way to the bathroom.

We apologize for what must have been a traumatic visual.

Ever heard of MRSA, or that “bad staph infection everyone is talking about”? It was right here, up close and personal, about two doors down from your room.

Across the hall was Harry Homeless. He brings his pets with him. Actually, they live on him 24/7. And yes, that smell was quite obnoxious. It’s called alcohol with a hint of urine incontinence. Yes, we are quite sure pretty Polly is not used to hearing such language. We apologize for the auditory assault.

Oh, the x-ray that took, like, forever? We’re so sorry, but those folks having strokes, bowel obstructions, appendicitis and dissecting aneurysms need cat scans and take precedence over Polly’s puny pinkie injury.

But, then again why should you have to wait just because they are there?

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Our apologies for not being the Ritz-Carlton. You see, for every affluent patient/family with a sense of entitlement, such as yourself, we see ten economically challenged patients who need our services. For every patient/family who has to peer down at the lowly emergency department worker bees because their nose is so high in the air, there are ten patients who are grateful we are available to them.

You want a germ-free environment for your offspring. Unfortunately there isn’t an emergency department in the world that can make that claim.

Including ours.

We apologize for not meeting your expectations, and hope that if you do find a ER that can, you let us know.

Sincerely,

Superior Medical Center RN

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Original post from www.emergiblog.com

The 2008 Pan-Mass Challenge.

What it is:

The Pan-Massachusetts Challenge raises money for life-saving cancer research and treatment at Dana-Farber Cancer Institute through an annual bike-a-thon that crosses the Commonwealth of Massachusetts.

Why I’m involved:

This is Dr. Sam Blackman, and with him is Miss Rebecca Hopkins.

We know Sam as Blog, MD.

Rebecca knows Sam because he is her oncologist.

Every year, Sam rides in the Pan-Mass Challenge to raise funds for pediatric oncology research. It’s a cause I have been honored to support since Sam first emailed me about it a few years ago.

This year, Sam won’t be riding. He has a new location and a new job in cancer drug development.

But Rebecca will be riding in his place, in memory of and for his patients.

Sam recently gave a talk at the Pan-Mass Heavy Hitter banquet.

I suggest you get a cup of coffee and your Kleenex while you watch the presentation.

2008 PMC Heavy Hitter Banquet Talk: Dr. Sam Blackman

And when you are done, go to Rebecca’s site and send in a donation.

I did it for my nephew, who is being treated for leukemia.

We might not be able to ride, but we can make a difference by supporting those who do.

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An original post from www.emergiblog.com.

A clever ad, and absolutely true if you are a physician or medical student. You really do “bet your youth” during the years and struggles of a medical education.

So, it’s not surprising that Dr. Edwin at edwinleap.com chose “Why Do We Do It?” as the theme for his first stint at hosting Grand Rounds.

Edwin struck a chord, as many responded to his question. He even found a way to include non-bloggers in the responses.

A great, inspirational edition! (PS - check out the entire site, the blog is just one section!)

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Grand Rounds will be undergoing some changes after almost four years of providing a place for med bloggers to meet and exchange ideas. Oh, the ’rounds aren’t going anywhere, but they will be under new “management”.

Nick Genes, the Father of Grand Rounds and blogger at Blogborygmi will be stepping down as the organizer as of this edition. Many thanks to Nick for the hard work and dedication it took to establish (and keep) what has now become a blogosphere tradition for all (and Tuesday morning latte time for me!)

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But have no fear! Grand Rounds will be in the capable hands of Colin at Medskool and Dr. Val at Revolution Health. The Grand Rounds schedule can be found here.

Good luck to our two new go-to bloggers.

Nick is leaving Grand Rounds in good hands!

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An original post from www.emergiblog.com

Okay, I will admit it.

I love Richard Simmons.

I get a kick out of him.

His aerobic videos are great. Back in the old Deal-a-Meal days I lost 25 pounds in 20 weeks.

I’m not even dieting and I belong to his website

I wish he had a “Blogging to the Oldies”.

Because the truth of the matter is that Emergiblog got FAT!

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On some modems it was taking 2.5 minutes to load the site.

Heck, that’s about how long it took to load websites back in the days of 2400 baud, circa 1994.

Whoa.

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So…Shane is doing some behind the scenes work to give Emergiblog a waistline again.

One of those things was to move my rather extensive BlogRoll to its own page.

You can see it at the top, on the button bar.

It’s still in progress, so while it seems like entire sections were cut, they are just waiting in queue to be moved over.

I loves me my BlogRoll and I think it looks great on it’s own page.

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Many thanks to Shane (as usual) for being the brains behind the blog helping me get Emergiblog back to a size 10.

Now if I can just get Richard to help me do the same…

Wow. I’m not even sure where to start.

There is an article in Slate today regarding emergency room care. “Waiting Doom: How Hospitals are Killing E.R. Patients” was written by Dr. Zachary F. Meisel and Dr. Jesse M. Pines. They are emergency department physicians in Pennsylvania. (h/t to Robyn at An Interior Life)

This post is a response to their article. Before you continue, please read their article in full, as I will be quoting from it and it is important that the quotes are taken in context. It is linked above.

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The article begins by summarizing the case of Esmin Green, the poor woman who collapsed in a psychiatric ER receiving no help for an hour. As we know, by then it was too late. The authors noted the autopsy showed she had suffered a pulmonary embolism.

They also equate sitting in a waiting room chair for 24 hours as being “roughly the same time as a trip from New York to Tanzania”, meaning, if I understand it correctly, the risk of pulmonary embolism would be equal. As written:

“But what’s largely missing from this story is the likely cause of Green’s pulmonary embolism. The answer lies in a far more systematic and widespread danger in hospital care: E.R. waits. Why was Green sitting and waiting while blood pooled in her legs?”

I am confused. Did she sit the entire 24 hours? Did she not get up and walk to, say, the bathroom, or to grab a magazine or get a drink of water? Was she fed during that 24 hours? Didn’t she have to move to eat?

The fact that she had to wait so long for an admission is inexcusable. The fact that no one came to her assistance is nauseatingly horrific. To say that the “likely cause” of her PE was blood pooling because she was sitting in a chair in a psych ER waiting room (as opposed to what, her hospital room/day room?) is ingenious.

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I am aware that my impression of emergency care comes from my working in smaller community EDs. I’ve never worked in an inner-city ED, so my perceptions may be skewed. But my jaw dropped when I read this: “…hospitals have incentives to keep their E.R. patients waiting.”

What? I’ll return to that in a minute.

The authors do a great job of describing the hazards of boarding patients in emergency departments - it is concise description of why it happens and why it can be dangerous. I have no issues with this, in fact I agree with them.

Let’s get back to those hospital “incentives” regarding ER boarding. The authors state:

What hospital would promote such a practice? Potentially, those that profit more from boarding, particularly in poorer communities with high numbers of uninsured and Medicaid patients.

The authors believe that because the ER patients are likely poorer, the hospital leaves beds open for direct admits and transfers instead, as this patient population is more likely to be insured. Ergo:

Do the math: If you fill your hospital with the direct and transfer admissions and maroon the E.R. patients for long periods, you make more money….In effect, then, E.R. boarding allows hospitals to insulate themselves from the burgeoning needs of the poor.

Or, if they keep the ER full, then the average non-emergent patient will get up and leave, saving the hospital money. This has not been my experience.

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Rich, poor, old, young, drug-seeker, homeless, insured or not (and we see everything, albeit at a less intense level than an inner-city hospital) if there is a bed in the hospital you get it - and you don’t wait in line.

The hospitals that I have worked in don’t want AMAs or left-without-being-seen patients, it’s a sign (usually) that something went wrong. In fact, they are constantly working to lower our door-to-disposition time and still maintain a high standard of care.

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In all fairness, the authors point out other reasons a hospital will keep patients in the ER. Noting there are often strict nurse/patient ratios for the floors:

Sometimes the nursing ratio in the E.R. can be as high as 8-to-1. That’s unacceptable in inpatient units, but just stack ‘em in the E.R. hallways and suddenly it’s OK.

I have experienced this, and usually it’s because there are not enough nurses on the floors to take the new patients. Or the nurse upstairs is overwhelmed and needs more time, thinking the next shift is better equipped to admit the patient:

So you tell the E.R. nurse that the bed isn’t ready yet. This practice of “bed-hiding” is more common than you think.

Having not worked the floors in 17 years, it’s hard to address this. Sometimes, knowing a patient is going to be admitted, the hospital will staff UP for the next shift and the patient is held until then. Even so, it’s 2-3 hours at most.

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I came away from this article with mixed feelings.

On the one hand I have a hard time believing that hospitals are intentionally making people wait in ERs, hoping they will leave, or are actually “cherry picking” who gets a regular bed and who stays in the ER, or that it’s a conscious decision to deny care to the poor.

On the other hand, long ER waits are a fact and there are ways to increase the turn-over in emergency departments, so that patients can be seen in a timely manner. It’s good for everyone, patients, doctors and nurses.

There is nothing wrong with making the case for decreasing ER wait times. While I find their conclusions regarding the intentions of hospitals dubious, I agree that decreasing wait times makes for better care.

But, blaming the death of Ms. Green, an ambulatory patient who had already been evaluated for admission, by stating it was “likely” she died of a PE due to blood pooling because she was sitting in an ER waiting room is speculation at best.

The horror isn’t that she had to wait.

The horror is that no one cared enough to help.

Welcome to Volume 3, Number 2 of Change of Shift!

New year, new logo!

I tried, I really tried, to make a logo that wasn’t blue but I just could not do it.

I just love blue on blogs!

Many thanks to all who have contributed this week, and to those who contributed but don’t realize it yet!

As soon as I am done with this edition, I will be updating the CoS calendar to run through the end of the year. If you are interested in hosting an edition, just let me know!

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I’m going to start off with a nurse blogger who is so new, she only has three posts! Meet FlautoNP, a nurse practitioner who is also a flautist! She posts a hilarious video that happens to be The Best Way to Learn Arrythmias. Be sure to watch it to the very end. (She will also be rather surprised to find it on Change of Shift, but I saw this just could not resist! ) Welcome to the blogosphere!

Our Mother Jones tells us the conclusion of her recent work predicament in It’s Always the Nurse’s Fault, Part II at Nurse Ratched’s Place. (For those who missed it: Part I) Alas, no Las Vegas for her. (I can’t even think of Las Vegas without that atrocious “Viva Viagra!” commercial popping into my head! Ugh!)

I don’t know about you, but nursing has done a number on my back! A long time contributor to Change of Shift, Dean Moyer of The Back Pain Blog shares information about Aquatic Therapy for Back Pain. Be sure to check out the cartoon at the end - and make sure you have swallowed all beverages before you do! : D

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Miss Elaine gets her first patient with an acetaminophen OD in Acetaminophen: Good for Headaches, Bad For Liver. Don’t forget to send congrats her way as she has passed all tests and is officially an RN! You can find her blog at Miss-Elaine-ious,RN.

Jen Carroll was voted Valedictorian of her nursing class and presents a great post on Writing a Valedictory Speech. What is amazing, is much of what she wrote can work for any speech or even writing for your blog! The speech itself gave me goosebumps and took me back to my own pinning ceremony. Well done Jen, and congratulations. Her entry can be found on mendelbrot!.

Have a patient who is going to be laid up for awhile, or ever find yourself in that position? Just thinking about puts 10 pounds on me. In Forced to Rest? Watch your Weight!, Heather Johnson goes over some tips that can help your patients avoid weight gain associated with enforced rest. While Heather usually posts at NursingDegree.net, this post can be found at Lose That Tyre. Heather gets around! She also wrote a post on Relaxation Tips for Nurses at Stuffed Nurse. I’m not sure what a “stuffed nurse” is, but it’s pretty much how I feel after a pot luck.

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Over at NurseLinkUp there is an article by Keith entitled: Measles, Mumps and Rubella, Oh My! A great overview of vaccines for healthcare workers, It hit close to home as I just had all my titers checked. I’ve had measles, mumps, rubella, varicella - it’s a wonder we nurses-of-a-certain-age made it through childhood!

Katie Bee links to a story about overworked (and penalized) social workers as she wonders Could We Switch the Word Nurse for Social Worker? posted at Young and Restless Nurse. Sounds like they need mandated ratios.

The Nurse Came With the Room is a thought provoking post by Nurse Kathy at NurseConnect wondering just who will be held responsible for preventing the hospital-acquired conditions that will no longer be covered by Medicare/Medicaid. Weigh in with your opinion in the comments section. Then check out Kathy’s take on Nurses and the Media. Have we made any progress?

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What makes a nurse a “Professional”? Nurse Laura at Nurse Connect has some ideas in Professionalism: Is it Different in Our World? Are we different? Should we be different? Join in the conversation at Laura’s blog.

With an aging population, we will be caring for larger groups of older patients. Alvaro at SharpBrains looks Computerized Cognitive Assessments: Opportunities and Concerns. You’ll be surprised at who is using computerized cognitive assessments and why!

Okay, it’s official get-out-your-kleenex time. New nurse RNTed paints a vivid picture of critical care and connecting with her patient in Interventions and Outcomes posted at Vertical & Ventilating. Beautiful post

Oh man, Beka at Medscape Nurses read my mind when she penned Are You Ready to Quit Nursing? Surveys reveal that unbelievable numbers of us are ready to at least leave our current jobs. Find out what the survey said and discuss the state of your workplace!

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And that’s it for this edition of Change of Shift! Our next edition will be on August 7th right here at Emergiblog. Be sure to check out the schedule once it is up for future editions and hosts!

Thanks for reading!