I don't like others interfere with my patient nor my treatment plan; but sometimes I can't resist them ..... Today the hospital the head of development section(HODS) had come to our resting room while I was having a chat with my colleague L....
He asked L if 2 of the patients could be transferred to ICU as the ICU a little bit empty..... The HODS is not a doctor but an administrative staff, why did he requested so ? ---> it is all about this hospital bussiness....
In the past when the General Insurance Scheme(GIS) just started - its budget was unlimited. All the hospitals treat their patient and claimed the fee from the GIS office. The GIS office then select some of the records and examined it in a very detail manner. If any drug/examination is inappropiate the GIS office would fine the hospital according to the ratio of the selection - if 1 records was selected from every 200 records then the fine = fee of inappropiate examination x 200. The hospital could appeal though but it would take months for the final decision to be made. At that time, if 3rd generation antibiotic was prescribed in a small hospital there was always a 50:50 chance it would be deemed as inappropiate and appeal was needed to justified it's usage. So the small hospitall would tend to transferred critical patient to major hospital. And more transfer means the hospital was more incompetent thus jeopardising their name. The bigger hospital however enjoyed some better treatment - less fine and less appeal. Under this scheme, some of the smaller hospital could barely survived and shut down - this include some urban area and thos people who lived around would face the lack of medical resource as they had only 1 hospital around their area. The bigger hospital had developed into creature and consumed most of the budget. The GIS office has sufferred a great loss and the loss were filled by the government treasury. Finally the government decided to put an end and the GIS started the budget system....some sort like the British scheme. Each hospital were allocated a budget every quarter - if you get whatever you did as long as you don't exceed the limit, and if you did more than the budget you won't recieved more. So the hospital would like to do slightly over the target but not underdo it....
Due to the above scheme the hospital hired this HODS to push the bussiness a little bit....And from time to time, he would monitor our in out and "managed" our patient... I am just an employee: I need to comply to this strategy...
Anyway, I had this patient X who was not the critical but unstable was "requested" to the ICU as there were 2 empty patient..later another patient had some complication during a pigtail insertion for pleural effusion was sent into the ICU... By evening, there was this 80+ y/o female who presented to our ED for generalized discomfort who I noted with a full bladder on examination. A cathether was introduced and urinary tract infection with leukocytosis was noted. I admitted the patient to ward and on the way up - the lab informed me that her BUN was 165 mg/dl and Cr 14.1mg/dl respectively...I hailed the patient in front of the lift and sent her to ICU instead. No sign of hyperkalemia and pulmonary edema was noted. I had a discussion with the attending nephrologist and no emergency hemodialysis indicated.
While I was writing order in the ICU, one of the nurse grumbled,"see, why transfered patient X(my patient - which was requested....) to ICU, see now we are +1...". I got a little pissed off...I told the nurse, " well, our HODS did not know this patient coming and he don't know that I would admit another 4 patients into this ICU for the next 8 hrs..."(just kidding in a sarcastic way, where could I find 4 critical patient ? actually what I wanted to say was the HODS is not god and neither me...) +1 bed means more loading, but need not grumble, I dislike such situation as well....Only 1 word I would said- Lazy and attack of mouth itchness syndrome....I blame no one but this system : It took good care of the local people but the local people never appreciate it....
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