Signs

Issue: BCMJ, vol. 52 , No. 4 , May 2010 , Pages 168 Editorials

“Hey Bob, get dressed, the jig is up.”

“Tell me it isn’t true, Doc, what happened?”

“They’ve put up the signs.”

“OMG, not the signs!”

“Afraid so, Bob. I know things haven’t been very good at home with the wife but I’m afraid I can’t hide you in hospital any longer. The hospital Bed Needs Report signs are up. Apparently, we have 20 patients ad­mitted to Emergency and 15 patients in over-count beds/stretchers on the wards. When this happens the signs go up. These signs remind us physicians to discharge all the patients we have in hospital unnecessarily. So, I am sorry, but you have to go.”

“How can you do this to me Doc?”

“Do this to you? What about me? You think you have problems? I now have to move my in-laws out of room 408 and let them stay at my house.”

These signs have become a regular occurrence over the last decade at my hospital. The names have changed—Utilization Report, Decongestion Plan, Bed Needs Report, etc.— but the message has been constant. They outline how many patients are admitted to emergency and other “non-regular” beds. Somewhere on the sign is usually written, “Please help with discharges.”

Does anyone else find this message offensive? Hey, maybe the problem isn’t bed utilization but the number of beds? Does administration really think we have patients lying around hospital for no good reason? Do they think that misguided patients want to linger in our aging and occasionally smelly hospital? 

If this is the case, then these patients should definitely have mini-mental status exams and psychiatry consults. The problem isn’t inefficient physicians or holidaying patients. The problem is the lack of acute and chronic care beds. 

I am not going to discharge a patient prematurely just to satisfy a global overcrowding problem that I didn’t create. Doctors don’t make ill patients requiring admission. Our duty is to do the best for the patients under our care, and if that means keeping them in hospital longer than what administration deems, so be it. Inevit­ably, lengths-of-stay statistics are then quoted. 

These regional figures are touted as the standard of good care, but is it a good thing if an institution has a shorter average length of stay for hip replacements? This number does not measure the patient’s suffering or associated strain on their caregivers.

So okay, I am a little annoyed. I am so annoyed that I am considering putting up my own signs. How about these? Food Terrible, Please Up­grade; or Floor Dirty, Administration to Clean; or Nurses Grumpy, Please Fix; or Physiotherapist Not Available to Walk Patient, Administration to Do; or, perhaps most appropriate, I’ll Do My Job And You Do Yours.

I really think I need a holiday.

It just seems that the focus has shifted to getting patients out of hospital as soon as possible, instead of making patients the most comfortable while in hospital, thereby facilitating their recovery—the ultimate goal be­ing their reintegration to their hopefully productive and happy lives. I have a feeling I would never survive as an administrator. 

I think I’m getting grumpy in my older years. Pretty soon I’ll be spending endless hours on my porch in a rocking chair complaining about the world. However, this would be short-lived as they would likely put up a sign discharging me to the basement. 
—DRR

David R. Richardson, MD. Signs. BCMJ, Vol. 52, No. 4, May, 2010, Page(s) 168 - Editorials.



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