Military hospitals like DC's Walter Reed could ease national ER overcrowding, save lives

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dr zaius

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Military hospitals like DC's Walter Reed could ease national ER overcrowding, save lives

Haven't seen this gem posted yet. Interested in commentary from those of you who have been at The President's Hospital.

Many, many things would need to change before we could safely take street trauma, even if it is just Bethesda I-rolled-my-golf-cart-over trauma.

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It would probably be fine but they would have to improve the quality of the ER staff. The trauma surgeons are actually really strong as they spend a good deal of time at shock trauma moonlighting. Need to buy more ECMO and get that system going. They would also need to hire more nurses, we go on divert with open beds due to nursing shortages.
 
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It would completely wash away the country club mentality of the old NNMC. I agree that the ER,which functions more like an urgent care facility, and would have to be staffed with more active duty trained ER physicians. Also, we would have to open more than 40% of the ORs. We would need more nursing and social work staff. It would be a complete culture shift. I am all for it.
 
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Seems like a pipe dream. Ive never worked WR, but if it's 6% like any other military facility, you'd get so much nursing pushback due to the increased staffing needs of having a larger ER and a trauma OR-in-Waiting that it'd get shot down faster than a nerd at the prom. It's never about what more the military system could do. It's about how little can be done for the same pay.
 
Sadly true, and a problem with salary based models versus incentive based models.

It's not the salary that's a problem, many hospitals pay all on salary vs hourly wage. What would need to change is hospital leadership's mentality in that anyone can be canned for not doing their job, just as their civ hospitals would do.
 
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It wouldn't be hard at all to get the nurses on board. Simply hire twice as many civilian contractors as needed. Then the active duty nurses can sit on their ass all day or moonlight across town. Whichever suits them.
 
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It's not the salary that's a problem, many hospitals pay all on salary vs hourly wage. What would need to change is hospital leadership's mentality in that anyone can be canned for not doing their job, just as their civ hospitals would do.

Are you sure they don't also have an RVU bonus system as well? That seems to be what I have noticed and heard from friends on the outside. Ones that are straight salary probably have similar "don't pester me with extra work" mentality.

And while it is VERY hard to fire government employees, it is pretty darn hard to fire people at civilian places as well. The main issue on both sides of the road is the leadership's willingness to document and follow the protocol property.
 
SAMMC does it everyday, and Madigan is a level II trauma center, so it is hard to argue it is impossible or can't be done in the military. It isn't trauma surgeons, or in house neurosurgery coverage etc. that holds up other hospitals from level I or II trauma status. We have the physicians and sub-specialty physicians, it is just the huge category of 'everything else' that we would need (we would need more ER physicians). The ICU, ward, and consulting services would all be busier, and would require more physicians on the wards so this would impact access to outpatient care. The RVUs for consulting time spent in the ICU is much higher (but that implies that someone is properly capturing this work load). Again, it would completely kill the country club that was NNMC and the days of 2 patients admitted to the medicine service. Bring it on.
 
And the need for more work from more people is why I don't see it happening. The Army is big on "technically" offering services while not really supporting them with manpower or funding, and the minute you try to force the issue, someone gets their panties in a bunch because they think they're expected to do too much already. Plus, there's no way they'd properly capture the work load. They're absolutely terrible at doing it, and they'd need to bring in an outside consultant to teach them, AND they'd have to listen to what the consultant says. Even if they did it, it would last until the next CG came around and decided his OER bullet was going to be something about saving money and decreasing unnecessary funding, and he'd start shutting that down because the Army doesn't see skill maintenance as an issue, but spending money on civilians is.

The Army -could- do anything it wants with its medical system. It basically has an unending well of money. But it's too inefficient and too short sighted, and ultimately taking care of civilians isn't its mission. So I don't see it.
 
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I don't know, active duty nurses O3 and below carry all the weight at WRB. Can't speak for the more senior nurses as they only do admin.

Over time WRB has become a pretty big medicine heavy hospital... big business is supporting the cancer center and all of the complications that drives. I was never there during the NNMC days but medicine services are probably admitting about 15-20 a day. God forbid dc VA is full bc they are coming. Surgery services have languished with the end of the big medevacs.

It's really not a lot different from most hospitals and I've been to all types. That being said, I dont like the tone of that article ****ting on WHC- that is a hospital of last resort for the area and they do a pretty good job with the terrible cases that cross the door. I've done a good bit of training there and hope that kellerman et al are not torpedoing a good relationship we have with that hospital training wise.
 
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I don't know, active duty nurses O3 and below carry all the weight at WRB. Can't speak for the more senior nurses as they only do admin.

Over time WRB has become a pretty big medicine heavy hospital... big business is supporting the cancer center and all of the complications that drives. I was never there during the NNMC days but medicine services are probably admitting about 15-20 a day. God forbid dc VA is full bc they are coming. Surgery services have languished with the end of the big medevacs.

It's really not a lot different from most hospitals and I've been to all types. That being said, I dont like the tone of that article ****ting on WHC- that is a hospital of last resort for the area and they do a pretty good job with the terrible cases that cross the door. I've done a good bit of training there and hope that kellerman et al are not torpedoing a good relationship we have with that hospital training wise.

Agree with pretty much all of the above.
 
That's because, after O3, active duty nurses stop doing clinical work, gain a clipboard, a chip on their shoulders, and a "glandular problem"/profile.
And not to mention, they've taken quite about enough from you physicians. It's time to set the record straight!
 
Military hospitals like DC's Walter Reed could ease national ER overcrowding, save lives

Haven't seen this gem posted yet. Interested in commentary from those of you who have been at The President's Hospital.

Many, many things would need to change before we could safely take street trauma, even if it is just Bethesda I-rolled-my-golf-cart-over trauma.

They would be better off joining the Capital region network of trauma hospitals: MEDSTAR Washington Hospital Center, Inova Fairfax, Johns Hopkins Hospital and R. Adams Cowley in Baltimore or at least step up to a real Level II service. The nearest Level II is at Suburban Bethesda, a Johns Hopkins affiliate.

If they aren't prepared to accept helicopter traffic, they should forget it. Even level III centers in DC-MD-VA get regular air evacuations. And it doesn't just end with the ED, the entire inpatient service has to be prepared to support ED admissions. Knife and gun could cross the border or get diverted from P.G. County. They are near the Beltway/270 so MVA trauma could be received. Most of that goes to Medstar or Baltimore now.
 
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