Friday, July 8, 2016

Oldfoolrn"s Guide to Cost Cutting in Healthcare

The cost and financial end of healthcare today takes my breath away. The skies the limit with expenses and it seems like any price can be justified. We were constantly reminded to limit our use of expensive commodities like gloves and to reuse just about anything and everything. We used the containers of big piston syringes as props to hold heavy single hung windows open. Empty cardboard boxes were stuffed with trash and hauled off to the incinerator. If any hospital purchasing agents are interested, here are some money saving tips.

Hospital equipment is grossly overpriced. A Hoyer patient lift can cost as much as $3000. If you would like to save $2800, skip those over priced medical supply joints and hustle on over to your local, friendly Harbor Freight Tool store. You can purchase a $189 engine hoist that can easily double as a Hoyer and save thousands. Maybe you could give the nurses a raise. One caveat, both engines and patients can be prone to fluid leaks at the most inopportune times. Engines leak oil and coolant. There is something about the herkey-jerkey action of patient lifts that stimulate peristalsis. Blue chux pads are in order for patients and absorbing granules should be scattered on the garage floor. If you are a free spirit try the absorbent material for the patient and stick a blue pad under that oil belching engine.
Sometimes the new-fangled replacement for time tested equipment is a joke. We used the 3 bottle set up for closed chest drainage. I did not look this up and I can tell you exactly how a 3 glass (of course) bottle set up is configured: bottle 3 is the suction control. bottle 2 is the water seal and bottle 1 is the collection bottle.  When plastic pleurevacs came on the scene in the early 1970's we figured they would never come into widespread use. They were NOISEY. All that plastic amplified the bubbling sound to the degree that it sounded like we were working inside one of the fish tanks at Shed Aquarium. These fancy noisemakers were not cheap. Glass bottles were readily available at no cost from the pharmacy, pleurevacs were a hundred bucks or so. Bring back the trusty glass bottles and save money and wear and tear on your eardrums.
A no cost, quiet, effective chest tube drainage set-up
The expensive, noisy, alternative

I will let you in on a little secret. All animals on earth are carbon based lifeforms. Homo sapiens have only been around for 200,000 years or so. Inflammation, infection, and disease processes are similar in humans and animals. I think religious entities are to blame for spreading that baloney about humans being superior and having domain over animals. People and animals are more alike than most homo sapiens would admit.

When I took my best friend to the veterinarian she only charged $35 to remove a huge sebaceous cyst from  his back. They say pet owners are much like their pets and in my case this was true, but when I inquired of the veterinarian about removing the cysts on my back she looked at me like I was nuts. Something about licensing laws and such. Think of the money that could be saved by letting veterinarians perform surgery on humans. That would really be something to bark about.

Any type of specialized equipment is likely to be overpriced. A good example is evacuation chairs and I'm not talking about bedside commodes. There is actually a special device for moving patients down a flight of stairs in a disaster. These gizmos probably work but cost several thousand dollars and how do you keep one of these overpriced wonder seats available for disaster use. Ordinary chairs  and wheelchairs are everywhere in a hospital while evacuation chairs are few and far between. With practice a wheelchair can be used to evacuate patients down a flight of stairs. Just go down backwards with the big wheels first. Two people can carry a patient downstairs in a standard chair if you restrain the patient to the chair with a Posey belt. We used to actually practice this with drills.

With the influx of big business types and the corporatization of hospitals real money wasting is as common as infections in pre-Lister days. One of the most costly trends is when business types attempt to quantify completely subjective matters. I'm thinking of those pain rating scales where patients have 10 increments to rate their pain. Whenever I've been in pain, it hurt too much to figure out the difference between a 6 and 7.  When the cost of addiction and all the related pain and suffering is factored in, this has to be a very expensive endeavor.

I'm thinking of starting  a new feature called "caresucker of the month" for the most wasteful use of healthcare resources.  This month the award goes to those who seek to quantify subjective experiences. I suspect they are the same characters that would spend 3 thousand dollars for an evacuation chair.


  1. Veterinary surgery is no longer cheap. I had a small tumor the size of a pencil eraser removed from my dog's ear. It cost 1000 bucks. I can't think of a single surgery that costs less than that these days. If the pet needs to be knocked out you can expect it to run that amount of money at least.

  2. Wow..I guess times have changed. I was always impressed how vets managed anesthesia and operated at the same time. One of my dogs had an umbilical herniorraphy and the suturing was so very neat with equidistant spacing and tension.

  3. I remember having to diagram 3 bottle chest suction on my 1973 RN boards. In practice the glass bottles were always in danger of being kicked over in the crowded rooms, and they were hellish to manage when transferring patients. We also thought the plerevacs were terribly noisy, especially at night.

  4. Our hospital maintenance workers came up with a unique solution to the glass bottle breakage problem with chest suction. They constructed a 3 compartment box out of plywood and lined it with velvet like cloth. There was even a sight glass on the side of the box so you could easily view the contents of the bottles without removing them from the box. I suspect each box only cost a couple of dollars to make and those glass bottles were free. Pleurevacs were the equivalent of a Harley Sportster with straight pipes in terms of noise generation while glass bottles were the BMW R90S. A low soothing gurgling that I will never experience again. Boo Hoo!

  5. Think of the money that could be saved by letting veterinarians perform surgery on humans. RS Glass bottle

  6. This article gives the light in which we can observe the reality. This is very nice one and gives indepth information. Thanks for this nice article. sight glasses

  7. OFRN,
    If you were impressed with your veterinarian’s surgical technique, I have no doubt it was a work of art.