How to Go To a U.S. Hospital in 2022
Welcome to the hospital. You may have heard that we're understaffed. We are. We are no longer in a position to live up to the hospital experience you had back in 2019.
This post is about how to get the best possible care despite these trying times. Much of it is also applicable to long term care facilities and other institutions who are running on empty.
Consider: Do you have to go to an emergency department to get the care you need? If you need a prescription or a covid test or an inhaler or an x-ray or a STI test or basic diagnosis and otherwise you're probably fine, go to your doctor, a quick clinic, or an urgent care. You will not get care faster in the emergency room. I promise. Go to the ED if you are reasonably sure you would die or lose a limb if you didn't.
The ED is not first come first served. People who are going to die if they are not seen get seen first. If you are stable, even if you are in pain, be prepared to wait. At the height of covid we had stable people waiting for over 24 hours in the waiting area. We also cannot legally tell you to go somewhere else, even if we're pretty sure you're not sick enough to get seen anytime soon.
Bring your home meds. You are going to be there a while and you might not get in a bed in time to get your next dose. Even when you do, it takes a long time for a doctor to order your home meds. We never intended you to stay here for 4 days, so the infrastructure isn't there. Also, bringing your home meds is going to save you money.
RE: the above- tell us what you're taking, when you're taking it. We do want to know that so we don't give you anything that would interact with it. We also really want you to keep taking your home meds so you don't get worse.
Bring a charging cord for your phone, a change of clothes, a book, and if the visitation rules allow, a friend. You're going to be here a while.
The Emergency Department is designed to figure out what's wrong with you and do things that will save your life or help you leave the ED without having to get admitted. Sometimes the ED will treat pain, but each pain medication dose is ordered separately, so it's probably not going to be on the time scale you want or need. I hate to say this, but do keep asking. We have been really conditioned to assume if you stop asking, you're not in pain anymore.
If they tell you not to eat, or not to take a certain med, follow that advice. I know you've probably been there for a while and no one's told you why you can't do these things. That's not great. Ask why if you can, but assume the request is legit.
In order for you to be admitted, you need to be sick enough that they can't just kick you out with a cab voucher, a prescription, and a turkey sandwich. That's pretty dang sick these days. Pretty much, you have to be in danger of dying or losing a limb if you don't get admitted. And also, a bed in the hospital has to become available that can accommodate your needs. This usually means someone else has to get discharged or die. That might take a while, because they were just as sick as you when they came in.
So they decided to admit you, a bed became available, and transport finally showed up to take you to your new bed.
Bring the following: A charger for your phone (I know you'd think we have these, but I swear we don't- they've all been stolen). If you smoke, bring nicotine lozenges or gum (you can't smoke or vape here. We have patches, but if you wait until you need a cig, it's too late for a patch to work, and if you try to sneak out most places will not let you back on the floor and you'll have to go back to the ED). If you have heartburn regularly, bring tums (we can order you tums, but you'll only be able to take like 1 every other hour, and let's be honest, if you use tums you usually need more than that). If you take a weird med, bring it (especially HIV drugs, chemo drugs, and meds for autoimmune conditions, because it takes forever to get some of these because we don't always have them on site). If you have severe allergies, consider bringing your own food. Seriously.
RE the above: Tell us what you're taking, when you're taking it.
Do not bring narcotics. There's too much liability on our end. Both because we cannot control how much you take if they are in your possession and if we find them we have to call security to watch us count them and store them in a locked drawer and which will be destroyed in 30 days if you forget to ask for them on the way out. It's just a hassle and someone is always in danger of getting sued over it.
If you drink more than 4 drinks a day, or use street drugs, tell us. Tell us please please tell us. We will not tell the cops. If we know, we will then be able to ask you questions about your withdrawal symptoms and can give you meds to control them. If you wait until you start swinging at us and having seizures we will not be happy.
Also, if you're on MAT, tell us. We don't automatically re-order suboxone or vivitrol like we do other meds. Addiction med has to be consulted, come see you, and work miracles to get that ordered for you while you're in the hospital.
If you see pain management, tell us as early as you can. Pain management has to be consulted and then work absolute miracles to get the admitting providers to order your home regimen, because anything more than 10mg of oxycodone every 4 hours is terrifying to them, even if you take 160mg of methodone everyday at home without a problem. The sooner they know you're here, the less likely you'll be miserable for a week before those things can be re-ordered.
Also, bring a friend. Seriously. I'm not kidding please bring a friend who is willing to help take care of you- things like turn you, help you dress, feed you, hold your hair back when you puke, and change your sheets when you pee the bed. And please bring someone you feel will follow the rules and ask before getting you something. You don't want to stay longer just because your friend brought you food you weren't supposed to eat because they felt bad for you.
A scheduled event is not really scheduled. Yes, you might have been told that your surgery is scheduled for 8am. You might have been told your dialysis was going to be "this afternoon". These things are not set in stone, and unless you are literally and currently dying, nothing is happening "right now". I have watched people wait days for appendectomies, gallbladder removals, displaced fractures, and other urgent-but-not-immediately-life-threatening problems. All a late intervention means is that someone else would have died if they did it as scheduled.
MOVE. Barring an unstable pelvic fracture or two broken femurs, if you can get out of bed and walk around, walk (ask your nurse if they want you to ask for assistance when you get out of bed to prevent falls). If you can't, sit up in a chair for part of the day. If you can't do that, move around in bed- roll back and forth, bend your knees, point your toes, do anything to keep you moving. If you're in pain, take pain medication strategically and move when it's most effective.
6:30 to 9:30, day or night, is the worst time period to put your call light on. Report time is 7 o'clock, meaning we have about a half hour to learn about our patients and set up our day, after which we have about 15 mins allotted per patient to assess the person, discuss goals for the day, find and pass daily medications, get vitals and blood sugar if applicable, and do anything the patient needs to get them set up for the day (water, pain meds, set up tray/feed, toilet, etc...). Put it on if you need to, but know that it will take a lot longer to be answered during these time periods than any other time of day.
You can refuse anything you want to refuse. You just can't sue us about it later. You can even say "I know you told me to do this thing, I am not doing it, please document accordingly". We will probably try to explain the consequences of not doing the thing. I recommend you listen, but the choice is certainly and always up to you.
You can leave against medical advice. It is also a thing you can do. As long as you let us tell you the risks, you can leave with prescriptions, education, and a wheelchair ride to the front door if you care to stick around for an hour or so after you declare you would like to leave. Some insurance companies have rules about this, which you can find by calling them. Just call and ask "what are the consequences of leaving against medical advice?" Some insurances don't have any consequences, some will completely refuse to pay for the stay, and some will refuse to pay for a second ED trip or admission within 30 days for the same problem.
Our prioritization system is: Critical (CPR, evaluating changes in status, dealing with changes in vital signs) Urgent (bed change for incontinent patient, pain/nausea/time-sensitive meds, drawing stat labs, answering phone calls from doctors, etc..) Routine (scheduled meds, scheduled assessments, calling family members, basic comfort things, ambulating patients, education, etc..) and Extra (everything else that has to do with comfort but isn't necessarily going to change outcomes).
I have had whole shifts where I don't do anything that isn't critical or urgent (with one routine med pass that was really late). I've rarely had a shift in the last 3 years where I've been able to do anything extra.
We're doing our best. Seriously. Nearly every shift I've worked has been absolutely flat out for 12 hours, and it takes a solid 2 days actually to recover from 2 days in a row of work. I would say I rarely get a full lunch break. Our patients are more and more complicated, and the decisions higher and higher stakes. Please understand. If you or a loved one hasn't been seen by the nurse in a few hours, it just means we're not as worried about you as the person down the hall who keeps trying to die.
We wish we could give you 2019 care. We really, really do. We don't have the resources for that anymore. We are triaging. The hotel vibe they were trying to present in 2019 is in the facility design only. You have to bring your own bells and whistles. You have to help us help you now.
