In theory it works really well when it gets proper money. But in my opinion mega hospitals have more wait time and are very busy. That is why I hate going to mega hospitals.
I have been to hospitals that look better than that.
sorry the above should read I have been to hospitals in industrialized countries that look better than this
http://www.mobridgehospital.org/images/contentmgmt/ER_web.jpg
I wonder how much of it is patient driven as well. I work at a very large “mega” hospital that is very well known, and I’ve definitely had patients who flat out say, “I came to XXX hospital because of the name!” despite living much closer to multiple community hospitals. There have even been a few who have specifically requested their ambulance drivers to go to the brand name hospital rather than the much closer community hospital.
I, too, am curious what sweat209 is looking for in an ER. My hospital has mostly private rooms in the ER, but more often than not there are patients in the hallways and outside rooms because they are all full. Having been to a third world hospital, I hope it’s just hyperbole and not an actual comparison in his/her mind.
Ironically, those patients might be happier at the smaller, community hospital. Those big mega-hospitals can be impersonal, industrial affairs. And they’re mostly teaching hospitals so you have residents and interns visiting you all day.
Yeah, the plus to minus range of teaching hospitals is pretty wide, but they don’t see it that way. They just see the name and think they’re going to get the best care in the world. Obviously from this humble resident’s perspective, I think they’re right (I mentioned humble, right?), but the things that make big hospitals famous aren’t treating run of the mill cellulitis and community acquired pneumonia.
My town of about 100,000 has one major hospital (and one smaller hospital on the other side of town.)
One distinct advantage of having the one central hospital is that an entire medical district has arisen around it over the years. If you need to see a specialist, there’s a 99% chance that they’re no less than two blocks away from the hospital’s front door.
There’s very little about decor that matters to me when I’m looking around an ER. What I can see that does tip me off that I don’t want to be there:
[ul]
[li]Lots of tape on the IV pumps and other machines (good sign they don’t work well, alarm too often and have trained the nurses to ignore alarms). [/li]
[li]Lots of mismatched equipment (good sign they don’t have a good budget, and are cutting corners in other, more important areas like staffing levels).[/li]
[li]Clearly exhausted staff (again, staffing levels, also schedules; a tired doctor or nurse is a doctor or nurse more likely to make mistakes).[/li]
[li]Puddles on the floor, particularly if they look like vomit or blood (again, staffing levels. Also, if housekeeping can’t clean up spills quickly, they’re probably not taking the time to properly disinfect things between patients).[/li]
[li]Men in suits looking at clipboards (this may be a temporary issue, but any day when The Suits are on the floor is a day when the staff is worried about their jobs, not about my injury.)[/li][/ul]
Open bays are not about “efficiency”. They’re about making it more likely that someone will see or hear you if you fall or otherwise need emergency assistance. They’re a safety strategy, not a workflow strategy. There *are *architectural workflow strategies, but they involve things like the placement of nursing stations, wash stations and supply rooms, not whether your room has a door or a curtain.
I am lucky enough to live in a city with over 200 hospitals. I have lots of choices. My choice is based on a couple of things: acuity of need, certification/specialization and proximity to the home of the people most likely to visit me while I’m hospitalized. When my mom had a stroke last year, we were in the car and literally equidistant from three hospitals that I knew of. I took her to the one I knew was certified by The Joint Commission as a Stroke Center (Lutheran General). When I had premature labor, I went to the hospital with a Level III NICU (Evanston), instead of the hospital I’d planned to deliver at, which had a midwife friendly birthing center but only a Level II NICU (West Suburban). When my daughter got pneumonia, I took her to the children’s hospital (Lurie), rather than the (much closer and more convenient) hospital near my home that doesn’t have a good pediatric unit (Swedish). If I saw a person get shot, I’d try to get them to a hospital that was Trauma certified (St. Francis). I send my patients with severe chronic pain to the hospital with a good Pain Center (Rush or Rehabilitation Institute of Chicago). When my husband had a heart attack, we went to the nearest ER (Swedish). (Wow…a lot of those names are out of date, thanks to massive amounts of mergers. But I’m too lazy to look up what they’re calling themselves this week.)
There is no one single best hospital in this city of 200+ hospitals, and no strong correlation between size and patient outcomes.
Jackson Park, however, is the worst. Don’t go there. Please.
**Smapti **brings up the one potential benefit I do see to mega-hospitals: they tend to have more specialties and more specialists in their network, often in close proximity. Theoretically, they should be therefore more able to access your information, visit notes, test results and medication list more quickly, keep it more accurate and have fewer unnecessary duplicate tests and procedures. I say theoretically, because it doesn’t always work that way. We’ve got hospitals here where nurses can’t see your medication list from the Emergency Room once you’re admitted on the floor of the very same hospital. It’s stupid, and frustrating, and increases errors, as well as earning you another round of “what medications do you take at home, Mr. Smapti?” even though you told them in the ER three times.
I think it depends what the issue is; if you’ve fallen and maybe broken your arm, pretty much anywhere with an x-ray machine is fine, so the local centre (we have ‘Minor Injuries Units’, which are sort of an ER lite) might well be faster to get you in, and the staff may well have more time to deal with you- plus you don’t feel like a tit sitting there with a bruised arm when someone else is rushed in unconscious.
You also may be able to park easier at the small place, and find the right ward faster (my local big hospital is one of those that has grown over more than 250 years into a bewildering labyrinth- the facilities are perfectly up to date, but the buildings sure ain’t).
Our system is very different though, for a start, all the hospitals (and my GP) have access to the same set of records, and they will refer patients to other hospitals in the area that have specialist units if they do not.
A con is that the hospital can set larger fees and since insurance companies do not have alternatives they have to sign up with that hospital.
I had a stay in a teaching hospital earlier this year, and the doctors/residents/interns etc. only came in between 6:00am and 10:00am. Granted 6:00 is a little early, but I wasn’t bothered by doctors any other time unless a nurse requested one to come.
How about we poison this discussion with some actual facts?
The number of hospital beds per 1000 is way down from what it was decades ago, 45% as many beds as in 1975.
The number of hospitals is also down over the same time period but not by as many, 80% as many hospitals.
There is no trend to mega-hospitals.
The average hospital does not have more beds than it used to have; it has fewer. Even with an aging population the rate of inpatient utilization per 1000 is decreasing. (See figure 2.) Even with fewer beds occupancy rate is dropping. If new hospitals are physically bigger it is not with more beds; it is with pretty lobby space and attempts to compete with surgicenters and for fewer patients who need inpatient care.
Hospitals and hospital systems are afraid. The push is on to do things better and cheaper than inpatient systems do it.
The smaller hospitals tend to be more cost effective too. Insurance companies are trying to put the kibosh on this with tiered plans that charge more for big inner city and/or famous hospitals.
Besides all the changes and advances in medicine patient expectations are changing too. It’s often not cost effective to remodel an aging semi-private facility into a private rooms or incorporate the latest MRI machines and whatnot so they’re left with trying to get financing to build new ones, or shut down or merge if they can’t.
You’d think that, but here in St. Louis, Anthem (Blue Cross/Blue Shield), the largest health insurer in Missouri, doesn’t include BJC Healthcare in many of its policies. BJC is not only the largest healthcare system in the region, it’s the largest* employer* in the region. The two organizations have been fighting over rates for several years.
The number of beds has been decreasing steadily for a long time. This has nothing to do with the number or size of hospitals.
That’s the same as the previous link.
It’s not a useful statistic anyway. The number of hospitals changes by mergers and shutdowns independently from the number of patients served or extent of the services.
Of course there is. There’s a trend to mega-business in general. Hospitals merge to pool resources creating larger business entities, it may not change the number of physical buildings, or anything at all about those buildings, but they are larger corporations.
That part is dead on.
BJC may be the largest in the region, but they do have substantial competition from both Mercy, SSM, and Tenet. There is no lack of hospitals to serve Anthem customers. (Mercy alone has a very large physician and clinic network as well as their hospital facility). I really doubt that Anthem customers are having any trouble accessing care.
Sorry for posting the wrong link but trying to find the same graphic I found one that demonstrates the basic facts more clearly and deeply, from the CDC.
In 1975 there were 7156 hospitals in the US; in 2009 there were 5795. (Again, 81% as many.) The only size hospital that saw an increase were the tiniest ones. In 1975 there were a total of 1,465,828 hospital beds; in 2009 there were a total of 944,277 hospital beds. (64% as many.) In 1975 the average was 205 patient beds/hospital; in 2009 the average was 162 beds/hospital. That is by basic math math what happens when the number of hospital beds decreases by more than the number of hospitals does.
In 1975 303,099 of the available hospital beds were in hospitals 400 beds or greater; in 2009 275,573 were.
Digging in the numbers certainly demonstrate that medium hospitals (the 50-99 and 100-199 bed ones, which historically have had poor occupancy rates) are disproportionately not surviving, while tinier ones increased some and the hugest decreased more modestly. And the biggest became marginally bigger - doing some basic math the average hospital over 500 beds in 1975 actually had 694 beds; in 2009 the average of that category had 717 beds. Nevertheless many more hospitals are smaller than 300 beds big than larger and more beds are in hospitals under 300 beds big than in those 300 beds or larger.
The op’s impression that there is some trend to bigger hospitals (not hospital systems/corporations - a completely different conversation) is just not true. The actual trend is to fewer hospitals because people are being admited less often and for shorter periods of time. We don’t need as many as we’ve got.
Consolidation of hospitals into huge systems? Yes. The big sub-specialty driven hospitals need feeders. Hospital systems want to be the “must have” product for an insurer to contract with but being big alone won’t do it nowadays, not so long as there are others in the region who will play ball. It’s tough for hospitals. The insurer wants to see evidence of value for the money, people kept healthier because healthier costs them less, and care for in ways that gives the best outcomes for the least cost. Any system that does that is working to decrease unneeded hospital admits and lengths of stay and use of hospital facilities because they are the big cost drivers. Not something hospital systems really have their hearts into doing.
As to the bemoaning of overcrowded Emergency Departments (EDs) … ED volume is fairly consistently going the other direction across the board. According to this article between 1998 and 2008 ED volume increased by 30%. It increased another 10% between 2008 and 2009 alone. Again, the rest of the hospital business is meanwhile shrinking, fewer beds occupied to a smaller percent.
Hospital EDs were just not built for that volume. They need to figure out to handle it efficiently both from time and a financial POVs. And deal with the competition from more free-standing Urgent Cares and After Hour Care facilities that now bleed off the quick and easy (read more profitable given ED charges) visits.
Me! ME!!!
ahem That is, they’re using me, the home nurse. They’re seeing them in the ER and then sending them home to me rather than admitting them, for things that they used to admit for. Because, insurance. No, they don’t get paid for using me, either, but they often wouldn’t get paid if they admitted them, apparently.
The days of a nurse getting several days in a hospital setting to provide skilled observation and assessment and patient education, long gone. Antenatal is the most common example given, but just last week I got a post spinal-stim placement patient, 83 years old. 6 hours after her surgery to implant a freaking electrical device on her spine, and they sent her home with orders for (intermittent) home nursing. No reaching, no lifting, no stretching, no arms over her head for 6 weeks. At home. Oh, and she lives alone, on the second floor. WTF? How is she supposed to reach her phone if she drops it on the floor? (Yes, I got her a Reacher, which is good for anything that weighs less than three ounces and you don’t have to bend to reach…) I mean, I’m all for healing at home, but there are some times when it just isn’t appropriate. And, unsurprisingly, she dislodged a wire, apparently while using the bedside commode unassisted.
My billing guy is delighted with the trend to use home nursing instead of hospitalization, of course. We’ve got patients coming out our ears and not enough nurses to admit them all. But there are very real patient safety and outcome issues sometimes.
There’s no machine that goes Bing!