self inflicted cost-why?

One of our clients went to the hospital with a fever. She has pneumonia. Not surprising she has a history of lung disease related to smoking. She got admitted and within one day I have gotten calls that they are drawing blood for cardiac enzymes, have her scheduled for an echocardiogram and she is agitated. She has advanced dementia. I am her conservator of person. I met with the physician and asked how did she end up with a cardiac workup when she came in with a temperature.  "They", decided since she has a heart murmur that sending expensive cardiac enzymes in the ER was appropriate which left the physicians in the hospital obligated to follow up with more blood work and a scheduled echocardiogram.

This woman will soon be 88 years old. She is a past smoker and has lung disease related to that. She also has advanced dementia. I made it clear she is a DNR/DNI and wonder why those in charge felt it was necessary to pursue issues without symptoms that created more costs to a patient that would not have anything done even if there was a critical event. She was there with a temperature. It was quickly decided she had pneumonia. There was NO discussion with me about doing anything about a heart murmur that they found when they listened to her heart sounds.

We wonder why costs are so high in our healthcare system.  Honestly, this is so frustrating. She came in with a fever. There was no discussion about anything else while I was there with her as her conservator in the ER to pursue anything else.  The ONLY reason I found this out is because I called to get an update from the nurse and advise that her private aide would be with her to assist with her care as her vascular dementia has made her difficult to deal with sometimes. The nurse mentioned that they needed to replace her IV site and had to draw blood again. I asked why they were drawing so much blood and she then went on to advise that her cardiac enzymes were being monitored. What?? Why?? and oh by the way they had to give her lasix which she normally takes because she had some fluid in her lungs. Probably because they rapidly gave her IV fluids in the ER which I couldn't stop before I got there and asked to stop. All because she was a little dehydrated. Well, it was early morning and she had gone all night without anything. She was alert and awake when she arrived.

This woman will soon be 88 years old. She is a past smoker and has lung disease related to that. She also has advanced dementia. I made it clear she is a DNR/DNI and wonder why those in charge felt it was necessary to pursue issues without symptoms that created more costs to a patient that would not have anything done even if there was a critical event.

Not that we shouldn't treat someone because of their age, of course not. But when you have a patient who is elderly why are we doing expensive testing without a discussion ahead of time? They were treating the issue at hand, pneumonia.

Everyone needs to be acutely aware of the costs involved with our very expensive system and be sure that there is a need for all the testing going on before they happen. There was absolutely no reason for this woman to have cardiac enzymes drawn to begin with. I was present and I would have been happy to have a discussion with the physican about her heart murmur and what they should or shouldn't do about it. I don't think they should just go ahead and make decisions without that conversation to begin with.

Our system is out of control. This is just one example of I'm sure millions of dollars spent that no one has any clue is being spent.

 

Sharon Gauthier RN/MSN

www.patientadvocateforyou.com