Hospital Corner – October, 2020

Hospital Corner – October, 2020

Benjamin Franklin’s oft-quoted line “in this world nothing can be said to be certain, except death and taxes” is only partly true.  There is one more certainty—change.  As much as we resist or ignore, it is ultimately inevitable.  This is true at Mt. Grant General as well.  For decades, emergency department providers worked directly for the hospital, usually spending most of the day seeing outpatients in the Clinic.  The arrangement worked well during that period as our average ER visits numbered just a few each day; that is no longer the case.  For the past couple of years, we typically have seen 6-8 ER visits daily (14 on a recent Saturday!).  Consequently, over this time, we have had to hire providers dedicated to the ER only—at tremendous expense.  Given current economic climate and an uncertain future, such costs are not sustainable.  Change is needed now. A growing trend among rural hospitals in Nevada and elsewhere is to contract with a provider agency for such emergency department services.  A simple flat monthly fee is paid to agency for ER providers on call 24 hours a day—at about half the cost we are incurring now.  The potential amount saved wouldn’t grab much attention at a large metropolitan hospital, but for a small rural facility like Mt. Grant, it is tremendously significant.  This transition will take place late January 2021; change I hope you will agree is certainly needed.

An additional service this agency provides is performing hospitalist duties, i.e., daily rounding of acute and swing patients.  Combined with ER savings noted above, this added benefit cuts costs without sacrificing patient care.  Further, with advent of our Intermountain Healthcare telecritical/telehospitalist program kicking off next month, our patients will have the support, monitoring and care typically not possible at a rural hospital. The good news is that this change involves little risk: hospitals in Yerington, Winnemucca and elsewhere in rural America have transitioned with little difficulty; I expect we will experience the same.  As always, any questions, please call me: 945-2461 ext. 225.

“Why can’t my dog visit the hospital these days?”  Few subjects get pet owners fired up more than restrictions on where Fido or Fifi can stroll.  As the owner of two dogs myself, I get it.  But science (protecting vulnerable patients and residents with underlying health issues) must take precedence over sentiment.  Yes, the Americans with Disabilities Act (1990) grants broad access by service animals to most healthcare facilities—with this notable exception: “Nor does it overrule legitimate safety requirements. If admitting service animals would fundamentally alter the nature of a service or program, service animals may be prohibited.”  At a recent state infection control meeting, we were advised to bar entry by service animals until further notice.  Patient safety is our first priority.

Another holiday tradition falls victim to COVID-19!  Each October, staff, residents and patients look forward to the last Thursday of the month.  On that day ghosts, goblins, witches and all manner of creatures exit school busses and march through the hospital and nursing home. Sadly, no school children this year, no parade, no delighted nursing home residents with joyous smiles—many of whom hand out candy to students.  Staff costume contest is the sole surviving tradition; the king himself (Elvis) made an appearance last year.  Sure to be a few surprises this year as well, so patients and residents will have something to look forward to.  Always a fun day at Mt. Grant—though a bit less so this time.  Some dedicated staff members are planning to participate in Trunk or Treat (joined by a few residents in SNF van).  Doing what we can in these challenging times to make it a special day for kids of all ages, from preschoolers to nonagenarians.  Happy Halloween!

Hugh Qualls, Administrator