What do hospitalists do when they're staring down a record busy census to tackle on a cold Saturday morning? They stall, of course. And how do they stall? They stall by talking about anything that keeps the day from officially beginning. You might find this hard to believe, but a hospitalist's morning report is a time when some of the greatest discoveries in hospitalist medicine are made.
Creativity in morning report is like open mic night at a comedy club. You never know what you're going to get. The ideas flow freely and build upon themselves. Out of the pain and suffering of a brutal night shift comes amazing creativity I never thought possible. It's best to get it out early, for once the inattentional deafness of hospital rounds kicks in, the creative hospitalist mind shuts down in favor rigid robotic medicine.
Some of the greatest ideas to improve hospital care in America began with the procrastination. For example, I learned of a radical new hospital floor plan layout design that is sure to revolutionize the delivery of health care in America. And I learned about it right in my own morning report. How could hospital layouts possibly be any better than they are today? How could we possibly cut our 8,000 unnecessary foot steps per day down to 6,000 unnecessary foot steps per day? Who cares. It's not about the doctors and nurses. It's about the patient.
With that in mind, we have discovered the next best thing in floor plan design. Most hospital wings are divided by general disease process. If the patient requires surgery, they go to a surgical floor. If the patient requires chemo, they go to the chemo floor. If they patient requires a cardiac work up, they go the heart hospital within a hospital.
But who decided that was the best way to treat patients? Not I nor the great creative minds of morning report hospitalists everywhere. It's time to redesign how we care for our patients. The best way to divide our patients by unit is not by their disease process, but rather by how close they are to dying.
Observation patients get the first floor, because, well, observation is really just code word for needs a social work evaluation. All patients with otherwise acute medical issues get triage to their appropriate floor based on the likelihood they are to die during their hospital stay. The more stable the patient, the lower the floor they get. The patients more likely to die during their hospital stay are placed in ever higher floors. Patients with imminent death go to thee penthouse ICU with a one way ticket Home. Medicare ambulance payment rules may apply.