Latest news with #inpatientcare
Telegraph
02-07-2025
- Health
- Telegraph
The eight essential questions you should always ask your doctor in hospital
Spending time as a hospital inpatient is tough and, in some ways, not dissimilar to the experience of a long-haul flight (we're not talking premium economy here). Unwelcome noise can make sleep impossible. Shared bathrooms. Limited privacy. Neighbours coughing, spluttering or snoring. And, just as you are about to fall asleep, the lights come on and the food trolley arrives. Worse, you aren't awaiting an exciting business trip or relaxing holiday, but are living with the anxiety that ill-health, an operation or medical investigations can bring. Often away from loved ones and immediate familiar support, time in hospital can be scary and isolating. On the other side of the curtain, I recall with embarrassment my first ward round as a clueless medical student. It's a world of jargon, speed and uncertainty. Just getting to grips with the hospital hierarchy takes some time – even for a young doctor. But this isn't about me. It is about those on the receiving end of inpatient medical care. Those confined to a mattress designed more for practicality than comfort; those looking for answers. The following are essential questions that can ease the hospital experience, whether you find yourself, or a loved one, admitted. What is really wrong with me? Sometimes this is clear from the outset and a hospital stay is simply providing the treatment. On other occasions there is a more frustrating hunt for a diagnosis, using a combination of tests and investigations to inform the team. I once admitted a patient overnight with severe chest pain and arranged a barrage of cardiac investigations. It was not until the consultant ward round the following morning that the tell-tale blistering rash of shingles appeared across her chest. If you are unclear as to what the suspected diagnosis is then simply ask. The clinicians involved should have a working list of potential diagnoses, even if the final answer has yet to be reached. Sometimes time works well as a diagnostic tool. Why am I being constantly asked the same questions by different medics? One of the greatest frustrations patients report is the constant checking and clarifying of information during a hospital stay. Why have you come? Some are so fed up with being asked this question that they begin to wonder why they ever bothered. A&E receptionist, triage nurse, A&E doctor, senior A&E doctor, admitting junior doctor, speciality doctor, inpatient consultant, allied health professionals, the list goes on. It is not unusual to repeat your story 10 times over. Is this inefficiency or a system designed to provide so many safety-nets that hopefully little falls through? The truth is that your story matters. What you say and how you describe it – the history of the presenting complaint – is still the greatest diagnostic tool that we have. Take a pain in your chest for example: does the pain worsen with exercise and exertion? Yes. Can you press your chest wall and reproduce that pain? A 'yes' here might mean we can discharge you home after some simple safety checks with pain relief for musculoskeletal chest pain – a chest sprain, if you will. But a 'no' could point to a cardiac cause and require a series of more invasive inpatient investigations. Think of the tedious repetition therefore, as vital clarification rather than onerous interrogation. Medical decisions are based on a clinician's internal algorithm, not dissimilar to those flow charts you might have used at primary school to identify an insect. A badly placed 'yes' can lead to an incorrect diagnosis. The chart says caterpillar when, in reality, you're a bluebottle. Don't be baffled by the questions; instead, try to clarify in your own mind the exact events that have brought you here. It's not always easy. How long will I be in here for? The time you stay will vary drastically depending upon the diagnosis, the investigations required and your speed of recovery. Bed availability on specialist units, space in the scanner and emergency cases in the operating theatre can all extend hospital stays for logistical reasons. The most urgent cases usually take priority. What is going to happen today? Once admitted, the ward round, which usually happens each morning, is the key interaction of the day for medical updates and progress. A gaggle of enthusiastic healthcare professionals surround the bed, usually headed by the most senior doctor available from the team. This may be the consultant, but could also be a registrar or other junior doctor depending on staff commitments. Nursing staff and other allied health professionals often join the round too. Results are reviewed, medicines prescribed and that all-important plan for further management is created. Now is your chance for questions. The team of onlookers can feel somewhat intimidating, but do not be afraid. By involving yourself in your care you will be empowered to more clearly understand the path that lies ahead. For those unable to fully engage, it may be possible for an advocate to be present at the ward round or to arrange a meeting later in the day with a doctor from the team. Use your time wisely. Hours of boredom will no doubt ensue during your stay, so make a list of questions or concerns. This can prevent the inevitable stage fright when the team finally arrives at your bedside. Get timelines for further investigations or procedures and the working diagnosis. What tests am I having and why? Blood-pressure tests, heart-rate tests, oxygen-level tests. Tests, tests and then yet more tests. They are all part of the 'early warning scores' – a way for hospitals to identify patients who may need more immediate medical attention, which are calculated from your vital signs to determine how stable you currently are and therefore how frequently your 'observations' need to be taken. A quieter night is on the cards for those steady and stable, with closer monitoring for those more clinically unwell. Infuriating as the visits can be, do not underestimate the importance of the opportunity for a brief catch-up with the nursing team to discuss medical issues, request pain relief or simply share a joke or story. Keeping morale high helps everyone on both sides. Those staying a little longer will become overly familiar with the daily blood taking visit from the Dracula-inspired phlebotomist. These tests can provide vital clinical information for your team, but are not always essential every day. Sometimes the default position is simply to test, so if the daily ritual is becoming burdensome, check in with your doctors to establish whether such regular testing is essential. Perhaps the Count could have a day off? If I have more questions, who can I talk to? If you are uncertain or concerned about any aspect, start by discussing matters with the nurse looking after you. If they are unable to clarify things, then request a discussion with one of the doctors from the team. You will have a named consultant responsible for your overall admission to whom you should be able to speak should the need arise. For matters relating to logistics and your experience on an inpatient ward, the Ward Manager is an excellent first port of call. If you find that your concerns are still not being addressed, you can contact the Patient Advice and Liaison Service (PALS) team at the hospital, who can provide further support and information. How can I get out of here? Once a diagnosis has been reached and treatment delivered, the attention of most patients quickly turns to the quickest escape route. This can be frustratingly slow. Physiotherapists must ensure that you are safely able to mobilise. The all important 'stairs assessment', whilst sounding like a legal requirement from Building Control, is designed to ensure that those who have to negotiate stairs in their home environment can do so with minimal risk of falls. Occupational therapists may work with you to help optimise your home environment, ensuring that you can manage daily tasks such as cooking, washing and putting the kettle on. For those in need of more support, social workers may be involved in arranging a package of care to support you at home, or to help find a placement in a residential or nursing home. When the great escape seems tantalisingly close, the final hurdle, which I can liken only to the inevitable wait at the airport baggage-reclaim carousel, is for the pharmacist to deliver any medications required for discharge. Stringent checks and overstretched teams mean this can make even the most bureaucratic customs official seem efficient. If your ultimate exit is reliant upon hospital transport, I recommend a good book and patience of a saint. What happens after discharge? Accompanying you out of the door should be a 'Discharge Summary'. A copy of this will be sent to your GP for information and further action where required. It is well worth taking a photo of this in case the important document disappears in the baggage-reclaim chaos. This document should detail the events of your stay but, crucially, also any follow-up plans, including details of upcoming outpatient investigations and appointments. Any prescribed medicines are also listed on this document with instructions on when and how they should be taken, so keep this at hand to accompany that reclaimed baggage from the pharmacy team.
RNZ News
27-06-2025
- Health
- RNZ News
Construction begins on new $88 million mental health centre in Lower Hutt
Health Minister Simeon Brown. Photo: RNZ / REECE BAKER Construction has begun on a new $88 million mental health unit in Lower Hutt, which the government says will improve mental health outcomes for New Zealanders. The Sir Mark Dunajtschik Mental Health Centre will provide 34 adult acute inpatient beds - ten more than the existing Te Whare Ahuru. The government was investing $38 million in the construction of the facility, while $50 million was being donated by Wellington philanthropist Sir Mark Dunajtschik. Sir Mark also donated $50 million towards the new Wellington Children's Hospital in 2017. This morning Health Minister Simeon Brown, Mental Health Minister Matt Doocey and Hutt South MP Chris Bishop all took part in a sod-turning ceremony to celebrate the start of a project. Doocey said Sir Mark's contribution would leave a legacy of hope and care that would benefit generations to come. He said the purpose-built centre would help ensure New Zealanders in distress receive timely, appropriate care. "This project is about more than bricks and mortar. It's about improving lives and delivering the mental health outcomes New Zealanders deserve," he said. Doocey said people experiencing severe distress deserved care in the right environment, at the right time. "It's not only better for them, but it also helps take pressure off our busy emergency departments," he said. "That's why mental health care must be underpinned by high-quality infrastructure that enables clinicians and support staff to deliver the safe, effective, compassionate care Kiwis deserve." Brown said it was an important milestone for Lower Hutt and the wider region. He said the new facility would be purpose-built to support modern models of care, which would help to deliver better outcomes for patients and their families. "It will also enhance the region's mental health infrastructure, offering safer, more therapeutic spaces for those in urgent need." The current Te Whare Ahuru acute inpatient unit was built in 1995. In 2021, it came under fire from the Chief Ombudsman for being not fit for purpose. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
CBC
03-06-2025
- General
- CBC
Whitehorse hospital opens $33M mental health unit
The Whitehorse hospital says its new mental health unit is going to transform in-patient mental-health care. The grand opening of the Fireweed mental health unit was on Monday. The new unit will provide in-patient care for a maximum of 30 days to people with a mental health diagnosis. The renovation at the hospital took two years and cost nearly $33 million. The new unit replaces the secure medical unit, which was widely criticized for lacking basic safety features and failing to provide staff with violence prevention training. In her remarks at Monday's opening, health minister Tracy-Anne McPhee acknowledged that the secure medical unit — which was essentially eight rooms and a hallway — was not equipped to provide adequate care. "This new unit changes that," McPhee said. The new wing is shaped like a horseshoe, spanning 10,000 square feet with a communal kitchen, private outdoor smoking area, and healing room. There are eight private bedrooms, with capacity to expand to 12 beds later. There are also three seclusion rooms, which contain only a toilet and bed, adjacent to an observation room. "We know this unit won't solve every challenge, but it's a start," said Tiffany Boyd, Yukon Hospital Corporation CEO, at the grand opening. The new unit will be fully operational by July. The eight beds in the former secure medical unit will go back to general in-patient medical and surgical use. Mental health programming completely 'redesigned' The Fireweed unit has new security features lacking in the secure medical unit, said Kirsten Wilson, clinical care manager at the hospital. There are "code white" buttons on several walls for staff to signal when a patient is aggressive. Staff will also wear personal alarm systems. Most of the rooms have two exits and other lock-down features. Wilson said staff have also taken some additional online and in-person training in safety and de-escalation. The unit will be staffed by three nurses, a team lead and consultant psychiatrists. Stephanie Ralph, executive director of patient care, said an overhaul of mental health care is on the way as well.
CBC
30-05-2025
- Business
- CBC
Doctors at rural hospital say new payment model hurts inpatient care
Musquodoboit Harbour residents are raising concerns about inpatient care at Twin Oaks Memorial Hospital amid a pay dispute between the province and five doctors at the hospital. However both the province and the MLA for the area are seeking to reassure the community that hospital services will continue as usual. In a letter to the province dated May 9, the doctors said they would resign on June 14 in protest over a change to how they are paid for inpatient care. However the doctors rescinded their resignations on May 24 and will now stay on the job for at least another six months as they continue discussions with the province. "We rescinded our resignations despite the lack of flexibility from [the health department] basically to keep the hospital open," one of the doctors, Dr. David Brandon, told CBC News in an interview. The local MLA, Kent Smith, said he was contacted by several constituents about the status of inpatient care. "The doctors are in ongoing discussions with respect to their coverage of inpatients. I am cautiously optimistic for a favourable outcome," he wrote in a Facebook post on May 22. "The most important thing to understand is that this issue of inpatient coverage has absolutely no impact on any other services offered at Twin Oaks. We are all working hard to ensure continued excellent care for our community." The payment model the five doctors have criticized is part of the most recent contract between physicians and the provincial government. The previous payment model paid doctors for each service. Longitudinal Family Medicine (LFM) is a payment model that offers physicians higher compensation if they take on more responsibility, such as taking on more patients or providing additional services or working longer hours. The five doctors say the change will negatively impact how they are paid for inpatient care at Twin Oaks. They say the model doesn't fit the unique needs of small communities. The rural hospital has 15 inpatient beds in addition to an emergency department that is open 12 hours per day. Dr. Gehad Gobran is the president of Doctors Nova Scotia, which negotiated the contract on behalf of the province's 3,300 physicians. "We're educating physicians about the new model and trying to support any necessary solution-minded service delivery changes, within the existing remuneration structure, that will sustain services, while not disadvantaging the physicians financially or increasing practice burden," he said in a statement to CBC News. CBC News requested an interview with the Nova Scotia Health Authority but received a statement instead. The statement says steps are being taken to ensure patients continue to receive medical care and the emergency services will operate normally. "The emergency department will remain fully operational, with no changes to its services," it says. "Virtual urgent care, which is already available at the hospital and underutilized, will continue to support patient needs." Brandon says the hospital should have six physicians on staff, but they currently only have five. As part of a temporary agreement, the province has allowed them to hire an additional physician. "The one thing that [health department] has made possible is that they've allowed us to bring in another doctor if we can find one using locum funding until a new doctor can be hired." For now, Brandon says, the doctors remain, but they will submit their resignations again if the conflict persists and communication with the province does not improve. "The hospital is going to stay open. The hospital is not going to close. We are going to do our best to provide the best care that we can within the limitations of the system, which is what we always do."
