Facility Moves

[sk732]

So, in 5 days, our hospital moves lock, stock and barrel down the road a few hundred meters to new digs.  We're a busy place normally, management has been hard at work making sure that this will be allegedly smooth...allegedly since, frankly, not a lot of forethought went into much beyond the physical space, like policies/procedures for new depts. that were created, etc.

 

Anyone here gone through a full facility move?  Just wondering if it's normal for a move to happen without knowing how things are supposed to be run once you hit the ground (beyond patient wanders in and gets processed to, well somewhere)...I'm on the inaugural shift Sunday morning in the ER.

 

SK

[medic25]

We moved into a new hospital midway through my OB rotation in PA school.   We were literally pushing patients down the street on stretchers to get to the new hospital, but it was worth the upgrade.

 

Lots of pre-planning, extra staff on the day of the move, and make sure you have lots of signposting on the old ED entrance to patients know where to go when they show up to the old facility (which they will).  Unless the two facilities are right next to each other, it's probably worth stationing an ambulance in the entrance of the old ED.  I worked at a place that moved to a new ED 2-3 blocks away, and we'd still get walk-ups to the old ED entrance.

[sk732]

A compnay that moves hospitals has been contracted to move the patients - they apparently do this world wide.  Funny you mention people going to the wrong place - people are going to the new place already expecting to get seen.  Apparently the construction workers scare them off :-D.  I'll have to think a bit when I'm driving in, as muscle memory/autopilot at 0Dark OMFG has a habit of kicking in.  I'll find out if they're going to have an ambulance at the old place - that would be a good idea, since Murphy will have a few wobblies on board I'm sure, so someone will show up and hammer in thinking they're where they should be.

 

SK

[sas5814]

we moved out of our 22 bed critical access hospital which was well past its "use by" date into a new facility. Did you every see that episode of MASH where someone yells "BUGOUT" and they all start running like mad? It was like that only less organized. Because we were so small they just didn't allow any admits for a period before the move so there were no patients to move.

[sk732]

They (the Circus Ring Masters) want us to operate at only 50% bed capacity...which is a joke since none of the hospitals in our region have empty beds to accomodate and the guys in the urban region south of us give us that blank stare of "you want us to do what?" when we ask for an admit there.  Oh well - over in a few days - watch and shoot.

 

SK

[sk732]

Just finished my last shift at the old place...get some sleep, start in the new one in the am.

 

SK

[sk732]

Things went reasonably smoothly - there were a lot of hiccups, since no previous full shift sims were done (builder behind sched and other usual government contract drivel), so we were operating a bit blind regarding where things were.  Locals held off coming until yesterday and today - and it went nuts apparently (my wife is one of the ER ward clerks).  Funnily enough, people thought they'd be seen faster in a new place...

[sk732]

My thoughts so far after working a few shifts in the new place - code's need better paging and rehearsal so that overheads and broadcasts are heard.  Flow needs to be worked on - RN's are forgetting that they need to pull the patients from the internal waiting rooms, vice having them brought in by the charge or triage nurse like previously (or one of the PA's/MD's as was the case sometimes).  We really needed a good long time to walk the place, get lost in it, and have a good mental and physical imprint of where everything is - we didn't until the last second get a chance for walk arounds because it was still a construction site and management clowns were insistent upon the drop dead date for us to go hot regardless of us or the building being actually ready...of course, they're patting themselves on the back for a job well done despite us telling them that people and the place itself weren't ready.  Do you really think everyone is good to go when >2/3 of your RN's can't access the computerized medication dispenser because of a cock-up with the passwords on the opening day?  Do you really think everyone is good to go when a code alarm goes off and NOBODY but the ER staff respond and NOBODY thinks to call it overhead or better yet, knows the actual process/drill to be followed when that occurs?  Do you think that we're good to go when a code alarm goes off nobody and knows the fastest route to the place, despite a single 30 minute class on code routes within the facility (woohoo - a whole 30-40 minutes for a place where the square footage of the old place is likely the square root of the current one). 

Ex-military folks will/can relate to Battle Procedure and the 7P's - Step 15 in the 17 step Battle Procedure process is "Conduct Rehearsals" - none of that was done until too late and we went live with very little prep.  The 7 P's - "Prior Planning and Preparation Prevents a Piss Poor Performance" weren't paid attention to at all...this is all the difference between leading change and managing it; and even then, there was very little of either except at the lowest level (code drills being organized by one of the docs because nobody else would/could, etc).  Conducting full shift sims would have shown that nobody could get the meds they needed when they needed them, identified the need for better training in use of the overhead call system (they want us overhead quiet, so we use Vocera...nobody remembers to use the broadcast function other than us in the ER); non-ER personnel need to be well practiced in initiating codes beyond hitting the button at the bedside, since not all of them happen there.

Much like how the Navy uses a hunt and find system regarding every compartment on any new ship you're posted to - what's in it, fire and flood suppression specifics for it, HAZMAT, ingress/egress routes in emergency, nearest medical equipment, shut off valves and switches etc - a hospital needs something similar.  You need to know your way around all the wards, the maintenance and support areas (things go bad in those places too), emergency diversion routes if the code elevator goes boobs up for some reason, where each fire alarm and extinguisher is, which directions doors open (important if trying to get a cart into somewhere or a bed out), where back up supplies are, transport routes back to the ER/ICU, etc ad nauseum...I know I'm preaching to the choir here, but why is it that people that are allegedly experienced RN's or other health professionals that are in charge of things like this seem to be completely clueless about ensuring it happens?  I'll tell you - they're not remotely connected to the people they're allegedly leading/managing, don't walk in our shoes anymore, are too afraid to tell their higher ups what they need to hear (or simply can't get their heads removed from their arses) and have ZERO actual training in management/leadership beyond maybe a theory class in college or university...which really is not training, because it often isn't that practically oriented.

Spleen smaller...thanks for listening.

SK