Barriers To Care

One of my favorite things about anesthesiology and critical care is the freedom I have to provide quality patient care. PACU and ICU nurses are top notch, pharmacists are always available with every medication I could possibly need, and as a provider, I’m given so much autonomy with very little resistance from the proverbial “middle man.” In my realm, I make decisions, push drugs, adjust therapies, and observe physiological effects virtually every few seconds.

When I talk to my colleagues in internal medicine about the number of times they’ve encountered barriers to patient care, their answers are often disconcerting. A patient could start crashing on the general medical ward and need higher level care, but in the process of relocating the patient to the ICU, things need to be done! Unfortunately, this is where some barriers are posed by nursing and hospital regulations.

  • “We can’t start a norepinephrine infusion on the floor even though the patient is en route to the ICU.”
  • “I know how to use a PICC line, but I’m not comfortable using a mid-line.”
  • “We can’t use high flow nasal cannulas in this ward. The patient has to go to to the IMU or ICU for that.”
  • “You need the pharmacy’s approval to use <insert drug name here>.”
  • “I can’t get the medications to intubate until the orders are in.”

I’m not blaming anyone in particular, but this is a real problem we face in a field as dynamic as medicine. People’s hospital courses can change very quickly, so having logistical and administrative limitations often clash with doing what’s best for the patient. When things go awry, we need to step back, ask for help, and streamline steps to promote our patients’ well-being rather than fabricating barriers which defeat productivity.

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