Daily Weights, and other senseless acts of hospitalization

InstaPundit’s spouse is in the hospital, apparently for evaluation and treatment of arrhythmic heart disease. The hoped-for ablation couldn’t happen, so now they plan placement of a pacer / AICD. I presume that’s why she’s still an inpatient, but don’t know for sure.

This morning he asked, reasonably, why it’s necessary to wake up patients all night long. Yes, vitals can be important, but his objection was to a 5AM “daily weight”. Shrinkette has given a well-written, objective rationale, along with personal experience doing the weighing. Also, Alwyn is on the job from Code:theWebSocket with the nurses’ outlook.

I’m going to point out the other side: orders like this (occasionally) are done ‘just because’. Heart failure is the most common reason to obtain daily weights, as the tale of the scale is very sensitive to fliud retention, and it’s simple and predective enough it’s taught to patients as an at-home screen to adjust diuretics.

However, sometimes patients get admitted to the Cardiac Unit and get Standard Orders, and it’s easy to check a box for daily weights whether that data point is really useful or not. (Data is what you make of it, and I’m not saying this is the case here, I’m just explaining a contrary view). Docs don’t actually DO these weigh-ins, so we don’t know exactly when it’s done, but when rounding on patients docs are going to want the numbers so they can act on them. Rounds will be early, as there’s an office full of patients to be seen today. (Please note, this is from my past experiences as a med student / intern / resident. I’m now happily only in the ED, and none of this impacts me, except for checking the boxes on the ‘standard orders’).

So, it might be necessary, and it might not. Wouldn’t hurt to ask the doc on rounds if that’s really something she needs.

InstaPundits’ latest: he helped his wife scrub her chest with betadine to get ready for her pacemaker insertion. Wow, what a vivid image of a couple sharing their mortality, hope, faith and trust.

Here’s for all the best for his wife and his family.


Comments

  1. Thanks for explaining the odd hour for wieght check. My reaction to Glenn’s post was to agree, why can’t something like that be done later? Now I know, and that helps alot. It’s another example of the value of blogs!

  2. Bolie Williams IV says:

    This brings home a good point, though… always be willing to question your doctor. If you are uncomfortably with something or simply find it inconvenient or difficult, it’s never wrong to politely ask about it or explain the problem. If your doctor dismisses your complaint or ignores you, find another one. Often, he or she will either explain why it’s necessary or change the order.

    In a busy hospital, of course, you may have to be patient (heh) and wait for the doctor to have a free minute to answer, though.

    Remember, you are the customer and the patient. The doctor may not be aware of everything going on and if you don’t communicate, he has no way of knowing some things.

    Bolie IV

  3. As a person who has spent literally months as a patient in Cardiac Care, I can attest that this is a major source of complaint amongst patients. Complaining, of course, is a sign of wellness in cardiac care.

    I believe the 5 am weight measurement has a lot to do with workflow, and training. It?s a time of day when the PM shift has very little to do. It?s a chore that can be given to new-hires that gives them some patient contact and is pretty hard to screw up. Like bringing fresh water at the beginning of the shift, it is also a forced bed check and head count. ?He was alive at five am?, is a great CYA. I?ll admit that would be a carryover from the old days since every patient has a heart monitor now.

    The beds in ICU have built-in scales. I?ve spent plenty of time in there as well. There are very few complainers in ICU.

    Ken Bergren CTX ’97

  4. My wife, being a nephrologist, actually has a valid interest in daily weights and asks for them often with patients. The fact that the staff almost never does it is a constant aggravation leading to dinner time venting on her part.

    I find it humorous that in this case they did. Perhaps the nurses are just more afraid of not doing what a surgeon wrote in the chart than a friendly lady nephrologist :)

  5. Billing has told me several times that Medicare won’t pay for a patient stay without a weight in the chart. I don’t know if it is actually true but I suspect it is. The next step of course was for other insurance companies use that as a criteria for not paying. Funny how Medicare and Private insurance can find thousands of ways not to pay but few ways to pay in a timely way.

  6. great blog!

  7. Having had far more hospital stays than I would like recently, I have definitely noticed the “every two hour” nightly awakenings.
    There have been some helpful comments by those in the medical profession, but I still wonder, are vital signs somehow more important at 12:00 am, 1:30 am, 3:22 am, and 5:08 am than during the day?
    I realize nurses are busy during the day, but it has been my experience that, while you can’t keep them out of your room in the middle of the night, you might as well forget about seeing one during the day. (Unless you actually manage to fall asleep, of course!)
    Since they are often the “go between” for the patient and the doctor, is it appropriate to call the doctor’s office yourself and leave your question, instead of waiting three or four hours for the nurses to actually respond to the call button and come to your room?