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  • Just watched 'don't look up' on Netflix. Such dark satire for our times. Today's Animal Farm for sure.

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    • Originally posted by pulmdoc View Post

      Old. Right now we are slowly climbing in the ICU; there is an explosion of outpatients (urgent cares out of test kits, fun!) which means next week will be the proof of how bad its going to get. Unvaccinated in ICU are all 20-55 obese, dying; the one vaccinated pt is 85 and already improving after a few days on high flow O2.
      Once someone gets intubated, what percentage of people are extubated successfully in your experience?

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      • What’s LWBS?

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        • Originally posted by doctorbone View Post
          What’s LWBS?
          Left without being seen. The number of people who check into the ER then leave without being seen by a provider.

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          • Originally posted by Jaqen Haghar MD View Post

            There is a real question about our hospital systems in general, highlighted by the pandemic. In the US, it appears we operate our hospitals in a “lean assembly line” model. Maximum productivity and full capacity at baseline. Maximizing workload and profitability. With COVID surges, you see a great variability in the ability to cope between systems. One hospital down the street has the flexibility and resources to accommodate quick changes, while the university or county system a few miles away implodes from a quick increase in volume.

            I’ve noticed that systems that have a hard time tackling a typical Monday rush, crumble when volumes double overnight. Of course, it’s hard to make a quick 90 degree starboard turn when you’re piloting the titanic though.
            I am no expert in hospital administration or policy, but the few places that I've worked in training and as an attending, this has been my observation.

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            • Absolutely true. US healthcare delivery is a business at its core. If we were really to be a primarily concerned on health and longevity, our system would look very different.

              That is also very different from a surge/triage/emergency delivery system in times of crisis/war too.

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              • I have a question for you proceduralists out there- are you wearing surgical masks in the OR/endoscopy suite, or N-95s? I was told the nurses "don't like" wearing N-95s and it's not required so tough luck.

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                • Originally posted by snowcanyon View Post
                  I have a question for you proceduralists out there- are you wearing surgical masks in the OR/endoscopy suite, or N-95s? I was told the nurses "don't like" wearing N-95s and it's not required so tough luck.
                  Surgical mask unless Covid+.. During the initial surge and delta I would wear an n95 on emergent procedures when Covid testing wasn’t back yet.

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                  • Originally posted by snowcanyon View Post
                    I have a question for you proceduralists out there- are you wearing surgical masks in the OR/endoscopy suite, or N-95s? I was told the nurses "don't like" wearing N-95s and it's not required so tough luck.
                    I’ve worn an n95 since this all started. OR, clinic, flying, grocery store. Only recently did I start using a Vog mask for social activities and errands. I figure if I’m going to wear a mask it might as well be the best possible protection. N95s don’t really bother me. So far have avoided COVID. I’m healthy but had bad asthma as a kid and as an adult it only flares if I get sick so I’m more risk adverse than most.

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                    • Originally posted by snowcanyon View Post
                      I have a question for you proceduralists out there- are you wearing surgical masks in the OR/endoscopy suite, or N-95s? I was told the nurses "don't like" wearing N-95s and it's not required so tough luck.
                      Granted I do only one or two procedures but have had 3 full dose vaccinations - two Pfizer and one Moderna.

                      I only wear surgical masks. I don't live in constant fear.

                      N95 is not required in vaccinated caregivers. So if you want your procedure done, be prepared with full vaccinations and having caregivers with surgical masks. Or don't have it. You can't force them to wear N-95 because of your fear of even the slightest chance of getting COVID.

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                      • Originally posted by Kamban View Post

                        Granted I do only one or two procedures but have had 3 full dose vaccinations - two Pfizer and one Moderna.

                        I only wear surgical masks. I don't live in constant fear.

                        N95 is not required in vaccinated caregivers. So if you want your procedure done, be prepared with full vaccinations and having caregivers with surgical masks. Or don't have it. You can't force them to wear N-95 because of your fear of even the slightest chance of getting COVID.
                        Double vaccinated for me. Wearing N-95 only when in exam room. Off the rest of the time. No face shield or other PPE. Been seeing daily positives for 2 years. I figure, I'm getting micro boosted on a daily basis.

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                        • Originally posted by Sundance View Post

                          Surgical mask unless Covid+.. During the initial surge and delta I would wear an n95 on emergent procedures when Covid testing wasn’t back yet.
                          Same. The occasional covid positive patient I interact with in real life, I wear a PAPR. Otherwise, it’s a surgical mask, which I only wear within the walls of the hospital.

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                          • Originally posted by Kamban View Post

                            Granted I do only one or two procedures but have had 3 full dose vaccinations - two Pfizer and one Moderna.

                            I only wear surgical masks. I don't live in constant fear.

                            N95 is not required in vaccinated caregivers. So if you want your procedure done, be prepared with full vaccinations and having caregivers with surgical masks. Or don't have it. You can't force them to wear N-95 because of your fear of even the slightest chance of getting COVID.
                            A high percentage of our caregivers (~20%) are not vaccinated at all. An even higher percentage are not boosted.

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                            • Originally posted by snowcanyon View Post
                              A high percentage of our caregivers (~20%) are not vaccinated at all. An even higher percentage are not boosted.
                              Then the healthcare facility should either

                              1. Force them to get vaccinated or else fire them.
                              2. Make the non vaccinated wear N-95 and the fully vaccinated get the choice of N-95 or surgical mask. Trying to identify each group on the floor and take appropriate action for non-compliance would be a logistical nightmare for them.

                              Or you can choose to leave or have the procedure in a facility that aligns with your ideal setup. This might be the best option for you since it looks like the healthcare facility dances to its own tune.

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                              • Originally posted by Kamban View Post

                                Then the healthcare facility should either

                                1. Force them to get vaccinated or else fire them.
                                2. Make the non vaccinated wear N-95 and the fully vaccinated get the choice of N-95 or surgical mask. Trying to identify each group on the floor and take appropriate action for non-compliance would be a logistical nightmare for them.

                                Or you can choose to leave or have the procedure in a facility that aligns with your ideal setup. This might be the best option for you since it looks like the healthcare facility dances to its own tune.
                                Agreed. But they won't, and that's the problem
                                Actually, I can't- I have no coverage for any facility that requires vaccination. I went through 4 levels of appeals with my insurer to get coverage at a facility that requires vaccination. I called and none near me will do the procedure without in-network coverage.

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