Rocks

Something I learned when I came to this trauma job is that there are some patients that are really difficult to discharge. Those patients that stay in the hospital week after week, and then month after month, are called rocks. And at given times, the trauma service can have multiple rocks, or a rock garden as we say.

This notion of rocks was new to me. In the ER, patients came and went. And I suppose in training I wasn't in any given rotation long enough to learn about rocks. But when I became an NP and followed the same patients throughout their hospital course I met the rocks. We've had patients stay on the trauma service for over a year. That's quite a while for a trauma team, which is generally notoriously known for the "young and healthy" hospitalizations. Clearly after that long they have healed their acute injuries, often able to walk independently again, yet usually remain in the hospital due to their social circumstances.

These long lasting patients tend to be homeless, undocumented, or have family unwilling or unable to care for them with no money/insurance to pay for long-term care. Usually the most limiting injury is a traumatic brain injury. Even if all their broken bones are healed, wounds closed, organ injuries resolved, the head injury is frequently what prevents them from other discharge options. This may leave them with limited mental capacity and poor judgement and reasoning that prevents them from caring for themselves; however, they may be able to walk, talk, eat, and otherwise function. Other patients are more severely head injured such that they are not able to follow commands, or track with their eyes, or feed themselves or walk. These folks clearly need placement, and if they have a trach and PEG will need a subacute facility. This can be quite difficult without funding, and sometimes not even knowing the patient's real name for a long time (which delays even applying for funding on their behalf).

It's really quite sad. I didn't truly know this problem existed until I worked directly with it. I imagine there are rocks on many trauma services all across the country. It seems to me there should be a better way to help these patients but right now the system doesn't seem to work in that favor. Maybe someday someone with the power to make a change will see using acute care hospital beds on patients that no longer need that high level of care anymore wastes money and resources when other new patients really do need those beds. Maybe then the rocks could get the more appropriate level of care sooner, free beds in crowded hospitals for those who need acute care services, and actually save money by spending it appropriately. I realize it's probably a pipe dream to think a big system change like that could happen in my lifetime but I'll hold out hope for the sake of all the rocks, and all the new patients that need the rocks' beds.