Whitecoat and Shadowfizzle et al. talked about some study that said ER wait times are increasing.
Here's my thing:
1) I don't really care how long a non-emergent patient waits. Yeah, I want everyone to get back ASAP for the sake of moving people through and dispositioning them and keeping them out of my hair, but if you're there for something like a cold or a boil and you wait 6 hours, I'm not going to lose sleep and the health care world shouldn't have a major meltdown over a general all-encompassing wait time statistic because non-urgent complaints are mixed in with urgent ones. After all, the average acuity of patients has gone down along with the numbers going up.
2) I really only care about how long patients with actual or probable emergencies wait. This is an emergency department after all. Maybe let's re-focus our statistics a little bit, hm? Sure, "emergent" patient wait times have also gone up nationally, so maybe there should be more "emergent" patient beds built in lieu of "non-emergent beds"? I think in our ER if we just had two more big, honkin' resuscitation rooms (to total 7 vs. 5) +1 more nurse and nothing else that there would be a nice increase in overall quality of care. Oftentimes, emergent patients have to go to the non-critical area to be attached to a monitor and then they essentially take up a lot of the nurse's time so they can't focus on their other 4 appys and bowel obstructions, etc, slowing the flow down for those belly pain-type patients, the sickest patients who wait the longest. If your hospital is too small, but doesn't have the budget for a 100 million dollar ER expansion, maybe just a couple more rooms for the really sick ones to take the burden off the nurses on the other side whose assignments are routinely 5 sorta-sick patients? That's all I ask.
3) Shadowfax says his hospital's average door-to-physician time is 25 minutes. I laughed out loud at that one. Wait. He wasn't kidding. Sounds like a cushy place to work.
4) People with no access issues still come to the ER time and time again for routine problems. Many of these people, especially young ones, actually view any and all sensations of malaise to be "emergencies". It's not that they have no access, they really think that their nausea and vomiting for 6 hours is a true emergency in need of medical attention rather than staying home crumpled up in bed cussing out God like most people waiting for it to go away. Or maybe they think all colds need antibiotics and any temp over 100 requires an ER visit (of course, no one owns a thermometer anymore, so a "fever" might not actually even be a fever). That abdomen cramp, that stubbed toe, those 3 "really loose" stools, that STD check. It's all an emergency.
When you give them a card to one of the local clinics, they look at you with a blank stare and say, "But I can't go to a clinic, I have a fever!" I think very few people have true access issues other than health care illiteracy, at least in my area, yet they still come. Since I go to the same semi-charity clinic that I give out cards for, I know that same-day appointments are available and they refer out to a local late-night urgent care if there are no times available and they get you in.
There are many people who I have personally given a lot of information about primary care, and they never follow up or never call the number on the business card(s). Our area is saturated with primary care, and I've never heard of a physician not taking Medicaid patients. Ever. The clinic 2 minutes away takes uninsured patients on a sliding scale fee, and has SAME DAY APPOINTMENTS. So, in short, even if you "fix" primary care, you'll still have people who come to the ER for routine, non-urgent problems because, in essence, they don't know any better nor really have much interest in knowing any better. Clinics or urgent cares are just not on some people's radar screens because they possess little or no ability to distinguish the severity of a problem, so they automatically default to "emergency".
Of course, it's a BIG taboo to tell anyone who wants to be an emergency patient that they could have probably gone to a clinic for their problem. Maybe a little leniency in the education department would be nice? No one ever educates these patients, so they just keep coming back, completely unaware that they're inappropriately there.
Thursday, January 17, 2008
Subscribe to:
Post Comments (Atom)
8 comments:
Door to doc time is 25 minutes? I want to work there.
We've been instructed that we may NEVER,EVER suggest in any way - verbal or non-verbal - that the patient should not have come to the ER.
I don't understand why people go to the ER for non emergencies but I guess urgent care clinics aren't as popular in some areas.
I live in walking distance from a hospital ER but I drive about 20 minutes to urgent care because I know what I am dealing with is not an emergency. Oh, and they have a promised one hour or less wait time. :D
My one ER visit was for DKA - which I guess was worth the 3 hour wait.
The irony of the overcrowding situation is that EMTALA doesn't require any ER to treat non-urgent cases.
All EMTALA requires is a "medical screening." Once that exam has shown the absence of an emergency, it's perfectly OK to send them packing.
Unfortunately, most hospitals are run by people who are afraid to do that en masse.
Well, for non-emergency cases, the assessments and documentation take longer than the treatment (a prescription, in most cases), so may as well just write for the script. The language of EMTALA makes it so really no one can determine what is legally an "emergency". Is something that can wait a couple days an emergency (eg UTI in healthy young person/STD check)? If someone is out of medications and has no primary care doctor for whatever reason, is that an emergency?
I think I would be upset as well if patients in the rural areas had all the access to care that is in your area. I have called around in the rural area where I work and none of the local docs are taking new Medicaid patients.
The only point in my post was that there is a dichotomy - some patients abuse the system and use it as a way of life while other patients use the system appropriately until they can find other means. The ones that try to use the system appropriately are being overshadowed by the ones that do not.
I think that more and more hospitals are going to go to the model that David mentioned.
Well, Whitecoat, Medicaid is a choice too for most people (save the mentally retarded, severely physically disabled, and some profoundly mentally ill people). I haven't seen many people in rural areas without some sort of access to a car, so maybe they'll have to bite the bullet and have a primary care doctor in the city to which they drive. I'm sure people drive to Wal-Mart or the mall in the city; may as well make driving to the doctor a habit too.
FYI,
Out hospital is not "cushy" by any stretch of the imagination. We are a charity-based hospital in poor community, in an ER that should have been expanded ten years ago. We see patients on gurneys in the hallways just about all day, every day. We bust our asses to "move the meat."
Where we are blessed is good administration. Our Hospital CEO, the ED Medical Director, and Nursing Leadership are exceptional. Our door-to-doc time used to be more like several hours. We made it a priority, added some resources, rebuilt the processes, and the hospital made a commitment to fix the inpatient side of the flow problem. It's taken a damn lot of work, but the results have been outstanding. I used to have docs quit due to burnout, and the nurses were always taking "mental health days," leaving us even more short-staffed. Now the morale is higher, turnover is lower, care is better, patients are happier, press-ganey scores rising -- it's a pleasure to go in to work now.
Post a Comment