ERs need urgent help, reports say

Thursday, June 15, 2006 - Page updated at 12:00 AM

ERs need urgent help, reports say
By David Brown

The Washington Post

WASHINGTON — Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.

That's the grim conclusion of three reports released by the Institute of Medicine (IOM) Wednesday, the product of a massive, two-year look at emergency care.

Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients, and patients, once in the ER, waiting up to two days to be admitted to a hospital bed.

As a system, American emergency care lacks internal stability and has no capacity to respond to large disasters or epidemics, according to the 25 experts who conducted the study. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money.
(snip/...)

http://seattletimes.nwsource.com/html/nationworld/2003062286_emergency15.html

I knew waits were long but I had no idea that things were so bad off.

K&R

just goes to show you... bush is bad for America. LOVE AMERICA, REPLACE BUSH.

NT

i would bet.

What does that mean, "lose.. money"? I recall reading that one hospital chain had so much profit it "was having a hard time finding good places to invest it."



BTW, the 48 hour and no sleep idea for the intern who treats you in the ER ...

was still being done, last i heard. All the proof needed that the ol boys who now run hospitals are incompetent. A "culture" with its own bizzare, deadly traditions exists in healthcare

Nationalized healthcare in Eng. and Germany , provide HOUSECALLS. What a contrast.

Call me a tinfoiler, but I think this is part of a larger move to create a large, complaisant underclass. Put it in the list of fundamentalist morals, creationism as rule, crap medical care, disinterest in public life, and radio propaganda. Go ahead and add to the list if you like...it is early in the morning.

no middle class.

beat down wages till we look like Mexico.. Poverty, and fifty percent joblessness.. few jobs there.

I had a conversation with my RW father about this when he came through the other day.

I asked, "What kind of jobs?"

He: "Oh there were lots of new jobs in Destin (Florida) when we went through there."

Me: Those jobs are largely fast food, grocery store checkers, etc.

He: But they make ELEVEN dollars an hour.

Stepmom (democrat) from Back seat: I don't make $11 an hour and I have been with the same company for 25 years.

I: Eleven dollars an hour goes a little further in Missouri than it does in Destin.

Dad: But you can live in a trailer with a roommate in a wooded area outside town for less than $600 a month.

job numbers will not be good till there is a job for every seeker.

12 million is the current job shortage. see my sig link for government stats. Unimpeachable stats.

when that 12 million number comes down to zero, that will be "good job numbers". Nothing less will be.

Your dad's comment is like saying "we are ten feet higher on the canyon wall than when we were five miles down yesterday." we celebrate when we are OUT of the canyon. Never should have had any job shortage in all of usa history.

My father and his wife, my sister, my step-siblings, most of my immediate blood family would love to build a community on the wall of that canyon and stay there. Most of them are lock-step brainwashed wing-nuts. Beleive in the Bible, and take what scraps you get from the elites. Its all part of God's plan, with God's agent Dubya in charge. Outside of my immediate family, many have strived to work their way into good jobs. But not in my branch. Our success story right now is my cousin the nurse. She did work hard to get there, and she wants a good life for her family. In her mission she has succeded. The rest are content to suffer and pray, and worry about paper tigers and chimeras.

traffic jams in rush hour.

why dont those ambulances divert to suburban hosp's during rush hour? I can only guess. The suburban ones are private, the downtown ones are public. I suppose poor patients are not allowed in the private ones. So, the poor sit in traffic. My surmise.

Healthcare here is one vast scandal. 25 nations outlive us. Small wonder. Under this bush, our longevity has slipped five slots in the rankings. Trickledown is deadly economics.

I don't know of what urban area you speak of ER's aren't allowed to turn anyone away, however they CAN divert ambulances away (though, if the ambulance shows up, they have to treat the patient).

Or, put another way, a private hospital has to treat anyone who comes to them requesting or needing treatment.

Another point to make - a well-funded ER attracts the big-money paying patients. In the DC area, we have a number of Excellent private (non-government) Level I trauma centers because the private hospitals consider a good ER a draw for the expensive angio (and other) patients.

Surge capacity: The US's for profit model provides much much more surge capacity overall than, say Canada's. One of the big selling points for universal healthcare, is that it reduces the redundancy in equipment. The US has a surplus of beds, operating rooms, MRI's, etc.; this is one of the reasons we are more expensive.

Ambulance Waits: ER's often make ambulance's wait - the ambulance staff has to stay with the patient until they turn them over to the ED staff. This tactic give's the ED free staffign for the time they make the ambulance crew wait. This was recently ruled illegal, I expect it to be cracked down on. The other half of the coin, though, is that in busy EMS systems, the ambulance crews have little or no guaranteed opportunity for restroom, hygeine, or meal breaks. The only time they can guarantee not being sent on another run is when they're sitting at the hospital with a patient, or sitting at the hospital while the dispatch center thinks they have a patient.

I'm in favor of some form of universal healthcare, I just want intellectual honesty in the demonization of our healthcare system.

At least in my facility...there are 2 other full service hospitals within a couple miles of mine and I can tell you that the chief nursing officer forbids our ER from considering any kind of diversion because they don't want to lose the patient revenue to the other hospitals.

We've had patients tell us (once they finally made it to our floor) that they had a 12 hour wait in the ER. Staffing is never to be an issue, either, they will put "over flow" medical-surgical patients on a post partum (new mommies) floor. Newsflash to administrators: Post partum nurses are not meant to take care of complicated, multi-system illness patients..nor do they WANT to take care of them.

All that matters to the bean counters is stuffing in as many patients as possible. No one in a hospital's administration will give a damn how long the ER wait is.

in the hallway. Collarbone belonged to a student of mine, who was in agony. All they would say in the ED when I asked the docs to see him was, "It's very busy today."

My epal tells me of that three day wait being on his local news thirty years ago.

ER's have been a constant scandal for decades.

Like all usa healthcare.

HOUSECALLS, in nationalized healthcare of Eng., Germany. Possibly others.. i only know of these because i got some replies to a post here at DU. Anyone know?

BTW, new zealand has/had, a twenty four/seven free phone line to call and ask a real dr. about your health worries. Another LW nation had a dr. on EVERY ambulance. Where you really need them, obviously.. when you are "in extremis". when seconds count. None of this ridiculous having to wait half an hour for the ambulance to get you to a dr.

this thread is now buried in the early replies. This thread is important to all of our's health, so i am repeating myself on the idea of RECOMMENDING it.

thank you for your patience

:kick:

to bring this country to it's knees. The Republicans are doing an excellent job of destroying it.

that so many people can't afford health insurance that they have to resort to going to emergency rooms for care.

does NOTHING!!!

The hospitals bleed money because most of the people in the ER are not insured...

Its a travesty to the American people!!!

Universal Health will happen its inevitable... all its going to take is a MAJOR crisis

he is a cardiac kid with lots of other medical issues, and a classic malrotation of the bowel. To make a long story short, he suddenly began showing symptoms of an intestinal obstruction, a condition to which he is much more susceptible than the average person. You know what goes through your head--volvulus, necrosis, all VERY bad news in anybody, much less an immunocompromised 6-year-old with a major heart condition.

Made an 80+ mph run to the town with the nearest quality medical center, which is about 20 miles. Brakes were smoking when we got there. For insurance reasons, went to the urgent care clinic first, but they saw him stat and said to get him to the ER. We did.

We got there around 7:00 pm, as I recall. With potentially life threatening symptoms. We sat in the emergency room with him vomiting his guts out until WELL AFTER MIDNIGHT, and he was finally admitted early the next morning. Basically, the ER was backed up and understaffed, everyone being seen was a critical case, and they took a gamble that he'd be OK.

It's a darn good thing he DIDN'T have a volvulus (had a bad intestinal bug that apparently put things in reverse, but no structural problems), because if he had, he likely wouldn't have survived. He'd have sat there dying in the ER waiting room, until it would have been too late.

someone in charge there needs to be put in prison for the rest of his awful life.

Staffing is just a matter of spending more money on wages.. just like grocery check-outs.

Stores which are kind will spend to hire enough cashiers. More cashiers, short lines. Same with ER's. Penny pinching administrators who shortstaff the ER's are causing the collarbone agony and gut agony of which i read in this thread.

not enough MDs and RNs

The whole American medical system is only surviving on the medical and support staffs continually going above and beyond their limits to keep patients alive. The resident hours restrictions have hurt many hospitals, and instead of actually hiring anyone, they're making attendings cover the large patient lists and keep things going.

My hubby always says that it doesn't makes sense to go to the ER unless it's trauma or you already know what you have. They'll make you wait forever if it's not trauma or heart (and they still miss some of that), and your doctor won't even know you're there. Hubby's much more comfortable with admitting from his office unless there's a real time issue (like with heart, stroke, or trauma).

He also says that every family should have a nurse and/or a doctor in it to fight for family members needing medical care. Even doctors' families get treated like crap these days, but we do get marginally better treatment overall.

It took almost a full day to get her a room she shared with five other people.

less than a week later, they discharged her, pale and with a high fever (she had pneumonia as it turns out) with less than 24 hour notice for us to find her a rehab facility, they were intending on dumping her into this shitty facility that always has room.

It sure isn't the standard of care. That's awful!!