The emergency room thread (1 Viewer)

[Terminalxylem]

ERs across the country are a mess. YLE had a blog entry on it recently, here, with additional commentary here.

The key issues are understaffing and overcrowding, which result in patients spending hours, sometimes days, in the emergency room, potentially delaying critical medical care.

In my hospital, patients are constantly bedded in the ED hallways, or shuffled back-and-forth between examination areas and the waiting room. “Virtual beds” keep popping up in every corner, closet, and otherwise unused space on hospital property. They even bed patients on the lanai outside. And “bed” often means hospital gurney, with a sheet and thin blanket, +/- a pillow (or a second, folded blanket).

ER nurses are forced to take care of patients who should be in the hospital proper, but can‘t go upstairs for lack of beds. Given the hectic environment and lack of floor-specific training, oversights and errors are bound to occur.

And don’t expect to eat anything, or sleep amongst the chaos of beeping alarms, cursing/screaming patients, and ambulance sirens.

Overall it’s a colossal cluster, and only getting worse. What are your experiences?

 

[JohnnyU]

Wal-Mart moms that take their children to the ER with sniffles doesn’t help. Expect a 4-6 hour wait most of the time.

 

[3C's]

Last year my appendix burst. Went to the local doctor's hospital and was taken in right away, no line no waiting. I know that experience is rare though; the main/big hospital in that hospital system is a madhouse.

 

[JohnnyU]

Last year my appendix burst. Went to the local doctor's hospital and was taken in right away, no line no waiting. I know that experience is rare though; the main/big hospital in that hospital system is a madhouse.

Yes, an appendix burst constitutes an immediate response.

 

[Dan Lambskin]

My experience is that it’s a ****show. Spot on about overcrowding and patients in hallways

I did take my oldest at the end of last year (stomach issues) and we were surprisingly in and out in like an hour

I’ve also had experience where little one fell off the bed and hit his head, after an hour in the waiting room I just decided to leave

Another time took one of them in for really high fever, we were put in a room and after seeing doctor initially we waited around for over an hour and finally just left (he seemed like he was feeling better)

We try to use urgent care for most things and only do ER as a last result, especially since the kids are older now

 

[bcat01]

My wife is a medical coder and does ER charts. We are in a rural area so there is no overcrowding. Their numbers are actually down around 30% pre-covid. Now she is seeing that there are a lot of people in worse shape coming in than ever before.

 

[Uruk-Hai]

I was in the ER of my local hospital last September. I was lucky, as I got one of the "real" rooms in the ER (instead of a curtained cubicle) - 4 walls, a door, and a bathroom. They wanted to move me to a room in the main hospital after they got me stabilized, but there were none available.

I went in at around 3 p.m. and don't recall if they offered me dinner or not (wasn't hungry anyway). They did bring me breakfast the next morning.

As the OP says, there was zero hope of sleeping in anything more than 15-20 minute shifts. Besides the patient out there somewhere screaming endlessly that she wanted her cigarettes, staff was checking stuff on me every hour or so, and that damned machine they had me hooked up to was not very respectful in keeping its sounds down.

They wanted to keep me a second night, but I passed enough pop quizzes to get released around 11 a.m. - so a 20 hour sentence overall.

 

[3C's]

Last year my appendix burst. Went to the local doctor's hospital and was taken in right away, no line no waiting. I know that experience is rare though; the main/big hospital in that hospital system is a madhouse.

Yes, an appendix burst constitutes an immediate response.

Technically it hadn't burst yet and all they knew was I had some stomach discomfort. Things definitely accelerated when I puked up green stuff after being admitted though.

 

[dgreen]

One thing that surprised me last year was to learn that you have to go through the ER in order to be admitted. My wife had some medical issues that eventually led to one of her doctors sending us to the hospital to be admitted for treatment. He even said he'd call ahead to let them know she's coming, but we had to go through the whole ER process before being admitted. It took about 16 hours to get her upstairs in a room. This was at the 4th busiest ER in the country. After about 6 hours they did move her to another spot in the hospital where they had converted into temporary holding areas for people waiting for beds to be admitted. That was better, but still not a great place to be.

My guess is the number of people who are sent to the hospital by a doctor for the purpose of being admitted is pretty low, but maybe that's a way to reduce the crowding in the ER. I know I'm completely ignorant on how hospitals work, but I just didn't see why we couldn't report to a different part of the hospital to be admitted.

 

[General Malaise]

ERs across the country are a mess. YLE had a blog entry on it recently, here, with additional commentary here.

The key issues are understaffing and overcrowding, which result in patients spending hours, sometimes days, in the emergency room, potentially delaying critical medical care.

In my hospital, patients are constantly bedded in the ED hallways, or shuffled back-and-forth between examination areas and the waiting room. “Virtual beds” keep popping up in every corner, closet, and otherwise unused space on hospital property. They even bed patients on the lanai outside. And “bed” often means hospital gurney, with a sheet and thin blanket, +/- a pillow (or a second, folded blanket).

ER nurses are forced to take care of patients who should be in the hospital proper, but can‘t go upstairs for lack of beds. Given the hectic environment and lack of floor-specific training, oversights and errors are bound to occur.

And don’t expect to eat anything, or sleep amongst the chaos of beeping alarms, cursing/screaming patients, and ambulance sirens.

Overall it’s a colossal cluster, and only getting worse. What are your experiences?

Funny, the first "similar threads" below yours is one I made about a year ago (and in a tragic state of affairs, I don't remember even posting it ). But yeah, I started it based off a visit to the ER for my wife. It was a gong show.

Had to take my dad to the ER for some bleeding that wouldn't stop - he had a stent put in and the wound wasn't healing up. My sister took him there as Urgent Cares were closed, so I met them there and told her to go home. They tended to his wound in a make-shift tent. All around were people laying on gurneys, some groaning in misery. There's no privacy, I heard all sorts of conversations from people I didn't want to hear and shouldn't have been privy too, but that's the nature of the beast I guess.

My supposition is that people aren't taking care of themselves routinely, aren't getting wellness checks, aren't in good overall health and wait until the last minute to hit the panic button. I don't know what those ER nurses and doctors make, but it's not enough. The stress levels would kill me. It never ends. It never. Ends.

 

[CGRdrJoe]

I went to the ER last Saturday and had 0 issues but I'm in Marin County so I'm sure that played a part in it, spent probably 5-6 hours in there before I was told that I wouldn't be going home because they suspected I had a gallstone stuck in my pancreatic duct. Finally on Tuesday they were able to get me in for a procedure a county north and after transport I went through their ER which looked like a disaster zone and exactly as described in the OG post, crazy how it was over crowded with multiple people having their own personal security team (police) while in cuffs. I don't remember what it looked like on my way out a few hours later as I was high as a kite still but I'm sure it wasn't a pretty scene.

 

[Dezbelief]

Ride to the ER in an ambulance to get admitted faster.

I've heard multiple horror stories about our local franchise hospital ER taking 8+ hours before being seen. I'm sure most of those cases were low level in triage. Still though you never know, what appears low level could be more serious.

 

[-fish-]

Last time I went to the ER with my daughter they examined her in the hospital chapel. Even did an EKG there. She never saw an exam room.

 

[Snotbubbles]

ERs across the country are a mess. YLE had a blog entry on it recently, here, with additional commentary here.

The key issues are understaffing and overcrowding, which result in patients spending hours, sometimes days, in the emergency room, potentially delaying critical medical care.

In my hospital, patients are constantly bedded in the ED hallways, or shuffled back-and-forth between examination areas and the waiting room. “Virtual beds” keep popping up in every corner, closet, and otherwise unused space on hospital property. They even bed patients on the lanai outside. And “bed” often means hospital gurney, with a sheet and thin blanket, +/- a pillow (or a second, folded blanket).

ER nurses are forced to take care of patients who should be in the hospital proper, but can‘t go upstairs for lack of beds. Given the hectic environment and lack of floor-specific training, oversights and errors are bound to occur.

And don’t expect to eat anything, or sleep amongst the chaos of beeping alarms, cursing/screaming patients, and ambulance sirens.

Overall it’s a colossal cluster, and only getting worse. What are your experiences?

My wife was an ER nurse before she became an assistant manager of the ER (until she left her health system to go to another and get back on the floor).

Her experience was that being a per diem nurse was much more profitable than being a full-time staff nurse. They would also give these ridiculous sign-on bonuses for new nurses and never reward nurses that were already with them. So a new nurse would get say $20-30K sign-on bonus, stay a year and then leave, while a nurse who was there for 10 years would get nothing. It's hard to keep a full-time staff when everything around them is telling them that they could make more money elsewhere.

 

[Terminalxylem]

One thing that surprised me last year was to learn that you have to go through the ER in order to be admitted. My wife had some medical issues that eventually led to one of her doctors sending us to the hospital to be admitted for treatment. He even said he'd call ahead to let them know she's coming, but we had to go through the whole ER process before being admitted. It took about 16 hours to get her upstairs in a room. This was at the 4th busiest ER in the country. After about 6 hours they did move her to another spot in the hospital where they had converted into temporary holding areas for people waiting for beds to be admitted. That was better, but still not a great place to be.

My guess is the number of people who are sent to the hospital by a doctor for the purpose of being admitted is pretty low, but maybe that's a way to reduce the crowding in the ER. I know I'm completely ignorant on how hospitals work, but I just didn't see why we couldn't report to a different part of the hospital to be admitted.

Under normal circumstances, you don’t need to go through the ER to be admitted. There is an admissions department in all but the smallest hospitals.

Yet many, many doctors take that path, for a number of reasons. Some are legitimate, based on the data available pre-admit, acuity of the problem, and hospital census. But it’s also less work for the referring physician.

 

[Scoresman]

Is this because COVID was such a nightmare that everyone quit and there's no staffing? But that doesn't explain keeping patients in the hall or a closet. What else changed?

 

[AAABatteries]

Been to the ER twice in the last year at our new hospital - once for my wife who was having some GI issues and once for myself when I had a suspected hernia. No issues at all.

 

[JohnnyU]

If more people would go to urgent care for non-emergencies it would cut down on ER crowding. Yes, a lot of trips to the ER seem to be taking children with a cold or less. Give them a baby aspirin and a shot of whiskey.

 

[AAABatteries]

One thing our hospital does that I like (and I have no idea how common this is) but after you checking in they have triage nurses that see you fairly quickly to discuss what you are there for, get vitals and assess. I assume this is how most do it but to me it at least allows for someone to see you fairly quickly.

 

[Zow]

The hospital/ER issue was a major issue in my city recently as the local hospital wanted to move to property it owns that isn't zoned for a hospital (so, the vote was to whether the rezoning ordinance for this plot of land would pass). I concede that I should be more learned on the issue given what I do, but I can say that this was hotly contested and many in the public as well as hospital workers had very strong opinions on either side. I believe a lot of the local opinion was focused on the efficiency of the ER and people's complaints about that which, if I understood opponents of the move, they wanted the money to be spent on the move to instead be spent on staffing and improving the ER in the existing hospital.

 

[Softballguy]

I work in a hospital that's part of a fairly large system. We're all facing the exact same issues, and a significant part of the problem is that large part of our community treat ED visits like primary and urgent care. We promote our urgent care options (and even there we're near max capacity) and have really starting pushing our virtual care options as of late. If we could keep those who do not need emergent care out of our emergency rooms, we'd be in a much better place. And if people would just establish with a darn primary provider (there's a crazy shortage of those as well... but don't get me started on the doctor vs. nurse practitioner model of care) and get routine wellness checks we would also be in a better place.

 

[Fat Nick]

I went to our local ER a few years ago, on my birthday, due to chest pains. I'd had some off and on for a few weeks, but this was finally enough for me to go. Went in, told them what was going on, and went and took a seat in the waiting room. Waited for 3 hours without anything, and then went to the front desk and said I was leaving. The lady freaked out and told me I couldn't go, blah blah blah. I told her that If anything was seriously wrong, I would've already died waiting for somebody to take a look at this point, and that I was holding up my own birthday dinner. They then said they'd get me back ASAP, which they did, then shoved an IV in my arm to keep me from going anywhere. 2 hours later, they said there wasn't anything wrong, and I left.

I'm terrified of dying...and I'm convinced I'll eventually die from something that could've been prevented because the barrier to getting healthcare is way too high for me. I'll keep saying "it's not anything serious," well past the point I should knowing if I'm wrong, I'll have just sat somewhere for half a day. It really sucks, but it's the reality of things.

 

[JohnnyU]

I'm terrified of dying...and I'm convinced I'll eventually die from something.

I believe you are 100% correct. I on the other hand am immortal.

 

[The Z Machine]

We live within walking distance of Johns Hopkins hospital. In fact, I'm there right now with my MIL who is getting radiation therapy for lymphoma. As you can imagine, the hospital is huge and serves a large population from in the city and all over the world. The main ED is a disaster, just like the OP mentioned. But! There's a special children's ED that only does Peds. That is remarkably well run and is the exact opposite of the adult ED. Wait times are reasonable and the quality of care is much better. Plus it's staffed with pediatricians and they have access to specialized care from the large pediatric department of the hospital. On the unlucky occasions that we've used the children's ED, it's been great.

 

[Zow]

If more people would go to urgent care for non-emergencies it would cut down on ER crowding. Yes, a lot of trips to the ER seem to be taking children with a cold or less. Give them a baby aspirin and a shot of whiskey.

I absolutely understand your point here, but I'll share an anecdote from the other side of the coin on this. When my wife and I took in our first foster child (who is now our son), the process is surprisingly simple: a Department of Child Safety worker literally just drops the baby off to you with maybe an hour's notice and with little to no instruction. If you're lucky, there will be a baby carrier, a few sets of clothes, and some formula. In this instance, we got one can of formula and no medical history.

So, we go to feed our son but he's throwing up the formula. He's also pretty clearly malnourished. I should add as well that he was born premature and was substance exposed in utero. After a couple of tries and dealing with the stress of him not eating (this is around midnight as we got him probably close to 10 PM), we throw our hands up and take him to the local ER.

The experience in the ER - a local hospital in a town of like 50k people - in the middle of the night was awful. They were busy and understaffed clearly, and it definitely worried me that there were clearly very sick people there and our exposure to them was worrisome, but we genuinely didn't know what to do. The doctor came in, spent a few minutes with us and merely checked vitals, etc. then basically told us he was fine and that he won't starve. When my wife pushed back a little bit the doctor became agitated and chastised us for bringing the baby in. We felt awful but, more to my point, we are generally competent people and we truly didn't know what to do.

A day or two later when the situation didn't get better and we got him in to see a pediatrician, we learned that things were not "fine" and, in fact, our son was very allergic to the formula provided to us and needed to be on a special formula.

The point of my post is that there needs to be a happy medium between trying to keep children without life threatening issues out of the ER but with the medical field also providing an expedited or emergent route for children to go. The lone solution I can come up with is a child-centered hospital (and I'd note that my experiences with Phoenix Children's Hospital were all very positive), but this isn't feasible in smaller cities/towns probably.

 

[SoBeDad]

When my daughter had severe abdominal pain while I was visiting her in SF during Thanksgiving, we went to the St. Francis ER. Only 2 people were waiting. It was 7am Sunday morning. Initial triage by a nurse was almost immediate, a doctor saw her within 5 minutes and gave her pain medication. The blood work, urinalysis and CT scan took another 3 hours. I think she was lucky cause the ER got full. My daughter's experience was good.

 

[Quint]

i went to the ER back in August of '23: couldn't catch my breath and didn't feel right. arrived at 8:00am on a Tuesday and was getting an EKG within 15 minutes of arrival. CT Scan and MRI were completed within 2 hours, and diagnosed with a pulmonary embolism (one blood clot in the leg, one in each lung straddling the aorta). things went kinda sideways about 5:30pm that night and got moved to ICU. spent the night in there and thankfully the pulmonologist assigned saved my life. got moved "upstairs" for monitoring in the small hours Thursday, and finally discharged on Sunday afternoon.

from admitting staff, to Doctors, Nurses, and specialists, the quality of care i received was exceptional across the board. every nurse i spoke to during the stay commented about how short-staffed they have been and how many OT hours they are working to cover the gaps. god bless those folks and what they do: i don't have that skill set.

 

[Beef Ravioli Part 2]

I’ve taken my wife to the ER twice in the last month. About 40 miles south of DC. Both times she was in an ER room in less than 30 minutes.

First time diagnosed with a severe upper respiratory infection. I took her back a week later and she was admitted with pneumonia.

Last time either of us have been in the hospital was 20 years ago in rural PA when I called the ER on the way there going about 100mph. Thought my 30 year old wife was having a heart attack. Amazing how fast she got in a room that time! Ended up having open heart surgery though.

 

[Dezbelief]

Is this because COVID was such a nightmare that everyone quit and there's no staffing? But that doesn't explain keeping patients in the hall or a closet. What else changed?

In my town one of the large Healthcare systems came in and bought both hospitals, then demolished one. I don't know how wide spread this behavior is.

 

[Runkle]

Last year my appendix burst. Went to the local doctor's hospital and was taken in right away, no line no waiting. I know that experience is rare though; the main/big hospital in that hospital system is a madhouse.

My appendix started to swell, once the pain moved from the middle to the right side, I went in and it was a good 3-4 hours in the ER until they got me in for the surgery, thankfully it hadn't burst yet.

Actually bursting is an immediate concern. I guess with swelling they were willing to risk it for a bit, once it does burst it's a massive undertaking to clean out.

 

[3C's]

Last year my appendix burst. Went to the local doctor's hospital and was taken in right away, no line no waiting. I know that experience is rare though; the main/big hospital in that hospital system is a madhouse.

My appendix started to swell, once the pain moved from the middle to the right side, I went in and it was a good 3-4 hours in the ER until they got me in for the surgery, thankfully it hadn't burst yet.

Actually bursting is an immediate concern. I guess with swelling they were willing to risk it for a bit, once it does burst it's a massive undertaking to clean out.

My journey was waking up in the middle of the night to an odd pain; took some gas-x to see if it would help, it didn't; got a bite to eat (mistake); pain didn't subside/got worse so I went to the ER knowing what it likely was; got checked in and checked and they confirmed it was the appendix; since I had eaten and it hadn't burst yet the surgeon wanted to wait until the next morning. It opened up later that night and they gave me stuff; surgery followed in the early AM. It was only about a 1/4" opening and there wasn't too much cleanup needed fortunately.

 

[Mrs. Rannous]

I feel completely spoiled now. A couple of months back, I had severe pain in my abdomen. Methodist has a stand-alone 24 hour ER not too far from here. At 3AM, I was the only patient. Got scanned and tested at once. (Kidney stone. Whee!) Got meds and was discharged around 8AM. Great care.

 

[The Dreaded Marco]

I do everything possible to avoid sending my patients through the ER if I think they need to be hospitalized (unless they are clearly unstable, then they go directly to the ER).

All of the hospitals I admit to now either have pediatric hospitalist services or have no pediatric ward so we no longer attend on inpatients. So there is no difference to me regarding the amount of work I have to do to get them admitted. I just hear the nightmare stories, like many upthread, from my patients/families about their ER experiences so I do my best to directly admit them to the floor. Sometimes the hospitalist requests the ER route if they are too busy at the time or are concerned about the acuity of the patient I'm referring.

 

[General Malaise]

Well, farts. This thread is timely.

Sister just texted me that she took our dad to the ER because he hurt his back at the gym. Not urgent care. Nope, straight to the ER. So guess where I get to spend Valentine's Day?

Feel free to ask me any questions as I'll need help passing the time. The ONLY thing slower than Church hours are hours spent at the ER. Time just stands still.

 

[Zow]

Well, farts. This thread is timely.

Sister just texted me that she took our dad to the ER because he hurt his back at the gym. Not urgent care. Nope, straight to the ER. So guess where I get to spend Valentine's Day?

Feel free to ask me any questions as I'll need help passing the time. The ONLY thing slower than Church hours are hours spent at the ER. Time just stands still.

How much does he bench?

 

[Terminalxylem]

Is this because COVID was such a nightmare that everyone quit and there's no staffing? But that doesn't explain keeping patients in the hall or a closet. What else changed?

In my town one of the large Healthcare systems came in and bought both hospitals, then demolished one. I don't know how wide spread this behavior is.

Very. It’s a huge problem, as mega healthcare systems have become more profit-driven.
Discussion here.

 

[ProstheticRGK]

Well, farts. This thread is timely.

Sister just texted me that she took our dad to the ER because he hurt his back at the gym. Not urgent care. Nope, straight to the ER. So guess where I get to spend Valentine's Day?

Feel free to ask me any questions as I'll need help passing the time. The ONLY thing slower than Church hours are hours spent at the ER. Time just stands still.

How much does he bench?

You think you're better than him?!?!?! Mandelbaum... Mandelbaum... Mandelbaum

 

[General Malaise]

Well, farts. This thread is timely.

Sister just texted me that she took our dad to the ER because he hurt his back at the gym. Not urgent care. Nope, straight to the ER. So guess where I get to spend Valentine's Day?

Feel free to ask me any questions as I'll need help passing the time. The ONLY thing slower than Church hours are hours spent at the ER. Time just stands still.

How much does he bench?

The bar? Maybe?

 

[Terminalxylem]

I feel completely spoiled now. A couple of months back, I had severe pain in my abdomen. Methodist has a stand-alone 24 hour ER not too far from here. At 3AM, I was the only patient. Got scanned and tested at once. (Kidney stone. Whee!) Got meds and was discharged around 8AM. Great care.

Yeah, those are good, if you don’t require hospitalization. I vaguely remember reading something about them milking the payment system though.

 

[General Malaise]

My co-worker (former Mr. Oregon body builder) saw my dad at the gym on Monday. Says he saw a guy wearing a shirt that read "I can make beer disappear" on the front and on the back "what's your super power?".

My dad is almost 80 and weighs 130 pounds. Good on him for going to the gym, though! Fight back death one curl at a time.

 

[Terminalxylem]

Is this because COVID was such a nightmare that everyone quit and there's no staffing? But that doesn't explain keeping patients in the hall or a closet. What else changed?

Many reasons, contained in the links of my OP.

 

[turnjose7]

Clearing up a few misconceptions in this thread:

1) People going to the ED with minor problems is not the main driver of ED crowding. It certainly doesn't help and you should avoid it if possible because it isn't a great use of resources, but a good EM physician can crank through patients who aren't very sick in no time. The main driver of ED crowding is lack of inpatient hospital beds. This itself has multiple causes including hospitals trying to run as lean as possible with their staffing (mostly inpatient nursing) and saving beds for elective surgery which is a hospital's major moneymaker. ED arrival volumes are up significantly in major urban hospitals and this is increasing the strain a bit, but it is the lack of inpatient beds that is putting most of the strain on EDs.

2) Physicians do send frequently send their patients to the ED to be admitted, but in most places patients can still be directly admitted. Around half of hospital admissions come from the ED and about half other avenues. Of those who are admitted from the ED, around 20% are sent in for admission while about 80% come in on their own and are found to need admission. Of course, all that varies from hospital to hospital and health care system to health care system, and each is set up differently. In general, having a patient sent in to be admitted isn't a big deal. They are going to wait somewhere regardless. What is annoying is when primary physicians send patients in to get workups that can easily be done as an outpatient.

3) Going to the ED in an ambulance doesn't necessarily mean you will be seen faster. We routinely screen ambulance patients and send them to the waiting room at the back of the line. More importantly, that is a tremendous misuse of resource if you don't actually have an emergency condition and anyone who does it should be ashamed.

 

[ProstheticRGK]

I work in a little hospital, outside of Sacramento. Pre-Covid, we could count on surges and lulls in both acuity and census. Post-Covid, we have been slammed with almost no breaks with higher acuity of patients and numbers that are probably 150-200% of what we were used to seeing. We routinely board patients in the ER for >24 hours, just because we don't have the physical beds available. I float down there regularly to care for ICU patients that have been admitted and are waiting for an ICU room to open up.

It's become more difficult to transfer patients to facilities that have open beds, or have services we don't offer. The constant refrain I hear is that they're all full, also. I thought maybe it was mostly due to an increase in population, because of the price of housing in the Bay Area, the whole swath of real estate from the Bay to Sacramento is becoming like L.A. to San Diego- one giant strip mall megalopolis. And people who can telecommute moved out this way for affordable houses.

Hearing that this might be somewhat universal is interesting. Makes me think the fallout from Covid, and people not getting routine health care for a few years has more to do with increase in acuity.

 

[The General]

Last time I went was about 25 years ago. Had no health insurance at the time, was sick as a dog and thought I was dying.

They gave me a couple IV's for dehydration, some pills that costs about 10 bucks, and pushed me out the door.

Got a bill for like $1400 bucks

 

[Chemical X]

me and the mrs. travelled to italy 12/14. we had dinner out 12/16. she was feeling ill the 17th, we suspected the flu. figured 3 crappy days and then 3 days getting better, but she gradually got worse and complained about stomach pain. when she puked while on the toilet it was time to hit the ER… xmas eve just outside of rome. emergency surgery to celebrate the birth of teh baby jeebus for a ruptured appendix. oh the stories i have for how their national system works. but, they likely saved her life from sepsis.

 

[General Malaise]

ED = Erectile Dysfunction. Right?

 

[JohnnyU]

ED = Erectile Dysfunction. Right?

That’s kind of limp isn’t it?

 

[Terminalxylem]

Clearing up a few misconceptions in this thread:

1) People going to the ED with minor problems is not the main driver of ED crowding. It certainly doesn't help and you should avoid it if possible because it isn't a great use of resources, but a good EM physician can crank through patients who aren't very sick in no time. The main driver of ED crowding is lack of inpatient hospital beds. This itself has multiple causes including hospitals trying to run as lean as possible with their staffing (mostly inpatient nursing) and saving beds for elective surgery which is a hospital's major moneymaker. ED arrival volumes are up significantly in major urban hospitals and this is increasing the strain a bit, but it is the lack of inpatient beds that is putting most of the strain on EDs.

2) Physicians do send frequently send their patients to the ED to be admitted, but in most places patients can still be directly admitted. Around half of hospital admissions come from the ED and about half other avenues. Of those who are admitted from the ED, around 20% are sent in for admission while about 80% come in on their own and are found to need admission. Of course, all that varies from hospital to hospital and health care system to health care system, and each is set up differently. In general, having a patient sent in to be admitted isn't a big deal. They are going to wait somewhere regardless. What is annoying is when primary physicians send patients in to get workups that can easily be done as an outpatient.

3) Going to the ED in an ambulance doesn't necessarily mean you will be seen faster. We routinely screen ambulance patients and send them to the waiting room at the back of the line. More importantly, that is a tremendous misuse of resource if you don't actually have an emergency condition and anyone who does it should be ashamed.

Good post. Regarding number 1, can you elaborate how you know inpatient beds are the major driver of ER crowding?

I have no stats to back it up, but my impression is it’s a combination of frivolous ER visits, lack of primary care physicians, ED hyper users (often homeless, with mental illness/substance abuse), and lack of inpatient beds, in no particular order. An aging, unhealthy population isn’t helping matters either.

 

[HomerSimpson]

The last time i was in the ER for my girlfriend (she had a medical emergency at night), most of the beds were taken up by drunk drivers with cops escorting them in and filling out reports by the bed side.

 

[Keerock]

Well, farts. This thread is timely.

Sister just texted me that she took our dad to the ER because he hurt his back at the gym. Not urgent care. Nope, straight to the ER. So guess where I get to spend Valentine's Day?

Feel free to ask me any questions as I'll need help passing the time. The ONLY thing slower than Church hours are hours spent at the ER. Time just stands still.

How much does he bench?

The bar? Maybe?

Does he even lift, Bro?