The emergency room thread (1 Viewer)

[General Malaise]

Alright, so almost 80 year-old dad weighs about 130 pounds soaking wet. Recently had a valve replacement and a pace-maker put in along with 2 stents. That was in Nov or so. He's been feeling better, appetite back up, started going to the gym again (he was close to death fall of 2022.....like "I'm dying tonight, get over here" kinda stuff) and was feeling his oats.

Starts in on shoulder shrugs. Not a difficult exercise, not too much range of motion, he's done it his whole life. 90 Lbs. So, 3/4 of his body weight. *SNAP*. That was the noise his spine made. Dropped the weights, drove home, took a Tylenol and sat in a chair moaning in agony. Calls my sister, she takes him straight to the ER around 2pm.

5pm, I get over to the ER and he's not in a ROOM room, but they moved him from the waiting room to what looks like a cleaned out supply closet. An alcove with a half curtain to close. He's got an IV drip, Dilaudid for pain, something for nausea and we wait. And wait. And wait. Waiting on an Xray tech to take him back.

Meanwhile, I can hear just about everything going on around us and it's Thunderdome, man. Loud wails, moaning, beeps, vomiting, screaming and then the conversations I can hear but not see of people who are so drunk/high they can't really process the information coming back to them and repeat questions. At one point, I left to use the bathroom, walked through the waiting area and back and I'm pretty sure I now have SARS. Some of the faces of the folks just sitting in chairs, waiting for anything....it's a den of despair, man.

Xray tech comes, we go get pictures, he can't move, he can't sit up so we have to wiggle him onto a green moving sheet and slide him on to the Xray table and he's just wincing and groaning in pain. Back to the alcove where we wait, and wait. This time, they need a CT Scan because his blood count is way low and the docs are worried he's got some internal bleeding. We know for sure he has a compression fracture, T12 and there's nothing to be done but strap on a brace and schedule some occupational therapy.

Goes to the CT Scan and I'm alone now. I hear a commotion in an area behind me, a guy who sounds like a teen, early 20s and he's now shouting, dog-cussing the nurse and everybody around him. He is making threats, going to FFFFUUUFJFF Kick this asssss and that asssss and then I just hear the loudest, most violent eruption of vomiting I've ever heard. I'm behind a curtain and I don't dare stick my head out for fear of getting barf shrapnel, but it just isn't stopping. Where is he throwing up? How many times is he throwing up? There are people everywhere, are they running for cover? Can they run? Can they cover?

By 10:30pm, they find him a room in the CDU - insurance isn't covering a regular hospital room for him but the docs aren't clearing him to go home. I stayed with him until almost midnight and once he fell asleep I went home to eat, watch Curb and go to bed. Got back to the hospital 6:45am, nothing really new to learn but they have drawn blood three times and have ordered a transfusion. I have no idea when he gets released, but he can't go home and live alone like he does now. Soooooooooooooo.................we wait. I'll be back up there after work.


TL;DR - ERs are not a fun place to spend Valentine's Day and the docs and nurses and orderlies and crew that work there don't get paid enough money. I can't imagine a more stressful work environment than this. Bless you all.

 

[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.

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.

My statement is partially just from experience of seeing rises and falls in boarding over the years and going over reports of our own internal ED data. Our busiest arrival days are not the days when our EDs are the most crowded. We have days where we see 350 patients and completely clear out the ED. But on days when there aren't inpatient beds, we might see 250 patients and get to a point where there are 30 patients in the waiting room with 5 hour wait times.

This contrast is readily apparent to me right now because I work at 2 big hospitals, one of which has about 90,000 ED visits per year and a poorly functioning system with frequent issues of bed availability, and one that will probably see around 115,000 ED patients this year but has a good functioning system with only rare difficulty getting inpatient beds. The latter is busy, of course, but the former consistently feels much more crowded and has much longer waiting room times.

I believe the literature is consistent with this and indicates there is an association between inpatient occupancy rates and ED boarding. And when strategies have been reported to help with boarding, it generally involves increasing inpatient capacity. It's not my area of expertise (I'm not an administration/operations guy) but that has been my impression from everything I have read over the years.
https://www.acep.org/siteassets/sites/acep/media/crowding/empc_crowding-ip_092016.pdf

Hospital Occupancy and Emergency Department Boarding During the COVID-19 Pandemic

This cross-sectional study uses national benchmarking data to evaluate hospital occupancy and emergency department boarding during the COVID-19 pandemic.

www.ncbi.nlm.nih.gov

https://www.sciencedirect.com/science/article/abs/pii/S0925527320302085

Also just personal experience. If I have just a few open rooms I can crank through 40 frivolous visits in 5 or 6 hours and keep things moving. But if I get a couple of sick patients and there are no beds in the hospital to admit them to, that totally gridlocks everything.

 

[ghostguy123]

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?

Tons of smaller hospitals closed, so more traffic through the larger hospitals.

Staffing issues are definitely real. Tons of older nurses who did a lot of training up and retired earlier than they planned due to COVID. A lot of new graduates are being hired straight to units that usually require two years experience like the ER.

The amount of documentation required by nurses these days is silly. So much over documentation due to the off chance you go to court. It totally kills productivity.

Everything moves slower, hence the buildup of people waiting.

 

[The Z Machine]

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.

My MIL has a friend that's 80 and lives alone. She has some heart conditions that inevitably crop up in the middle of the night when she freaks out. Instead of calling a friend to take her to the ED, she calls the paramedics, who wheel her out of her house on a stretcher, take her to the ED, where she gets in the back of the line. What as waste of resources. Medicare pays for it though, so who cares, right?

 

[Terminalxylem]

The amount of documentation required by nurses these days is silly. So much over documentation due to the off chance you go to court. It totally kills productivity.

I always thought nursing* documentation was excessive, and have argued for years ~75% of it should be omitted. Stuff like, “Dr. X at bedside”, and repetitive info that can be found elsewhere in the EMR.

Pretty sure nobody reads it, and extraneous documentation creates as many liability problems as it solves.

It would be interesting to hear from the lawyer guys. How often do nurses get called into court anyway?

*Chart bloat is a big problem everywhere, independent of the author‘s position. I blame a lot of it on templates + cut-and-paste, as garbage-in, garbage-out plagues the EMR. FTR, I use no templates, nor do I import data.

 

[turnjose7]

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.

My MIL has a friend that's 80 and lives alone. She has some heart conditions that inevitably crop up in the middle of the night when she freaks out. Instead of calling a friend to take her to the ED, she calls the paramedics, who wheel her out of her house on a stretcher, take her to the ED, where she gets in the back of the line. What as waste of resources. Medicare pays for it though, so who cares, right?

I'm not following. This seems like exactly the type of person who should be calling the paramedics.

 

[DA RAIDERS]

The ER is a **** show around me except in the most affluent areas. Even then, it’s not great. I’ve been twice in the last 10 years. Once for my daughter‘s broken arm. I drove her in the middle of the day. the break was visually obvious. Triage took over 2 hours. it was BRUTAL to sit there with my little kid in agony. Anyone with eyeballs could have taken one look at her arm and known it was broken. the admitting person even said, oh yea, that’s broken. But we had to wait 2 hours for the xrays to be ordered. Once we were out of the ER things moved quickly.

the other time, i went via ambulance around 3am. Smack in the middle of Covid. Heart issues. Immediate admittance. I was in the ER itself for about 4 hours. Then I was moved to some sort of storage area for the hospital. Big open room with around 6 of us in it. Curtains on wheels providing the only privacy . I too heard things I’d rather forget. I was at the end of the room, right by a huge active hospital door, facing all of the supplies. I laid there, staring at these supplies, for around 14 hours. Nurses would come and go to get stuff all the time Through the huge loud door. After a few hours I knew where stuff was and i Would ask them what they were looking for and try to tell them where it was. Some of the nurses thought this was pretty funny. Some thought I was a chode. Good times.

my uninformed opinion is that all of the unnecessary visits and the visits from the uninsured that treat the ER as their DR are the problem. the people that need care immediately are suffering because people are not using the ER for ya know…..emergencies.

 

[parasaurolophus]

We have a growing population of unhealthy people and a growing population of people that only know emergency care.

This is obviously the expected result.

 

[Softballguy]

We're doing our best trying to educate the public with "Know where to go for care" type marketing. It lists the ailments that should be treated by primary care, urgent care, emergency rooms, and virtual options. Our urgent cares are often as busy as our ED, so we're really trying to get those with sinus issues, cold and flu symptoms, pink eye... more minor problems to take advantage of virtual care. If we could get them out of our urgent cares I think more people would choose UC over the ED, freeing up the ED for more appropriate patients.

 

[hagmania]

Our company has been undertaking a huge ER throughput initiative for the last 2+ years. The end goal is basically a "Waze-like" map that updates realtime with predictive obstacles.

The problem is we have to hire people that know how to use these very complicated process maps or find a way to make our model produce more intelligent guided decision-making.

 

[the moops]

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.

My MIL has a friend that's 80 and lives alone. She has some heart conditions that inevitably crop up in the middle of the night when she freaks out. Instead of calling a friend to take her to the ED, she calls the paramedics, who wheel her out of her house on a stretcher, take her to the ED, where she gets in the back of the line. What as waste of resources. Medicare pays for it though, so who cares, right?

I'm not following. This seems like exactly the type of person who should be calling the paramedics.

Yea, i think we want 80 year olds with heart issues to be seen as soon as possible

 

[ghostguy123]

The amount of documentation required by nurses these days is silly. So much over documentation due to the off chance you go to court. It totally kills productivity.

I always thought nursing* documentation was excessive, and have argued for years ~75% of it should be omitted. Stuff like, “Dr. X at bedside”, and repetitive info that can be found elsewhere in the EMR.

Pretty sure nobody reads it, and extraneous documentation creates as many liability problems as it solves.

It would be interesting to hear from the lawyer guys. How often do nurses get called into court anyway?

*Chart bloat is a big problem everywhere, independent of the author‘s position. I blame a lot of it on templates + cut-and-paste, as garbage-in, garbage-out plagues the EMR. FTR, I use no templates, nor do I import data.

Nobody looks at it. Maybe just some of the written notes, but that only takes a few minutes to type for all my patients combined.
So much other redundant and unnecessary documentation.

 

[Mrs. Rannous]

Some thought I was a chode.

This made me laugh out loud. Thanks!

 

[Mrs. Rannous]

visits from the uninsured that treat the ER as their DR

Given the unavailability of preventative health care here, that's not very surprising.

 

[The Z Machine]

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.

My MIL has a friend that's 80 and lives alone. She has some heart conditions that inevitably crop up in the middle of the night when she freaks out. Instead of calling a friend to take her to the ED, she calls the paramedics, who wheel her out of her house on a stretcher, take her to the ED, where she gets in the back of the line. What as waste of resources. Medicare pays for it though, so who cares, right?

I'm not following. This seems like exactly the type of person who should be calling the paramedics.

Yea, i think we want 80 year olds with heart issues to be seen as soon as possible

It's the "I don't want to bother my friends so I called the ambulance" combined with the actual lack of acute need that gets me.

 

[ChiefD]

Some thought I was a chode.

This made me laugh out loud. Thanks!

DO NOT google choad. Or chode. Or any other spelling of that name.

 

[jm192]

I spent 2017-2023 practicing as a hospitalist. I left in November because, at least in our neck of the woods, the system is overrun.

Lack of inpatient beds certainly plays a role. Our hospital had a ton of unused beds. What we didn't have: nurses. There's a lot to say on this, but for the sake of keeping the post somewhat short: there aren't enough nurses doing bedside nursing in the hospital. This is nationwide.

I think understaffing is actually the biggest issue. Doctors and nurses. And that's drive by profits. At my hospital, the ER physicians and midlevels were employed by Team Health. The hospitalist physicians and midlevels were employed by Team Health. Team Health is a massive staffing company that staffs Hospitals and ER's across the country. They also staff Anesthesia programs, surgery programs, and intensivist programs. At some point, they left the NYSE and become a privately owned company. To do this, they sold to Blackstone. One of the largest investment companies in the world.

That's probably more info than you need on TeamHealth's finances. But I want to drive home that they are a for profit entity. They are one of several physician staffing companies. Some of the others have gone bankrupt in recent years. But as one disappears, another staffing company takes over their contracts.

A lot of times, we probably needed a 5th physician. That would have affected profits. So, we never saw that 5th physician. So we're overworked and understaffed. The ER is also understaffed. The understaffing on both sides leads to a lot of bad things.

1. Discharges aren't always as prompt as they could be. As much as the hospital pushes early discharges, it's hard to consistently do it when you're responsible for 25 sick people.

2. Admissions become even more of a fight. There are situations in the ER where the patient could be treated for a long time, and go home. Maybe they're dehydrated and need IV Fluids. Maybe they've got an Asthma or COPD flare and need steroids and multiple breathing treatments. Anemia is a complex issue, but there are cases where a patient is appropriate to get blood and go home. But when the ER has 40 beds that are all full and 20+ in the waiting room, those things become less practical.

3. Hospitalists also cause the fighting. When they feel like they're drowning, they don't want to take another admission that could maybe do xy or z in the ER and potentially go home. Take away the staffing issues, and that becomes less of a fight. Now don't get me wrong, I've seen Hospitalists tell the ER to discharge 80 year olds with community acquired pneumonia and a new oxygen requirement.

A lot of times, the patient ultimately gets admitted. But it becomes this back and forth of "well do this this and that." "Call this specialist and check with them." And there's a delay that isn't always necessary. Now don't get me wrong, sometimes doing this that and the other or calling Cardiology is important.

With more doctors and nurses, this gets a lot better. But hospitals and staffing companies are under this delusion that they can have their cake and eat it too. Hospitalists and ER doctors can just work harder and more efficiently. They can adjust their priorities to get people out of the building more quickly.

It's not working.

 

[Terminalxylem]

I spent 2017-2023 practicing as a hospitalist. I left in November because, at least in our neck of the woods, the system is overrun.

Lack of inpatient beds certainly plays a role. Our hospital had a ton of unused beds. What we didn't have: nurses. There's a lot to say on this, but for the sake of keeping the post somewhat short: there aren't enough nurses doing bedside nursing in the hospital. This is nationwide.

I think understaffing is actually the biggest issue. Doctors and nurses. And that's drive by profits. At my hospital, the ER physicians and midlevels were employed by Team Health. The hospitalist physicians and midlevels were employed by Team Health. Team Health is a massive staffing company that staffs Hospitals and ER's across the country. They also staff Anesthesia programs, surgery programs, and intensivist programs. At some point, they left the NYSE and become a privately owned company. To do this, they sold to Blackstone. One of the largest investment companies in the world.

That's probably more info than you need on TeamHealth's finances. But I want to drive home that they are a for profit entity. They are one of several physician staffing companies. Some of the others have gone bankrupt in recent years. But as one disappears, another staffing company takes over their contracts.

A lot of times, we probably needed a 5th physician. That would have affected profits. So, we never saw that 5th physician. So we're overworked and understaffed. The ER is also understaffed. The understaffing on both sides leads to a lot of bad things.

1. Discharges aren't always as prompt as they could be. As much as the hospital pushes early discharges, it's hard to consistently do it when you're responsible for 25 sick people.

2. Admissions become even more of a fight. There are situations in the ER where the patient could be treated for a long time, and go home. Maybe they're dehydrated and need IV Fluids. Maybe they've got an Asthma or COPD flare and need steroids and multiple breathing treatments. Anemia is a complex issue, but there are cases where a patient is appropriate to get blood and go home. But when the ER has 40 beds that are all full and 20+ in the waiting room, those things become less practical.

3. Hospitalists also cause the fighting. When they feel like they're drowning, they don't want to take another admission that could maybe do xy or z in the ER and potentially go home. Take away the staffing issues, and that becomes less of a fight. Now don't get me wrong, I've seen Hospitalists tell the ER to discharge 80 year olds with community acquired pneumonia and a new oxygen requirement.

A lot of times, the patient ultimately gets admitted. But it becomes this back and forth of "well do this this and that." "Call this specialist and check with them." And there's a delay that isn't always necessary. Now don't get me wrong, sometimes doing this that and the other or calling Cardiology is important.

With more doctors and nurses, this gets a lot better. But hospitals and staffing companies are under this delusion that they can have their cake and eat it too. Hospitalists and ER doctors can just work harder and more efficiently. They can adjust their priorities to get people out of the building more quickly.

It's not working.

The interplay between ER and hospitalist definitely plays into this. Any time there is a push for ED throughput, the time crunch encourages more, less differentiated admissions, vs. outpatient disposition.

In the past the ED would call the primary doctor, who had a lot better idea what could and could not be accomplished in the outpatient setting. And he knew historical information not evident in the EMR. Moreover, when the primary had more skin in the game, having to do the admission himself, he was incentivized (right or wrong) to develop creative dispositions.

Nowadays, the primary is rarely contacted. Patients get referred to hospitalists before basic diagnostic testing has resulted, urgent consultants contacted, or simple procedures like transfusion are performed. Ain’t got no time for any of that (both ED docs and primaries are swamped). It’s far easier to let hospitalists sort things out.

For every 80-year-old with chest pain the hospitalist tries to send home inappropriately, there are a half dozen patients with vague or easily treatable problems that get observed, just because it’s the path of least resistance. As my friend in utilization management says, “you can OBS a pig”.

On the other end of the hospital stay, I bet there are more bounce-backs nowadays, as the rush for throughput sometimes leads to premature hospital discharges. Granted, many of the issues promoting return to the ED aren’t medical in nature, but lack of social support, financial difficulties, and mental health aren’t typically solvable in a short hospital stay.

So there are problems with all parts of the hospitalization equation: input (more legitimate and frivolous admissions), throughput (ED/hospital bed and staffing shortages) and output (social barriers, bounce backs from premature discharge).

While hospitalists should theoretically help every step of the way, perverse financial incentives, limited time, and liability concerns may actually compound the problem. At this point, the toothpaste is out of the tube, but it would be interesting to see how things would have evolved if the hospitalist concept never was introduced.

 

[The Z Machine]

What's a hospitalist?

 

[Mrs. Rannous]

Some thought I was a chode.

This made me laugh out loud. Thanks!

DO NOT google choad. Or chode. Or any other spelling of that name.

See my post in the MAD's folder on "lemon party."

 

[The Dreaded Marco]

What's a hospitalist?

A physician that only takes care of hospitalized patients. They do not have any outpatient clinic obligations and do not follow up with the patients once they are discharged from the hospital. The patient sees their primary care physician for that.

This is now the norm in many highly populated regions that can support such programs.

 

[Terminalxylem]

What's a hospitalist?

A physician that only takes care of hospitalized patients. They do not have any outpatient clinic obligations and do not follow up with the patients once they are discharged from the hospital. The patient sees their primary care physician for that.

This is now the norm in many highly populated regions that can support such programs.

It’s the norm in all but the smallest communities- something like 75% of hospitals use them.

 

[The Z Machine]

What's a hospitalist?

A physician that only takes care of hospitalized patients. They do not have any outpatient clinic obligations and do not follow up with the patients once they are discharged from the hospital. The patient sees their primary care physician for that.

This is now the norm in many highly populated regions that can support such programs.

Seems like an efficient way of doing it. Keep the PCPs close to the community and don't force them to do rounds in a hospital. Seems particularly suited for areas with multiple hospitals.

 

[Kanil]

My wife broke her back skiing in Vail in 2021. Took 3 hours to get her off the mountain but once she got to the hospital she was in a room right away. Same experience in 2022 when she broke her leg skiing in Vail.

PS - Vail is a great place to have ski related surgeries!

 

[Terminalxylem]

What's a hospitalist?

A physician that only takes care of hospitalized patients. They do not have any outpatient clinic obligations and do not follow up with the patients once they are discharged from the hospital. The patient sees their primary care physician for that.

This is now the norm in many highly populated regions that can support such programs.

Seems like an efficient way of doing it. Keep the PCPs close to the community and don't force them to do rounds in a hospital. Seems particularly suited for areas with multiple hospitals.

It is, but there are all sorts of unintended consequences from dedicated, often hospital employed physicians, one of which is a bunch of unnecessary hospitalizations.

 

[Terminalxylem]

My wife broke her back skiing in Vail in 2021. Took 3 hours to get her off the mountain but once she got to the hospital she was in a room right away. Same experience in 2022 when she broke her leg skiing in Vail.

PS - Vail is a great place to have ski related surgeries!

Yeah, good orthopedists hang out in mountain towns. Alta is a great place to break your leg, fwiw

 

[Beef Ravioli Part 2]

My wife broke her back skiing in Vail in 2021. Took 3 hours to get her off the mountain but once she got to the hospital she was in a room right away. Same experience in 2022 when she broke her leg skiing in Vail.

PS - Vail is a great place to have ski related surgeries!

I take it she didn’t go back in 23?

 

[Kanil]

My wife broke her back skiing in Vail in 2021. Took 3 hours to get her off the mountain but once she got to the hospital she was in a room right away. Same experience in 2022 when she broke her leg skiing in Vail.

PS - Vail is a great place to have ski related surgeries!

I take it she didn’t go back in 23?

We did but no more cliff jumping!

And no further injuries to report, thankfully.

 

[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?

Back at the ER with my dad. Wait time is anywhere from 5 to 7 hours to see a doctor. It's not a pleasant place to be, this ER waiting room....

I have 2 suggestions for the suggestion box:

1) Each ER patient gets 1 - ONE - chaperone to wait with them. Real Estate and chairs are at a premium, don't clog them or the area with unnecessary family members and friends.

2) Somebody really needs to open up a cocktail bar with sports and salty snacks. It'd make a fortune. Time would go by so much faster, like at an airport bar.


Thank you for reading.

 

[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?

Back at the ER with my dad. Wait time is anywhere from 5 to 7 hours to see a doctor. It's not a pleasant place to be, this ER waiting room....

I have 2 suggestions for the suggestion box:

1) Each ER patient gets 1 - ONE - chaperone to wait with them. Real Estate and chairs are at a premium, don't clog them or the area with unnecessary family members and friends.

2) Somebody really needs to open up a cocktail bar with sports and salty snacks. It'd make a fortune. Time would go by so much faster, like at an airport bar.


Thank you for reading.

for number one (though even that may be too many). And make sure that person can clarify important details (like medications), if the patient can’t.

No to 2. Don’t need to give upset/irritated people access to alcohol.

 

[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?

Back at the ER with my dad. Wait time is anywhere from 5 to 7 hours to see a doctor. It's not a pleasant place to be, this ER waiting room....

I have 2 suggestions for the suggestion box:

1) Each ER patient gets 1 - ONE - chaperone to wait with them. Real Estate and chairs are at a premium, don't clog them or the area with unnecessary family members and friends.

2) Somebody really needs to open up a cocktail bar with sports and salty snacks. It'd make a fortune. Time would go by so much faster, like at an airport bar.


Thank you for reading.

for number one (though even that may be too many). And make sure that person can clarify important details (like medications), if the patient can’t.

No to 2. Don’t need to give upset/irritated people access to alcohol.

Okay, okay.....what if, it's only for chaperones?

3. Not sure if this is specific to THIS ER, but the way they send a human to walk back to the crowded waiting room and hallway and just YELL the patient's name repeatedly is a horrible system and jarring when the person shouting has a booming voice. Instead, hand the patient a buzzer like they do for customers waiting on food for pickup or a table to be ready. It's less intrusive and avoids all the forlorn stares at the patient, frustrated furls that it's not them getting "the call".

 

[acarey50]

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?

Back at the ER with my dad. Wait time is anywhere from 5 to 7 hours to see a doctor. It's not a pleasant place to be, this ER waiting room....

I have 2 suggestions for the suggestion box:

1) Each ER patient gets 1 - ONE - chaperone to wait with them. Real Estate and chairs are at a premium, don't clog them or the area with unnecessary family members and friends.

2) Somebody really needs to open up a cocktail bar with sports and salty snacks. It'd make a fortune. Time would go by so much faster, like at an airport bar.


Thank you for reading.

for number one (though even that may be too many). And make sure that person can clarify important details (like medications), if the patient can’t.

No to 2. Don’t need to give upset/irritated people access to alcohol.

Okay, okay.....what if, it's only for chaperones?

3. Not sure if this is specific to THIS ER, but the way they send a human to walk back to the crowded waiting room and hallway and just YELL the patient's name repeatedly is a horrible system and jarring when the person shouting has a booming voice. Instead, hand the patient a buzzer like they do for customers waiting on food for pickup or a table to be ready. It's less intrusive and avoids all the forlorn stares at the patient, frustrated furls that it's not them getting "the call".

Or just do the deli counter number thing or, like many restaurants these days, text the person.

 

[General Malaise]

4 hours now.

My dad is hunched over and trying to nod off, it's impossible with the loud coughing and yelling of names and phones going off and people talking loud and beeps of machines.

All the while the people keep coming and going. It never ends.

 

[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?

Does he even lift, Bro?

Not anymore.

 

[rockaction]

General Malaise, is your father okay? What's going on, if you have time? If not, forget me and just post updates.

 

[General Malaise]

General Malaise, is your father okay? What's going on, if you have time? If not, forget me and just post updates.

Thanks buddy, tonight he is here because the pseudo aneurysm he had removed last week - which was a result of a heart valve they put in for him (with a pace maker too) back in November through his left groin - left a suture wound from where they went in. That wound is swollen and hot to the touch. It's right by his kibbles and bits so.....

Got a room! Feel like we just got called on to The Price is Right!

 

[rockaction]

Thanks buddy, tonight he is here because the pseudo aneurysm he had removed last week - which was a result of a heart valve they put in for him (with a pace maker too) back in November through his left groin - left a suture wound from where they went in. That wound is swollen and hot to the touch. It's right by his kibbles and bits so.....

Got a room! Feel like we just got called on to The Price is Right!

Good luck, GM. Keeping you both in my thoughts tonight. Take care.

 

[Mrs. Rannous]

Thanks buddy, tonight he is here because the pseudo aneurysm he had removed last week - which was a result of a heart valve they put in for him (with a pace maker too) back in November through his left groin - left a suture wound from where they went in. That wound is swollen and hot to the touch. It's right by his kibbles and bits so.....

Got a room! Feel like we just got called on to The Price is Right!

Good luck, GM. Keeping you both in my thoughts tonight. Take care.

Me, too. That sort of thing is the major suck. I hope he is at least resting comfortably now.

 

[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?

Back at the ER with my dad. Wait time is anywhere from 5 to 7 hours to see a doctor. It's not a pleasant place to be, this ER waiting room....

I have 2 suggestions for the suggestion box:

1) Each ER patient gets 1 - ONE - chaperone to wait with them. Real Estate and chairs are at a premium, don't clog them or the area with unnecessary family members and friends.

2) Somebody really needs to open up a cocktail bar with sports and salty snacks. It'd make a fortune. Time would go by so much faster, like at an airport bar.


Thank you for reading.

for number one (though even that may be too many). And make sure that person can clarify important details (like medications), if the patient can’t.

No to 2. Don’t need to give upset/irritated people access to alcohol.

Okay, okay.....what if, it's only for chaperones?

3. Not sure if this is specific to THIS ER, but the way they send a human to walk back to the crowded waiting room and hallway and just YELL the patient's name repeatedly is a horrible system and jarring when the person shouting has a booming voice. Instead, hand the patient a buzzer like they do for customers waiting on food for pickup or a table to be ready. It's less intrusive and avoids all the forlorn stares at the patient, frustrated furls that it's not them getting "the call".

You’re right, but a big percentage of patients wouldn’t be reliable to use the buzzer system.

 

[DA RAIDERS]

General Malaise, is your father okay? What's going on, if you have time? If not, forget me and just post updates.

Thanks buddy, tonight he is here because the pseudo aneurysm he had removed last week - which was a result of a heart valve they put in for him (with a pace maker too) back in November through his left groin - left a suture wound from where they went in. That wound is swollen and hot to the touch. It's right by his kibbles and bits so.....

Got a room! Feel like we just got called on to The Price is Right!

Inquire about a collagen plug. That’s what they put in my entry point wound when I had my ablation. Pretty amazing.

 

[Scoresman]

If you go to an ER and claim to have something contagious like bad case of flu or COVID do they at least have you wait separated from others? I've always wondered this when waiting in an ER and trying to guess what everyone else there has.

 

[General Malaise]

If you go to an ER and claim to have something contagious like bad case of flu or COVID do they at least have you wait separated from others? I've always wondered this when waiting in an ER and trying to guess what everyone else there has.

Personally speaking? They do not. I'm quite certain I shared the waiting area with people who had leprosy, bird flu and tuberculosis, just to name a few. They wheeled out this old gal who sat in a wheel chair by herself in a hallway next to others and hack-coughed violently for hours. I'm either going to die soon or my immune system is so strong I'll be the lead character in Stephen King's sequel to The Stand.

 

[Terminalxylem]

General Malaise, is your father okay? What's going on, if you have time? If not, forget me and just post updates.

Thanks buddy, tonight he is here because the pseudo aneurysm he had removed last week - which was a result of a heart valve they put in for him (with a pace maker too) back in November through his left groin - left a suture wound from where they went in. That wound is swollen and hot to the touch. It's right by his kibbles and bits so.....

Got a room! Feel like we just got called on to The Price is Right!

Inquire about a collagen plug. That’s what they put in my entry point wound when I had my ablation. Pretty amazing.

Sounds more like he may have an infection at the surgical site, rather than a leak, though he certainly could have both. They probably already tried a collagen plus, at the time of his initial procedure anyhow, and it sounds like they did actual vascular surgery to remove the pseudoaneurysm.

 

[Terminalxylem]

If you go to an ER and claim to have something contagious like bad case of flu or COVID do they at least have you wait separated from others? I've always wondered this when waiting in an ER and trying to guess what everyone else there has.

No. They should ask the sick person to wear a mask.

Early in the pandemic, suspected covid cases were isolated, but there just aren’t enough iso rooms.

 

[Scoresman]

WTF. I don't know how anyone can argue we even have a slightly good health care system.

 

[General Malaise]

General Malaise, is your father okay? What's going on, if you have time? If not, forget me and just post updates.

Thanks buddy, tonight he is here because the pseudo aneurysm he had removed last week - which was a result of a heart valve they put in for him (with a pace maker too) back in November through his left groin - left a suture wound from where they went in. That wound is swollen and hot to the touch. It's right by his kibbles and bits so.....

Got a room! Feel like we just got called on to The Price is Right!

Inquire about a collagen plug. That’s what they put in my entry point wound when I had my ablation. Pretty amazing.

Sounds more like he may have an infection at the surgical site, rather than a leak, though he certainly could have both. They probably already tried a collagen plus, at the time of his initial procedure anyhow, and it sounds like they did actual vascular surgery to remove the pseudoaneurysm.

Correct. He had a vascular ultrasound last night to rule out a blood clot anywhere in his leg or region around his incision. His left leg below the surgical site was probably 1.5x his right leg in swollen size. It was pretty alarming when they took his compression socks off to look. I was like "Dad, you didn't mention that!".

Not much they could do for him so I took him home at 1am. He just texted me. Got home, had a Bud, read a book, dozed off and woke up today at noon. Not bad. He'll follow-up with his PCP and the doc who preformed the surgery. I'll check in on him later and again tomorrow. Glad he lives close to me.

 

[General Malaise]

WTF. I don't know how anyone can argue we even have a slightly good health care system.

Ehhhh.....I'm not sure what else my dad could have done, though I think the first thing would have been to call his PCP/advise nurse and relay his sudden swollenness around his groin area...

From there, I don't know what they would have told him to do. I said Urgent Care and he called me a fool, so....what do I know? Let's spend all night in the ER with 45 other people who are in various stages of agony, irritation and contagion.

But once we got in, the process was super efficient and well run. Nothing negative to say about the doctor, nurses or ultrasound tech who helped him. The ER doc was fire.

 

[Terminalxylem]

WTF. I don't know how anyone can argue we even have a slightly good health care system.

We have a mediocre, but extremely expensive healthcare system.

 

[The Z Machine]

The ER doc was fire.

Describe in detail. Is there a celeb that they look like? I'm hoping for redheaded Emma Stone here.

 

[Snotbubbles]

My wife got a bill for an epidural service she received from some company. I called to pay it and they wouldn't let me until my wife verified her information. I gave them all her information, birthday, address, etc. but they said it was a HIPPAA violation to allow me to pay the bill without my wife's verification. Pretty sure, HIPPAA is not in place to protect patients from 3rd parties paying their balances. Told the lady to mark in her system that this bill will now, not be settled while we're still breathing because of HIPPAA.