Wasteful use of Emerg

Specialties Emergency

Published

How do you all react when friends or family members tell you about trips to the emergency room when they could've stayed home and gone to the doctor's office in the morning? This is a HUGE pet peeve of mine. I don't work in energency, I work L&D, but I am sick of seeing the effects of low budget care caused by people abusing our system.

Last night a friend told me she took her sister in because it hurt when she was breathing. I asked more about it and it turns out the girl was crying and yelling about it hurting (she is known for her hysterics). So after about 2 hours of her carrying on they took her to the emergency room. My pov is that if you can yell and cry, for two hours, you're breathing ain't that bad. This girl also went to the emergency room once after scratching her foot on a nail because she thought she would die from tetorifice (and her tetorifice shot WAS up to date at the time). Do people not understand what a visit to the emergency room costs? Especially with all the CYA orders from docs? This drives me nuts. Am I just super anal?

The growing crisis in emergency room care is complex. More and more people are joining the ranks of the uninsured and using the ER as a "safety net" for primary health care. In addition, many hospitals and emergency rooms, atleast here in California, have closed because of poor funding.

Crowded ERs May Be Sign of Sick U.S. Healthcare System

By Todd Zwillich

WASHINGTON (Reuters Health) - Severe overcrowding in America's emergency rooms may be a warning sign that the nation's primary care and hospital systems are failing, analysts said Tuesday.

Healthcare experts are becoming increasingly alarmed over crowded conditions in hospital emergency departments and the fact that these departments are increasingly being forced to send patients to other hospitals. The problem is so bad that some hospitals have even resorted to advertisements asking patients to avoid their emergency rooms for all but the most urgent care.

Most say that the problem is not with the emergency departments themselves, but with the ability of the rest of the healthcare system--hospital inpatient wards, psychiatric hospitals and primary care offices--to handle patient demand.

They say the austerity measures brought by managed care companies and federal budget cuts in the 1990s have left hospitals unable to admit enough new patients. The result is that hospitals are forced to use beds in emergency areas, causing backups for new patients who come through the ER door.

While hospitals claim that they are at 60% to 65% capacity, they are actually full,'' Bradford Koles, a researcher with the Advisory Board Company, told an audience at a forum sponsored by the Council on Healthcare Economics and Policy.

Surveys show that emergency department visits rose across the US from around 90 million in 1994 to nearly 100 million in 1999, including a 5% rise between 1998 and 1999 alone. "All of the anecdotal information we have is that it's still going up,'' said David Schactman, a member of the council who is also a professor at Brandeis University.

Meanwhile, the number of beds available for patients at hospitals dropped from 820,000 to 745,000 over the same period.

Some analysts cite the graying population, aging rapidly because of retiring baby boomers, for the rush on emergency rooms. Other say hospitals don't have as many beds as they once did because newer, high-tech surgeries are making long hospital stays and recovery times shorter.

But others blame budget cuts brought on by the 1997 Balanced Budget Act. That law cut federal spending on hospitals, while cuts at nursing homes and other healthcare facilities may have increased demand for emergency department visits, said Charlotte Yeh, an official with the Massachusetts Department of Public Health (news - web sites).

The problem is worse in some areas of the country than in others. In Massachusetts, for example, a survey during a 1-week period last year showed that 67 of 76 hospitals state-wide had diverted patients away from their emergency departments because of overcrowding.

A few months earlier, Baptist Hospital in Miami, Florida published an open letter apologizing for long waits at its emergency department.

"What we've got to do is increase hospital capacity,'' said Koles. His research group is recommending that Congress and states spend the money necessary to increase hospital bed numbers 40% by 2010.

But pressure is also mounting as primary care offices are unable to offer the flexible hours or complex services many patients require, pushing them toward emergency departments.

"Primary care needs to be more available when and where patients need it. Right now patients are voting with their feet,'' said Robin Weinick, a senior researcher at the federal Agency for Healthcare Research and Quality.

Weinick quoted a study showing that three-quarters of all New York City emergency department visits between 1994 and 1998 were for avoidable or non-emergency care. Half of all patients in the study said that convenience, rather than financial considerations, caused them to use the emergency department.

"The primary care offices are saturated. We need more nurses, more payments to hospitals,'' Dr. Michael Carius, president of the American College of Emergency Physicians, said in an interview.

President Bush is due to release his Fiscal 2003 Budget on February 4. Until then, it remains unclear whether Congress and the White House will act to inject funds into the system.

"It's going to require a huge dedication and lots and lots of money,'' Carius said.

kids-r-fun...

having worked in many ERs, I would have to disagree that the docs "saw a cash cow" in your mom. Most ER docs are so worried about liability, they cover their butts, and most ALWAYS overorder. They treat an algorithm, not a patient.

i.e. your mom's doc gives most headache patients dilaudid and phenergan (dilaudid may, for example, have caused a vomiting episode in one of his past patients)

anyway, I have yet to meet a doc that's overordering for extra $$$... It's a combination of how he was educated, and his experiences up to that day.

I do agree that that the poor attitudes suck, as well as the wait.

"If you walk into a restaurant, and every table is full, you'll expect to wait. But if you walk into a jammed ER, you'll want to see a doctor now. Don't blame the ER. Do you think that we're having a party back there????"

Me

Originally posted by hogan4736

kids-r-fun...

having worked in many ERs, I would have to disagree that the docs "saw a cash cow" in your mom. Most ER docs are so worried about liability, they cover their butts, and most ALWAYS overorder. They treat an algorithm, not a patient.

I still disagree...her ONLY "admit slip" was a lab requsition with a notation for IV therepy to draw from the PICC. There was NO liability, at NO point was she a patient of the ED, the bracelt they finally put on her identified her as a cancer center lab patient. The whole thing just got away from us. Like I said, it WILL get pulled for UR, and I am sure it will come up that she was NEVER seen by admitting and NOTHING was ever signed. And I really hope everyone involved gets a big reality check when the hospital has to eat the cost of the whole mess because of it, because I really don't 'think' the insurance company will just let the claim slip through.

Originally posted by hogan4736

kids-r-fun...

i.e. your mom's doc gives most headache patients dilaudid and phenergan (dilaudid may, for example, have caused a vomiting episode in one of his past patients)[/b]

DILAUDID FOR A HEADACHE WHEN THE PATIENT IS ASKING (repeatedly) FOR TYLENOL...yeah right...I can see that happening all of the time.

Originally posted by hogan4736

"If you walk into a restaurant, and every table is full, you'll expect to wait. But if you walk into a jammed ER, you'll want to see a doctor now. Don't blame the ER. Do you think that we're having a party back there????" [/b]

No, but given the number of staff playing solitaire and the triage Nurse reading a book when we left I do think would have been really nice if someone could have gotten a wheel chair for my Mom instead of telling me where to find one. I'm not being nasty, I am really glad for them that they were having a quiet period.

kids-r-fun,

I worked in an ER in a retirement community, and after 1900, we got a lot of pts who would go to the outpatient center during business hours to get their IV antibiotics, but now the business is closed, so they come to the ER. Anyway, they had an order for Vancomycin, let's say, and that was it. No need to see the ER doc. Well, some of the docs felt that if something happened to that patient while in the ER, then it could be his hyde. So we were required to sigb the patient in, and have the pt see the ER doc. Many docs then worked the pt up. Some are friends of mine. They said they're just covering their butts. That was their normal style of practice.

And as for the Dilaudid, I had a patient Friday night that was asking for Toradol I.M., and the doc insisted on ordering Demerol. Some docs just do what they want to do. YES THAT'S RIGHT!!!!!!!

And did you follow the RN around to make sure that she had only washed her hands once. I usually was mine out of sight from the patients, in the nurses' station.

And why didn't she refuse the Dilaudid and Phenergan, ask for the charge nurse, and DEMAND Tylenol (all her rights to do)

When a patient walks throgh your ER door, the liability falls on the ER, and the staff within!

Irrespective of the order from his primary that he is carrying.

Look, no hard feelings here. I got FRIED from working ER for only 5 years. I've been out of ER for the last 2 years.

Outpatient blood draws don't belong in the ER. This isn't your mother's fault, rather a fault of the "system."

Hopefully nobody blamed you or your mom for her being there, though I'm sure it felt differently.

Is there not an urgent care/walk-in clinic that could do these labs??

sean

Specializes in ER.

I agree, once the patient comes to the ER then the ER staff have a responsibility to do an independent assessment and treatment plan. If they just drew the blood and a patient was septic, hypotensive, or had the beginnings of a meningitis and they didn't bother to do a full screening, well it would be their butt.

And given that, if you go to an ER (especially a teaching hospital) the full wrath of every specialty gets called in "just to make sure". They are trained and ready to deal with critical, life threatening illness, and if you go to Midas you get a muffler. And apparently at this ER you get the most aggressive care possible. Possibly it would be easier and safer to wait til morning next time.

Specializes in ED, House Supervisor, IT.

Here's my gripe when I worked the ER.

My taxes were paying for the very people I took care of that had no insurance and complain because of this or that. Especially those frequent flyers.

How dare you come at me with an attitude and part of my paycheck is paying for your visit!!! :(

When a PCP or any other physician sends one of their patients to the ER, it is really not thier call as to what is and isn't ordered there. The ER docs will usually consult with that doc, but the ultimate decision and responsibility lies with the ER docs. I agree that the decisions that the ER doc made was probably more of a liability issue than a money issue.

We have patients showing up in the Urgent cares, who should have gone to the ER. We have patients showing up in the ER who should have gone to their Primary care doctor. We have Urgent care patients showing up without an appointment at the Primary clinics expecting to be seen right away. It's a screwed-up system!!

I've read all the posts in this thread, and I haven't seen anyone address the root cause.

Without lawyers taking thousands of frivolous suits to court, winning millions of $$$ in unrealistic settlements, we could start treating the sick people and sending the whiners home. Healthcare insurance would be affordable, and abuse would surely decrease.

Since most of the system abusers can find a lawyer to file a suit, for huge damages, regardless of the right or wrong of the care delivered, everyone in the delivery system (us, and the docs) has to pretty much do what the abuser wants, just to keep their license and home. Malpractice goes up with each law suit. And the strain on the system increases.

problem is not the doctors, nurses, techs. It's the lawyers who file all the suits.

just my $ .02

ken :devil:

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