Death after two-hour ER wait ruled homicide - page 15

Death after two-hour ER wait ruled homicide "WAUKEGAN, Illinois (AP) -- A coroner's jury has declared the death of a heart attack victim who spent almost two hours in a hospital waiting room to be... Read More

  1. by   Jen2
    I feel for both the family and nurse involved in this situation. If a person does not do triage/ER there is no way they can fully understand this. I truly believe that triage is the most difficult job in the ER.

    I cannot count how many times I have had a person come to the triage window write down "elbow pain" on the sign in slip, and then proceed to look in the waiting room and see how busy it is and scratch out "elbow pain" and write "chest pain". There are also those paitents that come in 3-4 times a week complaining of classic MI sx. I have also triaged minor complaints such as knee pain s/p knee replacement three weeks ago that just don't look right and take them back and they are having a STEMI. Can I tell you how many homeless people come in when it gets really cold outside with the complaint of chest pain because they know that it will get them a warm place to sleep for at least 24 hours.

    There has been times when I have had 20 patients in the waiting room, every room in the ED was full, we have 12 patients in the hallway, two helicoptors are arriving 5 minutes apart, the ambulances won't stop rolling in, and 4 chest pains sign in at triage at the exact same time. Yes it would be nice to get all four of them back as the standard states. Is it going to happen? NO! I find it funny how we are so apt to slam the triage nurse.

    I work in a level 1 trauma center and we do not have the resources available when things like this happen. Oh sure we could go on diversion, but that does not help. We cannot divert traumas because we are the only level one trauma center in the region, we cannot divert strokes/MI's becasue we are a national stroke/heart center. We cannot tell the walk in, sorry go to the community hospital across the street becasue we are on diversion. WE ARE IN A CRISIS HERE PEOPLE! Things like this are going to be more common until something or some laws are changed.

    I failed to mention the fact that there has been a time when I had a mother and father bring in their six children because they found a dead bat in their house and they wanted vaccinated for rabies. Does any one have a clue how long it takes to triage a family of eight people? Try doing vitals on six kids all under the age of 9. It took me 50 minutes to triage this family. The family signed in at noon and around 12:30 a patient signed in with chest pain. I did not notice it because I was chasing around a preschool in the triage area. It was 20 minutes before I even got the chest pain in to the triage area.

    We cannot tell people to go see their PCP's. We cannot get support from administration. They just tell us to do the best we can and then when this case came about our director had the nerve to email it to us. When we do have patients in our ED that finally get a bed assignment after setting there for 8 hours it often takes another 2 hours to get them upstairs, because the floors are working short/busy or whatever. We cannot make the general public understand that becaue their child vommited once three hours ago it does not mean that they should bring them to the ER. Oh and just because you arrive to my ED by ambulance does not mean that you are going to get rushed back to a bed. Many of our ambulance patients are brought in and triaged just like walk ins. We even have doctors offices that do direct admits from their office and close at 5:00 so they bring the patient over to the ED in a wheel chair to wait for their room upstairs because they don't want to pay their staff overtime. It is a sad situation that health care is in. Especially emergency departments and ER nurses.

    The ENA is planning to write a statement regarding this case and I am interested to see it. I'll get off my soap box now.
  2. by   lhester
    several years ago a study was done about ER wait times and the national average wait time was 8 hours!!!
  3. by   dan_haifa
    Quote from ZASHAGALKA
    Excuse me, but she died of a HEART ATTACK, right? Them there's what we call 'natural causes' in these here parts. Failure to appropriately assist might be negligence, but it isn't and wasn't the primary cause of death.
    ~faith,
    Timothy.
    Exactly!!!
  4. by   Lurksalot
    Quote from Jen2
    I feel for both the family and nurse involved in this situation. If a person does not do triage/ER there is no way they can fully understand this. I truly believe that triage is the most difficult job in the ER.

    I cannot count how many times I have had a person come to the triage window write down "elbow pain" on the sign in slip, and then proceed to look in the waiting room and see how busy it is and scratch out "elbow pain" and write "chest pain". There are also those paitents that come in 3-4 times a week complaining of classic MI sx. I have also triaged minor complaints such as knee pain s/p knee replacement three weeks ago that just don't look right and take them back and they are having a STEMI. Can I tell you how many homeless people come in when it gets really cold outside with the complaint of chest pain because they know that it will get them a warm place to sleep for at least 24 hours.

    There has been times when I have had 20 patients in the waiting room, every room in the ED was full, we have 12 patients in the hallway, two helicoptors are arriving 5 minutes apart, the ambulances won't stop rolling in, and 4 chest pains sign in at triage at the exact same time. Yes it would be nice to get all four of them back as the standard states. Is it going to happen? NO! I find it funny how we are so apt to slam the triage nurse.

    I work in a level 1 trauma center and we do not have the resources available when things like this happen. Oh sure we could go on diversion, but that does not help. We cannot divert traumas because we are the only level one trauma center in the region, we cannot divert strokes/MI's becasue we are a national stroke/heart center. We cannot tell the walk in, sorry go to the community hospital across the street becasue we are on diversion. WE ARE IN A CRISIS HERE PEOPLE! Things like this are going to be more common until something or some laws are changed.

    I failed to mention the fact that there has been a time when I had a mother and father bring in their six children because they found a dead bat in their house and they wanted vaccinated for rabies. Does any one have a clue how long it takes to triage a family of eight people? Try doing vitals on six kids all under the age of 9. It took me 50 minutes to triage this family. The family signed in at noon and around 12:30 a patient signed in with chest pain. I did not notice it because I was chasing around a preschool in the triage area. It was 20 minutes before I even got the chest pain in to the triage area.

    We cannot tell people to go see their PCP's. We cannot get support from administration. They just tell us to do the best we can and then when this case came about our director had the nerve to email it to us. When we do have patients in our ED that finally get a bed assignment after setting there for 8 hours it often takes another 2 hours to get them upstairs, because the floors are working short/busy or whatever. We cannot make the general public understand that becaue their child vommited once three hours ago it does not mean that they should bring them to the ER. Oh and just because you arrive to my ED by ambulance does not mean that you are going to get rushed back to a bed. Many of our ambulance patients are brought in and triaged just like walk ins. We even have doctors offices that do direct admits from their office and close at 5:00 so they bring the patient over to the ED in a wheel chair to wait for their room upstairs because they don't want to pay their staff overtime. It is a sad situation that health care is in. Especially emergency departments and ER nurses.

    The ENA is planning to write a statement regarding this case and I am interested to see it. I'll get off my soap box now.
    Do you work in my ED? Scary fact is that you have just described soooo many EDs across the country, it could be any one! I hear you--can't count how many times I have been trying to triage a family of four because they had stuffy noses a couple days ago, when in rolls 4 chest pains at once--2 by ambulance and 2 walks ins! Even when we have 2 or 3 nurses in triage, people still have to wait. We only have so many hands, stretchers, EKG machines, accuchecks, nurses, techs, and SPACE available at once time....
  5. by   EmerNurse
    Jen2 - you expressed it perfectly!! I couldn't possibly add anything to your post!!!
  6. by   ManEnough
    Quote from Jen2
    I feel for both the family and nurse involved in this situation. If a person does not do triage/ER there is no way they can fully understand this. I truly believe that triage is the most difficult job in the ER.

    I cannot count how many times I have had a person come to the triage window write down "elbow pain" on the sign in slip, and then proceed to look in the waiting room and see how busy it is and scratch out "elbow pain" and write "chest pain". There are also those paitents that come in 3-4 times a week complaining of classic MI sx. I have also triaged minor complaints such as knee pain s/p knee replacement three weeks ago that just don't look right and take them back and they are having a STEMI. Can I tell you how many homeless people come in when it gets really cold outside with the complaint of chest pain because they know that it will get them a warm place to sleep for at least 24 hours.

    There has been times when I have had 20 patients in the waiting room, every room in the ED was full, we have 12 patients in the hallway, two helicoptors are arriving 5 minutes apart, the ambulances won't stop rolling in, and 4 chest pains sign in at triage at the exact same time. Yes it would be nice to get all four of them back as the standard states. Is it going to happen? NO! I find it funny how we are so apt to slam the triage nurse.

    I work in a level 1 trauma center and we do not have the resources available when things like this happen. Oh sure we could go on diversion, but that does not help. We cannot divert traumas because we are the only level one trauma center in the region, we cannot divert strokes/MI's becasue we are a national stroke/heart center. We cannot tell the walk in, sorry go to the community hospital across the street becasue we are on diversion. WE ARE IN A CRISIS HERE PEOPLE! Things like this are going to be more common until something or some laws are changed.

    I failed to mention the fact that there has been a time when I had a mother and father bring in their six children because they found a dead bat in their house and they wanted vaccinated for rabies. Does any one have a clue how long it takes to triage a family of eight people? Try doing vitals on six kids all under the age of 9. It took me 50 minutes to triage this family. The family signed in at noon and around 12:30 a patient signed in with chest pain. I did not notice it because I was chasing around a preschool in the triage area. It was 20 minutes before I even got the chest pain in to the triage area.

    We cannot tell people to go see their PCP's. We cannot get support from administration. They just tell us to do the best we can and then when this case came about our director had the nerve to email it to us. When we do have patients in our ED that finally get a bed assignment after setting there for 8 hours it often takes another 2 hours to get them upstairs, because the floors are working short/busy or whatever. We cannot make the general public understand that becaue their child vommited once three hours ago it does not mean that they should bring them to the ER. Oh and just because you arrive to my ED by ambulance does not mean that you are going to get rushed back to a bed. Many of our ambulance patients are brought in and triaged just like walk ins. We even have doctors offices that do direct admits from their office and close at 5:00 so they bring the patient over to the ED in a wheel chair to wait for their room upstairs because they don't want to pay their staff overtime. It is a sad situation that health care is in. Especially emergency departments and ER nurses.

    The ENA is planning to write a statement regarding this case and I am interested to see it. I'll get off my soap box now.
    Very well said. Thanks for sharing.
  7. by   bleppity
    I found this story interesting. My husband went to the ER in 2003 with the classic symptoms of a heart attack. They did an EKG on him quickly, but it did not show signs of a heart attack. So he was sent back out to the waiting room, where we sat for 4 hours. He was obviously in pain the entire time. When he finally got to go back, they put him on a monitor, but it had pretty much been decided it was just gastric reflux. Then the monitor suddenly had a VTach run just out of the blue, and that got them all interested in a hurry. For whatever odd reason, the EKG didn't show the MI. The doc claimed it was because he was totally blocked up ... ended up having 6 bypasses.
  8. by   flonurse
    Jen2 _Enjoyed your summary of ER - it's a nightmare to work in and it's a gross simplification to blame the nurse - she was probably set up for failure by the system you so eloquently described.
    Last edit by flonurse on Nov 5, '06
  9. by   scooterRN52
    Quote from EDValerieRN
    http://www.cnn.com/2006/US/09/15/er.....ap/index.html

    Death after two-hour ER wait ruled homicide

    "WAUKEGAN, Illinois (AP) -- A coroner's jury has declared the death of a heart attack victim who spent almost two hours in a hospital waiting room to be a homicide.
    Beatrice Vance, 49, died of a heart attack, but the jury at a coroner's inquest ruled Thursday that her death also was "a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation."

    Vance had waited almost two hours for a doctor to see her after complaining of classic heart attack symptoms -- nausea, shortness of breath and chest pains, Deputy Coroner Robert Barrett testified.

    She was seen by a triage nurse about 15 minutes after she arrived, and the nurse classified her condition as "semi-emergent," Barrett said. He said Vance's daughter twice asked nurses after that when her mother would see a doctor.
    When her name was finally called, a nurse found Vance slumped unconscious in a waiting room chair without a pulse. Barrett said. She was pronounced dead shortly afterward."
    What a shame for someone to die after reporting those symptoms, and to be neglected by ED staff. That is a major lawsuit due to negligence on the
    the part of the nurse and doctor if he/she was aware. I don't know how you could assess that patient properly without an EKG.I work on a telemetry surgical stepdown, that pt should have had a complete workup immediately.
  10. by   PANurseRN1
    You work in a unit that has some degree of control. Triage in a busy ED can be chaos. Unless you have actually worked triage in an ED, you really should not be so quick to judge.
  11. by   Overland1
    After so many interesting posts in this thread, I see a common point, and it is not that we need to throw more more nurses and doctors at the problem. People are misusing the ER and EMS system more than ever before, even in cases where there is a convenient/prompt/urgent care center nearby that could better address their needs. Between that and the (mostly college age) drunks who are brought in to occupy several ER beds at a time during any given weekend, the ER's are running out of places to put patients. Don't even get me started on the ones who come in and want "Dilaudid, 2 mg every hour" - yup, they state the demand just that way, and then say they are "allergic" to virtually all of the non-narcotic analgesics.

    Just the other day, my former neighbor called for EMS to take her husband to the ER for a sore throat. She also told those who responded on past calls to their apartment that she "pulls the cord in the bathroom so that they will get there quicker." She could have just as easily taken him to a CCC and had a doctor look at his throat. This sort of stuff happens all the time everywhere, and I doubt that people will ever learn otherwise.

    The national average waiting time is probably still around eight hours, although we run considerably less than that where I work. Some people often complain loudly if they have to wait more than ten minutes - they yell and scream, feign serious illness, lie down on the floor of the waiting room, drop names of people they actually believe will help them to be moved to the top of the list, etc., thinking that these (mis)behaviors will get them "seen quicker".
  12. by   makelsbelle
    Exactly! I thought almost every ED had protocols and standing orders. Chest pain being one of them. This lady fit the classic criteria! Another thing I am wondering, maybe this sounds stupid...but, I wonder what her daughter was doing when her mother was "slumped over" in a chair as the nurse found her?? That is horrible!
  13. by   PANurseRN1
    Quote from makelsbelle
    Exactly! I thought almost every ED had protocols and standing orders. Chest pain being one of them. This lady fit the classic criteria! Another thing I am wondering, maybe this sounds stupid...but, I wonder what her daughter was doing when her mother was "slumped over" in a chair as the nurse found her?? That is horrible!
    Since you don't know all the circumstances, you should not be judging what happened.

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