Death after two-hour ER wait ruled homicide

I feel very sad for that person. I had a similiar experience with my own husband, he was stuck in "hallway H" for evaluation was not seen for over an hour, because of no bed availability, he had very classic symptoms, the right age, and in agonizing pain. The nurse did not do anything for him. I am an RN with a history of working in cardiac ICU, I was with him and spoke up, almost reminding her of what Sx of an MI were. She then looked at me and said "oh, you're right" and moved him directly to a room that did not have anyone in it to begin with. Fortunately it was not a cardiac problem (hiatal hernia), but had it been, and I had not been the person there, it may have ended up the same way.

Unfortunately our ER's now-a-days are used like clinics to much of the "emergency access", or medicaide population. Which I am probably opening up a BIG can of worms even speaking about this. And they are overloaded for some really small problems, which could be seen as an office visit. That isn't the ER's fault, we are expected to give care to all, yes a triage nurse should know better and be able to decide "who gets in first." I can see though how overwhelming it would be to have dozens, which would be alot for my small hospital, of small to moderate cases, try to get everyone in, and think that maybe this isn't as bad as it is.

It's not just the medicaid pts that fill our ERs...It's everyone not knowing any better, or more likely, just not wanting to wait...It's the affluent to the homeless abusing the ER...

And yes, some chest pains will sit in the ER lobby...But rest assured they get an EKG, labs, CXR, etc...Hallways are meant for walking, NOT ER pts!

The jury’ findings:
http://news.findlaw.com/cnn/docs/neg...ryinquest.html


Many emergency departments have "fast track". Each patient is triaged by a competent experienced triage RN. When appropriate they are accompanied to the "Fast Track" next door or across the street. Fast Track is for patients who do not need to be assigned to a registered nurse.
They are staffed with physicians and LVNs, PA's, RNs, and techs.

That would be great, but I don't think a lot of places have the resources for that.
At the ER in our hospital any c/o chest pain automatically move you to the front of the line. You don't even go thru triage.

In our ED, the mere mention of "chest pain" moves you to the front of the line and directly to the back instead of thru the waiting room and triage.

Unfortunately, some of the frequent fliers are on to our ways and realize that "chest pain" is a quick way to get a room.

I have actually had a pt tell me that he just said he was having chest pain so he wouldn't have to wait.

I feel for this RN - it is too soon and there are too few details for me to make a judgement/opinion.

Exactly my point - triage needs to have the power, and the gumption, to say - sorry, your ailment does not qualify as an emergency, and we won't be treating you here. Call your Doctor; see ya!

Unfortunately, triage doesn't have that luxury. ERs have to treat whoever shows up at their door, no matter how trivial the complaint. It makes it that much more important that the triage nurse has razor sharp skills, so that those who can wait for hours, do, and those that can't are seen quickly. I once presented at the ER with a most unnatural gash below my patella. I'd been washing dishes and dropped a ceramic casserole dish that bounced off the tile and lodged into my leg. Little blood or pain, but I knew it wouldn't heal without stitches. I took all the required steps, called my PCP and explained the situation, got authorization and was greeted by one of the rudest nurses I can imagine during triage. She ridiculed me for coming in, and my doctor for authorizing the visit, until I suggested she take a closer look. It took all of my self restraint not to go back to her desk and announce to her that the plastic surgeon (yes, they called him down) put 20 stitches into my leg. It is a tough job, no doubt, and it ain't for sissies. But if you accept it, you better be prepared to do it well, IMHO.

Our policy is we NEVER,EVER let cp and nausea and sit in the waiting room They immediatly go to a trauma room, maybe after ekg's and bloodwork we may move them to a more appropiate room

That would be against the law. A person presenting to an ER must be evaluated by a physician or mid-level practicioner before determining whether the patient is in a life-threatening situation. Triage doesn't count for that.

Nobody is going to have a doc sit at the triage desk and do an eval on everyone who comes in.

My question is this - Where was the charge nurse? who should be aware of who is in the waiting room?, and determining who is brought back first?

That person has just as big a responsibility as the triage nurse.