Death after two-hour ER wait ruled homicide - page 8
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
Sep 20, '06I work ER and unfortunately the really sick cases are the ones who quietly wait there turn while the same old repeaters demand all the attention....if the facts are as they are being stated it was a gross error....I never, until I worked ER realized how self centered people are....so much of my time is spent telling people "I have no idea how long the wait is, we will get you in as soon as I empty out a room"....of course chest pains get seen immediately....for an ECG if nothing else....our door to needle time is excellent.
A sad reminder the responsibility we have.
Sep 20, '06Quote from tferdaiseI'd probably just down a couple of extra strength tylenol and hit the couch with plenty of fluids. (even before )Ok its 3pm on a thrusday, and you ( you aren't a medical professional) feel like crap, you are running a fever (low grade 100.8) and are flush looking. What are you going to do...
Sep 20, '06Quote from tferdaiseOk its 3pm on a thrusday, and you ( you aren't a medical professional) feel like crap, you are running a fever (low grade 100.8) and are flush looking. What are you going to do... Yup, call your Dr. the girl on the other end of the phone says, "I'm sorry, we aren't taking any more appointments today, but I"ll get you in tomorrow, or if you feel like you need to be seen, go to the closes ED to be seen."
I felt like this many times before going to in my late 20s...
did nothing, or...
WAITED until the next day...
If I had a dime for every pt, at 0200, who tells me he/she has an appt @ 0800, but "can't wait"
You described the problem...People who rush to the ED before trying things at home...
My son has had a fever for 6 days...I called at 1600 Tues afternoon (5th day of fever), and he got an appt at 0900 Wednesday...Notice I did not rush to the ED at 2100 (after his bedtime, why would I bring him in when it's not convenient for me, I mean, I'm only his parent)
And as far as giving "emergency services" to illegals...If they get the golden yellow "Federal Emergency Services" card (in AZ), they come to the ED for every stupid thing, (just like our own citizens)
stupid is as stupid does...
Sep 20, '06providing services is one thing.
prioritizing care is quite another.
we need to keep perspective.
i don't care if there were people waiting there for 8 hrs.
this is not first come, first served.
one can always find a place to do an ecg.
really, no excuses.
Sep 21, '06ER nurse here I have been listening to everyone here. Triage is very difficult, that is why usually facilities say you must have 1 year ER experience to do triage. I do not know what experience the nurse had to triage that patient so I cannot comment on this. ER Nursing 101 says C/P+SOB+ nausea=emergent, C/p alone does not get you in as any body who does triage knows that it is widely known that if you want to get in to the ED faster just tell them you have chestpain. Heck even our drunks know this. It does however buy you getting triaged faster and an ECG and a recheck every 30 minutes. Any nurse who leaves a pt >40 with CP in the waiting room without an EKG at least if not a full lab workup and not checking on the pt for 2 hours should be charged with neglegent homicide
The coronor ruled the case to be a homicide. There are many homicides and one is negligent homicide and if you read the definition this nurse fits the charge if she was "experienced" and knew that C/P +SOB= emergent and did it anyway. http://www.iejs.com/Law/Criminal_Law...nslaughter.htm If this nurse was not an experienced triage nurse she should never have been at the triage desk then she is neglegent in not speaking up, the charge nurse is just as neglegent in putting her on triage and all the way up the chain of command culpable for allowing this situation to occur.
Sep 21, '06I had a frightening experience in an ER in which I worked. I came to the ER alone having an asthma attack. Now the previous attack I almost bought the vent so I was very scared. The registration clerk told me to "have a seat for a few minutes till he could get to me" even though I told him I could not breath and it was obvious I was in distress.
The clerk registered me then had me return to the waiting room without seeing the triage nurse, although later he reported that he did tell her I was here. I became progressively more dyspneic and wheezy. I waited 45 minutes (one of the visitors even wanted to call 911 for me). I had already been to registration twice asking to be seen. The final time I could barely talk and begged to be seen. I even told the guy I was going to die if I did not get help. HE stated "oh don't be silly. You will not die."
The RN comes out to triage me, yells "Oh My God" and wheels me to the cardiac room and pulls out the crash cart. BY this time I was shutting down rapidly and had stopped wheezing. I did buy an ETT this time. Luckily someone thought to call my sister, who is a nurse, and she arrived to have me transported to another facility. I will never go there again......
Sep 21, '06in my triage days, we had standing orders for certain possible diagnosis that we, as nurses, could implement from Triage. So, ANYONE presenting with MI-type symptoms got a 12 lead and cardiac labs, right there in my triage chair, and taken for CXR while waiting for an ER bed. And if ANY of those things were remotely suspicious, it was MY responsibility as the triage nurse to make sure they were taken back. Stubbed toes and splinters would be moved to the chair in the hallway and the MI goes in the bed.
I can see something getting missed if the complaining symptoms aren't relevant (i have a cough, as opposed to gee, i'm nauseous, my jaw hurts and what's the crushing chest pain doing?).. but if someone comes in with symptoms relevant to an MI and the triage nurse doesn't make sure they're taken care of, then yes, I see this as negligence on the part of the triage nurse.
If you don't have the experience to be doing triage, you should NOT be accepting the assignment.
oh - and in defference to the previous poster - i gave treatments non-stop in triage too.Last edit by NICU_3_RN on Sep 21, '06
Sep 21, '06Quote from NREMT-P/RNYou said it all! I have drawn blood, done EKGs, given injections on patients lying on cots in the ED hallway. This isn't the first time this has happened and unless things change, it won't be the last.I'm not sure where to start on this one - but here goes...
1. You DO NOT KNOW what YOU DO NOT KNOW. I find a tragic set of circumstances that does raise questions. QUESTIONS we don't have all the answers to.
* 49 F patient with CP, SOB - sure at first glance "sounds like a classic MI to me". I'm a bit surprised at HOW FAST other nurses jumped on - "OH, I would have rushed the patient back, classic MI", "Did this triage nurse know how to do the job?" I challenge any triage RN that has NOT at some point had a "CP" that had to wait for a ED bed.
Sure it would be a perfect system where all CP's were rushed to a bed - but the reality is this - sometimes there is no bed to put someone in. Some places do 12 leads/labs at triage and then try to assign, but the fact is this:
MOST ER'S ARE NEAR THE BREAKING POINT. YOU HAVE FINITE # BEDS, FINITE # OF STAFF. UNTIL THERE IS A FUNDAMENTAL CHANGE IN THE WAY ED'S OPERATE - WE ARE PROBABLY JUST SEEING THE TIP OF AN ICEBERG SIZE PROBLEM - THAT MAY JUST SINK US ALL.
Yep, 2 hours does seems like a long wait - but I (and others) do not know the other circumstances. Maybe this was a 49 year old female frequent flier that had NO cardiac history (maybe she had a normal cardiac cath (or 2) - that was finally done because her 22 other ED visits in the past 6 months for CP - because that complaint gets me rushed right back- that were never ruled in as a cardiac cause) Maybe she had no family history. Maybe this CP had been going on for 4 days with a productive cough and her 2 pack a day smoking habit (with her last cigarette smoked just as she entered the ED waiting room doors). Maybe she did not look ill (no pallor, diaphoresis) Maybe the VS were normal. I am a fairly experienced triage nurse and I have had cases of CP that I either could/would/did not "Rush Right On Back". It really just depends on the patient/symptoms/available resources. I can say that regardless of the beds/staff - If I thought a patient was looking like an AMI - I made a spot for them (even if it was a radiology stretcher with a transport monitor and personally got the doc to the bedside now). But, I can say with 100% honesty that I have had a "CP" have to have a seat in the waiting room.
2. This Coroner that called the inquest - just what were their "qualifications"? In many states coroners do NOT have to be Medical Doctors or have ANY medical background for that matter. In many locales coroners are FUNERAL DIRECTORS that are elected to a political post. Most laws that deal with coroners in many states, require little training and give them broad legal authority. Pretty scary. (This is a whole other soapbox of mine, I'll stay off of it for this case) So depending on the circumstances surrounding this coroner and the "Patient/Victim" - I think the entire situation may need a closer review.
DEATHS can be ruled as to manner: NATURAL, HOMICIDE, SUICIDE, UNDETERMINED, ETC. AS to the cause of death there is the autopsy (with an MD, not necessarily the coroner) finding that will that detail the physical cause of death.
Also in some matters like this there could be some POLITICAL motivations.
KEEP IN MIND HERE - BECAUSE THE CORONER RULED "HOMICIDE" - Now means that the "case" will enter the CRIMINAL JUSTICE SYSTEM. Some prosecutor will now have to make a "case" against someone who is responsible for this death, err..HOMICIDE. This means that someone will be CRIMINALLY CHARGED and will be ARRESTED for a FELONY and may go to JAIL or ultimately PRISON.
WHO DO YOU CHARGE WITH THE CRIME?
The triage nurse?
The charge nurse?
The hospital administrator?
The ER physician?
I urge all the awesome nurses and medical professionals to take a step back here - and consider the practice decisions that we must make on a daily basis. Given any number of variables -
Could I have been that triage nurse?
WE are ALL dealing with serious issues:
ED overcrowding in general, in- patient admission issues,
limited staff (and some inexperienced staff) with high patient loads/acuities, some ED cultural practices,
the droves of the non-emergenct patients that due to the nature of the "beast" often take up ED beds for prolonged times,
and administrations, that although aware, that are fully not supportive of the ED staff and are unwilling to make the necessary adjustments that will allow ED's to treat the emergent patients and refer the others to alternate sources of care.
Anyway, before we rush to judgement - I urge caution from other providers. This tragedy has left a patient dead, but will destroy other lives as well.
Sep 21, '06There are uneducated people in all walks of life, as there are different levels of mentality among adults........these people obviously are not aware of the standards or prerequisites to walking into an ER. It was an unfortunate incident, the medical field or nurses in general will get a bad rap for this incident. Tomorrow will be a new day. Life goes on, unfortunately glorious for some. Sad and depressing for others. Money in your pocket does not make one more important, nor does knowledge. Everyone is important to the people that love them as is they except help when they think help is needed. There is only one judge and everyone has there day...........
Sep 21, '06geez..........I work 12 hours tomorrow and I see by my schedule that I am the only "regular staff" person on. I will have to be charge. Do I take the triage assignment if no one else can? Do I take charge and take the "code room" assignment? Yuck. After reading about this, I don't know if I want to triage ever again. Triage is only OK if we are not busy. I actually LIKE triage if I can triage and place in bed, triage and place in bed, etc..... I HATE triage when the waits stack up and people are staring daggers at me in the waiting room (like that will help).
off the subject, we have recently been told that "diversion is out of the question". I suspect it is in relation to a news article that I recently read that states the average ER loses $1100 per hour for every hour on diversion.
I wonder how many nurses you could hire for $1100 per hour???????????
Sep 21, '06An EKG for chest pain is mandatory within 15 minutes to our facility. I would've done one in triage if necessary. We've also got a really busy ER and I do alot of triage. I've made beds for patients in places that don't even exist for the doctors, but better safe than sorry. Now I know there are patients that know just "what to say" to get back to be seen, but that's where your critical thinking comes in. If something's not quite right about the situation, if your gut tells you something, follow it. Who cares if the doc comes out there and fusses at you? We had an interesting case a couple of weeks ago. 38 yr old hispanic male comes in around 0245 with a complaint of chest pain that was pretty much resolved by the time he was in the triage chair. Fortunately, we had a bed available, sent him straight back to a room. EKG showed NSR, IV started, labs drawn. Radiology was in his room doing a portable CXR when he grabbed his chest and slumped over. He was in Vfib, we shocked him, got back a sinus rhythm, went back into V-fib, shocked again, amiodorone given, shocked again. sinus rhythm. EKG showed massive ST elevation. Shipped him to another hospital for a cath, he had a complete LAD!!!! Oh, did I mention he had had a negative stress test that day in his cardiologist's office??? Wild!!!! It's all possible!! Whenever the hair stands up on the back of your neck in triage??? Make a bed!!
Sep 21, '06As a 12 year ED nurse, I agree with you on a couple of points. The patient should have called 911 and many patients do deny their problem. I also think there's more to this story, and we are only getting the media version. Unless I read the chart, interview the staff involved and get all the answers, I can't pass judgement on another ED. As an ED educator, I know what's right, and I know what's possible or impossible to do. In the state of CT, we have the largest increase in ED volume and my facility is expanding. There are many days when we have literally no wall space left to put anyone even in the hall. Let's not totally judge the hospital or the triage nurse unless we know all the facts involved. It's an impossible situation out there..... Negligent....perhaps. Criminal......absolutely not.
Sep 21, '06The criminal issures here are all the sore throats and belly aches that take up precious time and rooms in the ER because that's where their FREE access card covers them 100% coverage. People who come in and demand we give them Tylenol because they can't "afford" to buy it, but they can afford that $5.00 pack of cigarettes in their pockets