Code Blue for the ER....

  1. from newsweek

    a three-part series on the state of emergency room health care in america today.

    'we're at our breaking point'

    gunshot wounds. blood and brain matter. exhausted nurses, endless wait times—and no end in sight. the only thing scarier than an average saturday evening in the er: what if it was forced to close? one night in atlanta.

    may 8, 2007 - enter grady memorial hospital's er and your senses come under attack. mangled, blood-coated bodies lie in the trauma bays. shrieks of pain pierce the din. rank smells curdle the air, released by flesh that has been battered, gashed and infected. the place throbs with frenzied, unrelenting activity. hospital workers race about, struggling to prioritize patients, leavening the mood with sardonic cracks. just when it seems the staff can't be pushed any further, paramedics burst in with another critical patient, setting off yet another spasm of mayhem.

    to get a closer look at grady's inner workings, a newsweek reporter and photographer spent five days in the er last summer. such access is rare, and newsweek agreed not to publish the names of patients—or photograph them in identifiable fashion—unless they agreed to it and signed releases. the portrait that emerged was disconcerting. like many ers across the country, grady's is perilously near collapse. the reasons are familiar: cutbacks in funding, a growing pool of uninsured people, and an older and sicker population that requires more costly treatment, among others. grady has been sending distress signals for years, but those warnings are now direr than ever. the facility is losing $3 million per month. it's 120 days behind in paying some creditors. and it almost failed to meet payroll in march. to put it simply, the hospital cannot survive much longer in its current state. were it to shut down, the impact on atlanta and the surrounding area would be devastating. what follows is the account of one revealing, and utterly routine, night....

    how to stop the bleeding
    portrait of an er on the verge
    sounding the alarms
    interactive: the alarming stats
    photo gallery: scenes from the er
    tell us about your er experience
    video: grady hospital's er in atlanta, georgia
    Last edit by NRSKarenRN on May 31, '07
  2. Visit NRSKarenRN profile page

    About NRSKarenRN, BSN, RN Moderator

    Joined: Oct '00; Posts: 27,520; Likes: 13,729
    Utilization Review, prior Intake Mgr Home Care; from PA , US
    Specialty: 40 year(s) of experience in Home Care, Vents, Telemetry, Home infusion


  3. by   NRSKarenRN
    from: how to stop the bleeding

    ...some hospitals have introduced innovations to deal with the boarding problem. dr. peter viccellio, vice chair of the department of emergency medicine at stony brook school of medicine in stony brook, n.y., came up with a simple fix: move patients waiting to be admitted from hallways in the er to hallways in specialized units elsewhere in the hospital. they're still not in rooms, but they receive better care and rest more comfortably outside of the er. at stony brook, the program has reduced the average length of stay in the hospital from 6.2 days to 5.4 days--a dramatic savings in resources and money. the move has also reduced the strain on er nurses, because patients awaiting admission usually require more attention. since viccellio's innovation was implemented, stony brook has never had to divert a patient (it receives about 75,000 er visits per year, compared to around 170,000 at a large urban hospital like grady memorial in atlanta)...
    thought jcaho and hospital safety regs prevented caring for patients in hospital hallways !!!!!!!!!!!!!!!!
  4. by   bethin
    I've heard horror stories about Grady for years. How anyone can stay even one shift is a miracle. I would be petrified to work there thinking I'd surely(not on purpose) kill someone. Hard to believe they are the only Level 1 trauma center in Atlanta. Even small Indy has 2 excellent trauma centers.

    Something must be done about the state of healthcare. Like the article stated, even the insured use the ER as a dr's office. There have been many times where patients just show up on our med/surg floor telling us the dr told them to come here. They admit without ever seeing the patient.

    Wouldn't it be lovely if we could spend the billions that are going to a war on healthcare?
  5. by   errneducator
    ERs in general are in distress. I wonder sometimes what it is going to take for the issues to be addressed. I worked at a Level 1 hospital in KY and can very much identify with the scenario's talked about at Grady. Sometimes I would have a pt crashing and not see my other 6-11 patients for hours. I think my worst assignment was the day I had 12 patients. 3 of them were ICU holds (pt waiting for a bed), 3 of them were PCU holds, 3 of them were MS/Tele holds and 3 were ER patients. One of the PCU holds was crumping and one of the ICU patients was crumping. So who do you take care of first. Oh did I mention, I was also the trauma room nurse?
    Overcrowding, misuse of the ER, holding/boarding, diversion, etc., are all major issues facing ER's all over the US.
    I think sometimes that the only thing that is going to help is government intervention and then I wonder what will they do but add more regulations that are not really in tune with what is going on in the real world.
  6. by   Dixielee
    I work in a level 2 ER that functions as a level 1. We get all the transfers from our half of the state, neuro included. Memorial day night shift at one point we had 50 beds full and 35 in the waiting room. We were holding 6 ICU patients, 5 on vents. We were reasonably staffed, but still running, and hoping no one crashed, because the traumas kept rolling in.

    These articles are right on target. Wait times for patients to get admitted to the floor/ICU are increasing. Many times we have a patient 10-12 hours before an admitting doc even sees them, then there is the wait time for a bed. Unacceptable? Yes. But no one seems to be doing anything about it.

    The ER is the only department who can never close the door and say "we're full, go somewhere else", or "housekeeping hasn't cleaned the room yet, you will have to wait", or "that nurse is at lunch, we can't take report on that patient yet". They roll in hour after hour, and we do the best we can, hoping to stave off death or lawyers who both seem to be hovering around the ER doors.
  7. by   Altra
    Quote from nrskarenrn
    from: how to stop the bleeding

    thought jcaho and hospital safety regs prevented caring for patients in hospital hallways !!!!!!!!!!!!!!!!
    i've yet to hear about an er that doesn't care for patients in hallways ...
  8. by   CseMgr1
    I know the place well. Did several of my clinical rotations there in SICU, ER, Peds, Med-Surg and L&D many moons ago. It's just a shame.
  9. by   NRSKarenRN
    Quote from mlos
    i've yet to hear about an er that doesn't care for patients in hallways ...
    per article, move patients waiting to be admitted from hallways in the er to hallways in specialized units elsewhere in the hospital.