Death after two-hour ER wait ruled homicide - page 10

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   ernurse4ill
    Quote from alcml6473
    new aha/acc guidelines call for only 10 minutes from entrance of er to get a 12 lead ekg and have it reviewed by an experienced physician. they also call for right sided leads in patients with inferior stemi to screen for st elevation myocardial infarction then you have 30 minutes or less to give thrombolytic therapy (if not contraindicated), and within 90 minutes of arrival should have percutaneous coronary intervention like ptca need to be done.

    this is truely a sad situation, my heart and prayers go out to the family.
    i agree that my heart goes out to the family. but i also agree that there are many facts missing here. i would hate to stand in judgement of anyone without all of the facts.

    given the recommendations quoted above, i can say that i have worked in several er's from the very small to the very large over the last 20+ years. all that i have worked in have always strived to attain these guidelines. but you must remember that in very small rural hospitals, it is almost impossible to obtain invasive interventions on these patients within that time frame. the ekg should most certainly be done immediately, and the thrombolytics are started asap when ordered. but beyond that, the patient must be transferred to a larger hospital and trust me when i say, that does not always happen in minutes.

    you must find a cardiologist available and willing to accept, then you must have the hospital with the available space and staff to accept the patient. then, of course, you have transport time, be it by ground or air. so as you can see, there are always variables to every case. hence why i say, i will hold my judgement until all of the facts are released.
  2. by   ernurse4ill
    Quote from erdiane
    geez..........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???????????

    I have also worked in a few hospitals that have demanded "NO DIVERSION for ANY REASON". How absurd it that??????!!!!!!!!!!! As we all know, there are times when diversion is absolutely necessary for the safety of the patients. Needless to say, I never stayed with those hospitals very long. There were only a few, but when the hospital will place more emphasis on the money than the welfare and outcomes of the patients, I have no respect for them. I have seen many nurses and ER docs leave these facilities for the same reason.
  3. by   tferdaise
    Quote from hogan4736
    I felt like this many times before going to nursing school in my late 20s...

    I either:

    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...
    Oh my, is this "Toad" from County ???

  4. by   nursego
    This patient went to an ER which means EMERGENCY ROOM.I am a RN not an emergency room RN to be sure but other nurses that I know who are ER RNs said a MI which is a fancy word for myocardial infarct which is a heart attack is a bonefied emergency. Not a semi emergant. Even I know that if you consider the classic symptoms of chest pain, SOB and nausea. As for criminal that is a local DA issue but it certainly seems to be a sueable case and lord help the RN who did that assessment unless she tried to intervene for the patient. And lord help anyone with full knowledge of the details. This was a preventable death or at least an attempt to prevent it could have been more fully made.Triage as happens at a local trauma center dictates that this patient would bump grandma with the hip fracture or the stubbed toe for sure. This is certainly one hospital to avoid if one is acutely ill.
  5. by   ernurse4ill
    Quote from PaRN210
    I 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......

    I have seen ER registration or techs send patients to the waiting room, and the triage nurse will not have a clue they are out there until the chart comes to them. This is simply a lack of education and communication. These ancillary staff members should be educated in the importance of the nurse being notified and aware of EVERY patient that enters the building no matter how minor they feel it is. The nurse is responsible for the patients. It is far too dangerous for the patient to be sent to the waiting room prior to the nurse laying eyes on them.

    Sounds like that is what happened to you PA. So sorry for your bad experience. I hope and pray that they learned from this.
  6. by   tferdaise
    Quote from nanb
    I am so with you and could add another 1000 lame excuses for misuse of the ED....but EMTALA says we turn no one away. If we had the ability to tell the obvious they're not an emergency problem and sent people away to take responsibility for themselves, our chest pains wouldn't have to sit for 2 minutes!! God forbid anyone takes care of themselves these to the ED!!!!!!
    AMEN SISTER !!!!!

    Once again it becomes Personel Responsiblty or the lack of...

  7. by   ernurse4ill
    Quote from MikeyBSN
    Thank you, I'm a new grad in the ER and sure it's hard but I don't think that I don't deserve to be there. Some of the people I came in with never made it off orientation. It's a good place to learn because you see so much of so many different things. Sure it's overwhelming at times, but not impossible.

    I think the main point being made here was (in my opinion) that a new grad does not have the experience, background in critical thinking etc. to be placed in a very busy triage setting. I have been doing ER nursing for 20+ years. I did not start as a new grad, but rather had about 3 years med-surg experience and was still somewhat overwhelmed at times. However, on the flip side of that coin, I have also seen new grads that had other medical experience such as ER tech, etc. that did quite well in the ER as a new grad. I believe that each nurse is a individual case and should be treated as such. However, I will never believe that a new grad should ever be placed in the triage area until she has had adequate experience in the ER setting itself. There are far too many "ER pearls of wisdom" that only come with experience. Too many subtle signs that an in-experienced nurse may not pick up on right away. My opinion only of course. :wink2:
  8. by   ernurse4ill
    Quote from Bikechicky
    For those of you that have never done triage in a busy ED you have no idea how hard it is. I once worked in an ED that I could always make a place for a CP. I now work in an ED that is frequently overwhelmed with patients. 6 hour waits are not uncommon, 2 hour waits are common. Yes those include pts with classic CP sx. Yes I can get EKG's at triage, but even that takes time when you have 6 or 8 pts and family lined up waiting to check in, bleeding and in pain. A waiting room full of pts! I just explain to every pt checking in that there will be a wait, and tell them how long people have already been waiting (it is nice to see the whiners leave then!)

    Anyway this is truly a case of ...."there but for the grace of God goes I"

    I am a compassionate, caring and skilled nurse, Triage kills me, and after 6 hours of it I have no compassion left.
    This is a crisis in health care, I hope it helps make a change in our systems.
    We used to split triage for this reason. It is an emotional killer! We would do 4 hours only, then switch off. 12 hours would leave you absolutely burnt!
  9. by   ernurse4ill
    Quote from Pat_Pat
    What is a "triage nurse"?
    We have ONE nurse in our ER. She does it all.
    Who is this "charge nurse"?
    Hallways are for walking.....AND putting patients in if all 5 of your ER beds are full, and their s/s warrant.
    BTW: We DON'T have pharmacy after 5pm, we NEVER have a Radiologist in our facility and sometimes the (one) lab tech takes vitals in the ER.
    Welcome to life in Rural America.
    You make due with what you are given.
    Arise and overcome, it is what our Country was made from.
    Be grateful for what you have.


    ABSO-FRICKIN-LUTELY!!!!!! This is exactly true!!!! It can be some SCARY stuff at times! (it was one of these that was owned by a big money corporation, that demanded no diversion ever!) Sheeeeeesh! An hour from the city (minimum) and we were to never divert, no matter how bad it got! I think NOT! lol
  10. by   NC-RN
    Quote from clee1
    This is going to happen more and more in the coming years.... until the ptb and the medical establishment get the guts to say "No, Mr./Mrs. Whinybutt. Your sinus infection is NOT an emergency - call your PCP in the morning. Oh, you don't have a PCP? Find one.... in the morning. Good bye."

    Also, the rash of Un/under-insured people using the ER as a PCP HAS to stop - like right now!

    It is unconscionable that people with emergent conditions like MI, SOB, or even a serious lac requiring sutures have to wait for hours for treatment because our ER's are crammed full of the slightly sick, chronically lame, or the insufferably lazy. Oops! I almost forgot: the severe LBP x 3 months that HAS to have some IV narcs RIGHT NOW!

    Gimme a break.

    Amen! If the report is correct this patient was mis-triaged, very unfortunate with tragic consequences, but not a crime. This sort of incident is going to increase as EDs increasingly become free minor care clinic. We do not know the situation in that hospital on that day, but I can easily imagine it happening in mine. We have one triage nurse with no support who sees an average of 75 patients or so in 12 hours. Most of these patients have minor problems that they see as life threatening and expect to be seen immediately.

    My ED has been under a lot of pressure to reduce wait times and increase "customer satisfaction". If we did a better job of filtering the whiney patients and sending them on their way, preferably never going farther than triage, we could focus on the important patients. If the frequent flyer with a "migrane" or "back pain" leaves pissed because they had to wait too long, did not get the Rx they wanted, or were not given a meal, and a TV to watch maybe they will think twice before coming the next time.

    Quality and expediency of care for our acute patients should be the standard to which we are judged. The conundrum is that if we focus on the patients who need care the most our "customer satisfaction" scores will decrease and complaints will increase.

    If the ED was managed like Disney it would cost $100 (Cash or Card) to be triaged and you would be told told from that point the wait will be six hours, no refunds.
  11. by   ERTRAVELER
    Hello Corporate America!!!!. Hospitals are big businessl. They cut corners everywhere they can. First of all, the very first person a patient should see when coming to the ER is a nurse, not a registration clerk. I've worked in many ER's as a traveler and . . guess what.. they are all the same. Majorly understaffed.
  12. by   weirdRN
    Quote from tferdaise
    I do NOT know how many time I was told at the Triage window from people who called t hier Dr's office and was told to go to the ED. The Family Practice Dr's are working twice as hard as they did 15 yrs ago since the insurance comanies and as well as Medicare reembustments are less and less, so they have to see more pt to make the same amount of money..
    The real problem is the Healthcare system..
    It is my opinion that health insurance should be for hospitalization and big ticket diseases, medications and Emergency Care only. If the only way the DR was getting paid was if he saw the patient then the ER crowding wouldn't be happening as much b/c primary care Docs would see their patients. Consider that most Docs see between four and ten pts an hour for at least six hours everyday, lus most of the docs I know make rounds and bill for services in the hospitals too. I know that the Peds Dr that my son sees charges $70 per annual physical and $35 for an office visit when he is sick.

    It is just ridiculous! Especially when you conside that the Doc is only seeing my son for a grand sum total of about six minutes... or LESS!

    As for the whole scenario you described earlier, I have only ever been in the ER when I really thought I was going to DIE (I had lost a LOT of blood) (hct was 7.6), or I had a very badly sprained ankle. (I thought it was broken) or I was being checked out b/c I was involved in an MVA.

    When sick, I usually just use OTC colds meds and drink lots of juice and eat soup until I feel better until I can get to a Doc's Office. Now that I have a F/T job, I just go to work and I'm miserable until I can get to my PCP.

    I once worked in an Urgent Care clinic that was attached to a Hospital. All the "real" emergencies went to the ER side, everything else went to the Urgent care. There were four triage nurses. I can not ever remember anyone complaining of CP and SOB being sent to sit in the urgent waiting room. The MINIMUM was an EKG and stat labs, even if we had to sit them in the nurses station until it was done.
  13. by   Pat_Pat RN
    You better be careful sitting people in the nurses station, that could be a HIPPA violation. (I know, who cares.)