Death after two-hour ER wait ruled homicide - page 11
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 22, '06We ALL know that hospital ER's are being over utilized by people who have no reason to be there (it's an emergency room, not a place for panicky people who feel lonely, overwhelmed by thier sick kid at 11pm, or too damned cheap to pay for an office visit).
THIS is quite possibly why this lady died. EMTLA is here to stay,and hospitals need to set up emergent/non-emergent facilities to allow people to be properly triaged.
I come from an experience as an RN who had recent need of the local ER for abdominal pain. I was in the hallway for 5 hours, but still got excellent medical care. They did the best (ekg, because it could be)etc. etc. All was done, I was sent home (my decision) with pain killers after the CT and labs were normal. What if I was not a nurse who could handle herself and knew when to come back?
Yeah, Maybe I could have had more attention; the aftermath was that my primary told me that ERs are motivated to sending you home alive rather than getting to the root of your problem.
Morale: Don't get sick on Saturday night.
Sep 23, '06People have caught on to c/o CP, get a room. Happening more and more. Recently I had a patient call back to the treatment area from the waiting room (chief complaint low back pain for weeks). He was yelling and angry that people were going back ahead of him. I tried to explain triage and pateints seen based on acuity (using laymen's terms). Then he said "Then I'm having chest pain". I instructed him to return to the triage nurse for reassessment.
Another favorite, teenage boy with cold sx waiting to be seen with Dad. We had 3 MI patients present within a short period of time prior to this patient being seen. Dad angry at wait, once again explained acuity, critical patients first, .... His remark "You mean if someone else comes in having a heart attack, we're going to have to wait even longer?" Yes sir??????????
Sep 23, '06Quote from MilitaryMedtoRNThey may make it sound badWhat was this nurse thinking??? Nausea, SOB and CP. This is ridiculous.
But you werent there to make the assessment
Sep 23, '06Quote from teeituptomYes you are right I wasnt there to make the assessment, however, if I had been I would have taken the patient back immediately. Some co-workers saw this story on the news and they said that the patient's daughter went up to the nurse five times to tell her that her mother wasnt feeling good. I did not see this news broadcast but if this is what happened this is not good.They may make it sound bad
But you werent there to make the assessment
Sep 23, '061. So you are making your harsh criticisms on what you heard. Not what you can see and measure with your own eyes. How come the worst criticisms are always from young military medics who are in nursing schools. and think they know everything.Last edit by teeituptom on Sep 23, '06
Sep 23, '06Quote from teeituptomThats a good question. 11 years as a medic. Nurse now and because I love ER nursing thats what I choose. You have a nice day.1. So you are making your harsh criticisms on what you heard. Not what you can see and measure with your own eyes. How come the worst criticisms are always from young military medics who are in nursing schools. and think they know everything.
Sep 23, '06Quote from teeituptomGood point teeituptom. However, I wasn't there for any of the items in "Nursing News". Do you figure we shouldn't discuss them since we weren't there? It would make for really short threads if we just posted news items but couldn't discuss them since we don't know all the facts or even if the reports are accurate.1. So you are making your harsh criticisms on what you heard. Not what you can see and measure with your own eyes.
I figure if anyone really messed up at that ED, we'll see it in a new thread with a title "ED (doc/nurse/tech/pt daughter) charged with murder". Maybe a grand jury will indict the whole department and a judge will shut it down. That would surely protect the community from poor triage.
Sep 23, '06Quote from EDValerieRNit really is unfortunate that the old statistics that women are not taken seriously as much as men in regards to heart issues is true to this day - when i was about 35 i had classic heart attack symptoms the PA took a chest xray gave me abx and sent me home - i woke up a week later to find a whole week gone and that i had supposedly talked to the doc 2 days later - i went in for the FU which normally i wouldn't do if i felt better - to see what he had said when he called.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."
apparently he called to tell me i did NOT have pneumonia as he thought - i dont remember it - next thing i knew there were 3 docs in the room checking my heart and pulses and i was being sent to the hospital for tests - turns out i had had a heart attack -
the reason i dont recall the week i suppose is i went out from the heart attack and was just blessed i did not die. thank god my teens were on spring break as my toddlers would have been running the house!! of course the kids did not think to much cause mom was leaving them alone - they said i hardly even got up to the bathroom - i dont recall. and i had been sick before and stuck in bed.
even sadder is my chart shows very heavily EVERYWHERE that i have a very heavy family hx of heart issus including my mother died at 45 and that i have my own heart issues including an electrical conduction problem - i know it was there even at that time as i have always made a BIG deal out of it being there due to fear of dying young like my mom. not a good feeling knowing i was nearly a statistic.
trying to find the good of it -i am alive and we did find out that 2 of my valves are not good and will need to be replaced eventually so now we keep an eye on them and i have to take preantibiotics.
Sep 23, '06Quote from rjflynnot that its an excuse but perhaps she was a chronic and the nurse did not believe her - i know its a sad excuse ( we had one - wanted morphine - one of or very very few that made "the list" but we ALWAYS took her right in and did all the appropriate tests and admitted her for observation overnight every time) just a thought - as i said no excuse but a possibility?My question is where was the EKG on this patient. The national standard of care is that a patient having an MI have one within 15 mins of arrival. Hence at my facility even when full up and overflowing we have one done on every patient presenting with chest pain in the triage area if need be. I would find it extremely hard to believe that this patients EKG did not have changes consistent with MI or at the very least abnormal to the point of she would not of waited in triage long enough to move some BS pt out in to the hall.
So yes something criminal did take place. As to what I will not say as I dont know that hospital system or their protocols.
With out all the informatin ie the chart specifically its hard to know what the triage nurse was presented with or saw. But since a jury determined a gross deviation from standards I would bet something pretty glaring occurred.
Sep 23, '06Quote from CHATSDALEi worked for a DON once who told me if i needed to go to er no matter the problem to c/o of cps she felt that that was the smart thing to do... i don't think she ever worked in an er
as to the denial part, i had crushing chest pain, disphorisis etc i jumped in the car and drove 20 minutes away to a hospital passing a charity hospital on the way...please don't call me stupid, my kids and the er people took care of that md said that he hated to have nurses for patients..turne out to be hh and it has not repeated in 5 years, i really don't know how i drove through traffic in that condition
not stupid - done it myself - my family said its cause i was stubborn - just did not want to bother anyone in case it turned out to be nothing lol. turned out tobe someting, but you are not alone
Sep 23, '06Quote from mysticalwaters1also - experience I've had with my kids- first few times waited though they had fever gave em tylenol - made doc appointment after few days as ok - 3 - 4 days its not going away like a cold would and ear pain didnt come till you guessed it - middle of the night - worried about a rupture - i immediately took him in and glad i did cause it was on verge - after second time i knew better and did not wait - called doc first day so got in within next few ( better to cancel appointment if he got better which he rarely did) as knew he'd go to full blown infection.I don't know all the circumstances of your story but an ear infection can be quite painful. Also primary md offices are overloaded as well. I agree ED is for emergencies but if you can't get treatment for an ear infection what are you going to do? I had a cyst on my back, became huge size of a tennis ball, hurt so much and was draining but needed to be cut out, cultured and stitched up. I went to PMD, got my hmo referal to the dermatologist, took week see dermatologist only to be scheduled it for removal in THREE WEEKS after that!!!!!!!! I almost started crying infront of the receptionist when she told me. I couldn't sleep on my back, stained bunch sheets and clothes despite continually putting on bandages to my back. Had to WORK like that. But I did it b/c that's how I thought it should go. NO it should not take that long. We only have one dermatologist in our entire area. Now I'm working in the ER and I'm like wow should've just came here probably fixed faster. So some cases have to come just based on the failure of other systems ex other pmd and specialty offices. And what about Ortho coverage for ED. Been a big joke, ortho refusing to do it. It is such a mess. Now I'm sure people just come to Ed without considering pmd and that should not be but the way the health system is right now sometimes you do have to go to the ED to take care of things. Now, those people then should definitely wait for less emergent cases. We have a huge issue b/c some mds like to cram in minor cases to increase number meanwhile more critical maybe not cp but definitely more critical are waiting longer. So our management wants to implement if there are more critical waiting then minor emergenices to select 1/2 the minor section for the fast track cases and then the other for those acute make it a subacute to get them in. Now some mds don't like this then there's staff issues. But that is what should be done but with staff and equipment dynamics mixed with overload pts it's just so difficult.
Sep 23, '06Quote from ernurse4illI 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:
that would work in the big hospitals but for our small town hospital the er nurse IS the triage nurse , the charge nurse and the admission nurse - id have been to scared as a new grad to go er right away - but know several new grads who went to large er and are doing well with great mentor-ships.
Sep 24, '06We only put the most experienced nurses out in triage, and those with skills and the penchant for knowing the entire department at all times. As MANY ERs across the country, we dedicate a triage nurse (we would not defer to a PA or NP; see "experienced" above), and put only those who can handle it in that role. THe good triage nurse KNOWS AT ALL TIMES the next patient she can "bump" from a monitored bed for a patient such as a chest pain.
How very sad this case is, and none of us have walked in this nurse's shoes to know exactly what happened that day, but boy, it sure does seem like it was avoidable.