Strained Tennessee hospitals try to cut everyday ER use - page 2

found at healthleadersmedia.com: strained tennessee hospitals try to cut everyday er use the tennessean, feb. 19, 2007 midstate hospitals in tennessee are adopting new strategies to... Read More

  1. by   ND76
    Quote from TennNurse
    SOS........

    I am in Memphis, and we are operating at almost triple capacity tonight. For the first time in history, we've gone on diversion several times over the last few weeks, and it means nothing. The EMS guys just say, "Patient still wants to come to your facility." They are told up front that there will be a minimum 8-hour wait, even for typical emergencies like chest pain and SOB, and still they say they want to come here.

    Why is this an option? Why has there been nothing on the news channels advising people that every hospital in the city is in crisis mode and people should exercise every possible option before coming to the ER? I am having a hard time being civil to the people who come in on the ambulance after being told that we are on diversion- I've got 2 pts right now who did this very thing, one for reflux pain and the other for N/V/D for 1 day, and now I am straining under an unsafe patient load.

    We have 80-year-old septic ladies on hall stretchers for 24 hours or longer. We have newborns barely a week old also on hall stretchers waiting for a bed. When I pass these stretchers at a run, I look to make sure they are still breathing. It truly amazes me that no one has died yet. We have no rooms, we don't have enough staff. Most of us have little or no ICU experience, but we're stuck taking care of multiple critical patients because we are so short on both rooms and staff. I've heard that the average wait time at our only Level 1 trauma center is a DAY.

    Please, tell your friends, tell your families, send out emails, whatever, but help spread the word that Memphis hospitals are past the point of maximum capacity and you are better off at home. This is a nightmare straight out of the twilight zone.

    Hello, fellow Memphis ER nurse! We are in the same boat as you. I haven't had lunch in a week, but on the flip side, since I've not been eating or drinking, I've not had to go to the bathroom, either. :wink2:

    Our problem is two-fold, our hospital has been at capacity almost a month now, plus, our acuity level is ridiculous! We've been holding ICU admissions for a day and a half. Tele admissions have actually been being DISCHARGED from the ER, they've been down there so long. We've tried using outpatient specials for a holding unit at night, but during the day, the ER fills up again... At one point in time a couple of weeks ago, there were only three beds in the ER that weren't being taken up by a hold.

    We have been trying the 'triage out' system. Non-emergent patients (and I mean truly non-emergent. No interventions required at all) are being seen by the PA or and ER doc in triage for their medical screening exam. Registration then comes and they have two choices: they can leave and go to a community clinic on a list we give them (or go see their own PCP), or they can pay a $100 co-pay upfront and stay and be seen. Most private insurances will NOT pay for non-emergent ER visits, and the patients are told that. Most of them end up leaving, royally peeved, yelling at me.

    The problem is, it didn't really work for TennCare patients. They always wanted to stay and be seen, knowing that TennCare would pay, and we couldn't legally collect a co-pay. They can't get it through their head that the reason we triaged them out was because they didn't need anything done! So, the PA comes back, hands them their discharge papers and bids them adieu. It's good in theory, but people are getting wise to it, and when we tell them they are going to be sent home, suddenly another complaint arises.

    We see patients every day now that come in with one or two wristbands on. They'll say, "I sat at ABC for 6 hours, then I went to XYZ and sat there for four, and nobody saw me." I just tell them to hunker down, because it's going to be at least that long here, too, and if they had stayed put at ABC they might already be home by now!

    I'm just waiting til I hit Powerball, then I'll retire!
  2. by   RNsRWe
    Until our health care system changes drastically, the ED abuse system won't change. I see people who come in because they have no primary care....why have they no primary care? Because the ED is free to them (on "the system" in one way or another). Why bother with the Free Doc who makes you (OMG, hold on for this one...) WAIT for an APPOINTMENT! That's right, can you believe these people who are too busy to hold jobs (or are too busy having child after child to have TIME for a job) actually are expected to wait for a doctor's appointment?

    Heck no....they go to the ED with every little thing. And then, many times, they are there specifically to blow it out of proportion so that they can get admitted (try their best, some of them and don't get in, you should see them back the next day or in two days, with fresh new symptoms that might just get 'em a bed and room service for awhile while they are "tested").

    All too often I see the crammed waiting room of the ED and just know it's going to be a bad night for my unit (med-surg) because they will be admitted by some idiotic resident or hospitalist who feels the need to spend a few thousand bucks we don't have on endless tests to rule out stuff WE know our Frequent Flyers don't have! And once they GET to my unit, admitted for abdominal pain, n/v, etc, they will start demanding meals and narcotics. But that's another story.

    NO amount of referring them to free docs will matter. They know they can go free now. They don't want to bother. NO amount of asking for insurance payments or co-payments for non-emergencies will matter, because the gov't cards they carry now get them off the hook. And the Drama Mamas and Bed Freds who are trying to GET admitted aren't interested in NOT going to the ED, are they? It gets them attention for a week if they wiggle their way in.
  3. by   pickledpepperRN
    I had chills, fever, pain, and dizziness. I also pay $$$ for insurance.
    So I called my doctors office and was tols the next appointment available was in 5 weeks. The woman on the phone actually said, "If you are too sick to wait you can go to the ER."
    I said, "No I need to speak with the doctor."
    He called back hours later and told me i could wait until Saturday when they have walk in urgent care. I did that and my sinus/inner ear infection was treated.
    I also changed doctors.

    Maybe they don't tell people in your state to go to the ER but it happened to me.
  4. by   banditrn
    Quote from Email4KH
    Although I'm certainly no fan of Hillary, I have to wonder how guaranteeing payment for primary care will increase the wait in emergency rooms.

    (In the future, it might be wise to actually take a moment to think about things Rush says before we respew them.)
    What does Rush have to do with it? I agree with Dixie Dawg - Universal Health Care isn't what it's cracked up to be - do some research.
  5. by   Simplepleasures
    Quote from banditrn
    What does Rush have to do with it? I agree with Dixie Dawg - Universal Health Care isn't what it's cracked up to be - do some research.
    I think it is possible to come up with a Universal Health Care System that would do away with the nightmare scenario in ERs that is described on this thread, go to the Healthcare /Politics forum, there is an in depth discussion about Universal Healthcare.There are postings with news accounts and other media onfo on ways in which a universal healthcare plan could be implemented to WORK, not fail abymsmally like TENN CARE.We have brilliant folks in this country who are working on this crisis right now.Again read up on all the different news and views on Universal Healthcare right here on Allnurses, go to Healthcare/ Politics section. Getting INFORMED is the first step.
  6. by   Email4KH
    Quote from banditrn
    What does Rush have to do with it? I agree with Dixie Dawg - Universal Health Care isn't what it's cracked up to be - do some research.
    Rush, Sean Hannity and all the other talking heads who bash the concept of less expensive health care for all are the ones who inspire listeners to dismiss the idea because of the socialized medicine systems of countries like England and Canada. I've done the research. Make the snide comment to somebody else. Those systems don't work because health care providers are government employees. I'm talking about guaranteeing payment to private primary care physicians so that every citizen will have access to such care.
  7. by   BULLYDAWGRN
    Pt's who utilize the er for a family clinic know the game, they know that their bills will probably be written off.
  8. by   MAISY, RN-ER
    Healthcare should be available for all, however, the system has become ridiculous! My ER has been packed daily-overnight holds for icu, ccu and tele are common place. We are fortunate enough to have an fast track er, but even that has become overwhelmed at times due to inappropriate patients who end up being admitted or are more complex than they appeared. We are also dealing with a huge non-english speaking populace who have no records, and are usually very sick by the time they access us. One problem that we see is that f/u visits are done in er rather than dr office-doctors will not even remove stitches or do wound care anymore! Another is that people are truly not educated what should precipitate an er visit-I have heard often that doctors are sending their patients to the er for treatment-there are no appointment and honestly I think their staffs don't want to be bothered. I think that Urgent care in the ER has created some of these problems-earaches, sorethroats, and sprains are seen and released quickly-today doctor's office visits(if you can get one) take hours-yet, urgent care er has freed up the beds so desperately needed by the sicker pts. The news media has not helped with their coverage of er waits and what takes precedence as an emergency-cp and sob entries have gone up ridiculously -all have to be taken seriously till cleared. I don't look kindly on these people that bs us, but you can't say anything-there are many playing the system! I think we should have well clinics at all hospital sites that educated patients on what is considered an appropriate er visit-I also think that an ER phone nurse or information line may help cut down on nonsense visits that could use OTC meds.
  9. by   jollygreenRN
    We have many here playing the system as well, our local flavor seem to be exquisite ABD pain with n/v/d over several days. When they get to the floor, max narcs, no emesis or loose stools, why can't I eat (usually NPO until seen by hospitalist) etc. I call 'em the "peanut butter and phenergan sandwich" crowd, after one such patient who c/o constant unremitting nausea, which somehow never affected her appetite. She would get on the call bell and ask for a peanut butter sandwich and her nausea meds.

    We are a growing community, and our hospital, even though expanding, cannot keep up with the increase in population. We also have a HUGE illegal immigrant population with large fruit and berry farms nearby. The illegals come to the ED because they don't have family doctors.

    I hate to be cynical about these things but I see it more every day, and am becoming resentful of the fact that these patients take up most of my time with their demands (and never a thank you) that care for the truly sick is being compromised.
  10. by   jollygreenRN
    As to health care available for all, I agree it is a great idea, but has anyone here actually looked at the logistics of it?

    The current US population is over 301 million people, and that does not include the undocumented aliens in our midst. The problem with "free" health care is that once given as a bennie, it will be abused, as we are currently seeing in our Emergency Departments. :uhoh21:

    If .gov is going to pay for it, be prepared to scream as your income tax rates will skyrocket, the money will have to come from somewhere.....which ultimately means the back pockets of the working class folks, which I am sure most here on the board are included.

    If we go to a Canadian model (God forbid) everyone will get universal access to health care. Notice I said access. Does not really mean you will get PROMPT access to health care. My brother in law needed a hip replacement. Common everyday surg in the US. He had to wait SIX MONTHS walking around in pain and on narcs until it was his turn. And the worst part?? It is ILLEGAL for you to go outside the Canadian health system to get health care on your own, or pay for it out of your pocket.

    That is unless you leave Canada. One reason why we have a large number of Canadians coming to our hospital for CT scans, MRIs and surgeries (we are about 20 miles south of Vancouver BC)

    That said, our CURRENT system is broken in some places (Texas, California, and it seems like Tennesee now too) and about to break under the strain in many others. What will it take? Germany's two tier system is a possibility, but I do know that the Health Care Reform that was proposed by Hillary years ago was not the way, nor would it have worked in our society.

    Solutions? I'm fresh out at the moment, and tomorrow I start 3 weeks of vacation(WooHoo!). Last year's vacation time was taken up by surgery recovery............
  11. by   stillsmilin
    I'm an ER nurse in TN and there is never a day that goes by in triage that
    several pt's tell me that they called there PCP, couldn't get in, and were advised to go to the ER.
  12. by   TennNurse
    [QUOTE=NurseDiva76;2095347] Hello, fellow Memphis ER nurse! We are in the same boat as you. I haven't had lunch in a week, but on the flip side, since I've not been eating or drinking, I've not had to go to the bathroom, either. :wink2:

    Our problem is two-fold, our hospital has been at capacity almost a month now, plus, our acuity level is ridiculous! We've been holding ICU admissions for a day and a half. Tele admissions have actually been being DISCHARGED from the ER, they've been down there so long. We've tried using outpatient specials for a holding unit at night, but during the day, the ER fills up again... At one point in time a couple of weeks ago, there were only three beds in the ER that weren't being taken up by a hold.

    We have been trying the 'triage out' system. Non-emergent patients (and I mean truly non-emergent. No interventions required at all) are being seen by the PA or and ER doc in triage for their medical screening exam. Registration then comes and they have two choices: they can leave and go to a community clinic on a list we give them (or go see their own PCP), or they can pay a $100 co-pay upfront and stay and be seen. Most private insurances will NOT pay for non-emergent ER visits, and the patients are told that. Most of them end up leaving, royally peeved, yelling at me.

    The problem is, it didn't really work for TennCare patients. They always wanted to stay and be seen, knowing that TennCare would pay, and we couldn't legally collect a co-pay. They can't get it through their head that the reason we triaged them out was because they didn't need anything done! So, the PA comes back, hands them their discharge papers and bids them adieu. It's good in theory, but people are getting wise to it, and when we tell them they are going to be sent home, suddenly another complaint arises.

    We see patients every day now that come in with one or two wristbands on. They'll say, "I sat at ABC for 6 hours, then I went to XYZ and sat there for four, and nobody saw me." I just tell them to hunker down, because it's going to be at least that long here, too, and if they had stayed put at ABC they might already be home by now!

    I'm just waiting til I hit Powerball, then I'll retire![/QUOTE]




    Hello there! Sorry I have not logged on in so long, have been working my patootie off! Like you, I've also been experiencing the wonders of 18+ hours without having to pee, due to not having time to take a sip of water. I never knew urine could look so dark!

    Many thanks for your kind hello and commiseration. In a weird way it has been a comfort to know that all the other ERs in Memphis are in the same boat; even though it heralds a crisis right out of a Robin Cook book, at least I do know that we are not alone. Powerball is a brilliant retirement plan, and I, too, hope that I've hit it when TennCare finally implodes under its own weight. Life in the ER will not be worth living at that point.

    Thanks again for your support, and hang in there. :kiss
    Last edit by TennNurse on Mar 14, '07 : Reason: Hit "submit" before I found the hug icon!
  13. by   EmerNurse
    We were talking today about the huge influx of patients, many of whom are sicker and sicker, and self-pay, whatever that means. And they're wedged in between the 90% of the other patients there for a clinic problem but.. the wait is too long, it's too far, they want me to pay a sliding scale fee, etc.

    We're all beat up. I stopped at the grocery store on the way home (off tonite yay!) and realized in the shampoo aisle that I desparately had to pee. Off I run with my full cart to the BR when I realize it's the first time I've gone since I LEFT HOME the night before.

    Something has got to give. I love my job, my co-workers and nursing, but good grief, no human being can keep this up forever <sigh>.

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