Patient Died in ER lobby

[Kitiger]

Even if I were capable of working ER, I wouldn't work here.

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This week, a local media outlet reported that a patient died in the ER lobby on June 6 after waiting for hours to be seen.

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A full day after the report first came out, the hospital disputed the details of what happened with the patient in question, but in vague terms.

“How this story has been described publicly is not how things occurred, but in respect to the family we can’t comment on a specific situation at this time. We can confirm the State has not been on site this week for any reason,” a Novant Health spokesperson said in a statement.

The full statement can be found at the end of this story.

Hospital responds to reports patient died in ER lobby waiting to be seen

[speedynurse, ADN, BSN, RN, EMT-P]

This is not a shocker - I left the ER basically because of an incident very similar to this. 

[ThePrincessBride, MSN, RN, NP]

I'm sorry but we should not be putting the onus on nurses to de-escalate a situation. If a family member or patient is misbehaving, they need to be removed from the facility (unless this is a psych or demented patient). 

Healthcare is not a human right.  I used to strongly believe that it was until all of the abuse I have witnessed and experienced by a & o x4 patients. People have a right to access healthcare but that right should be taken away if they start abusing or mistreating those who have to give them the healthcare.

[J.B.Chan, BSN]

Tragic situation.  

[Kitiger, RN]

6 hours ago, ThePrincessBride said:

Healthcare is not a human right.  I used to strongly believe that it was until all of the abuse I have witnessed and experienced by a & o x4 patients. People have a right to access healthcare but that right should be taken away if they start abusing or mistreating those who have to give them the healthcare.

So everyone starts out with the right to access healthcare, but if they abuse or mistreat the healthcare workers, they lose that access. Their actions have consequences. 

If we're talking about alert and oriented adults, then I agree.

When we're talking about people with mental health disorders, then I don't know the best solution. It'd be nice if we could separate them from the other patients and have them treated by doctors and nurses with who have extra skill in dealing with these problems. How to do that? I don't know.

[CommunityRNBSN, BSN, RN]

A coworker of mine— a  competent, kind, sweet nurse— recently spent many hours in the lobby of an ER. She’s 8 months pregnant, and none of her family members were allowed to be with her. She had nothing bad to say about any of the staff; she said everyone she encountered was caring and professional. But she also said “Honestly, when I see news stories about a patient becoming aggressive, I get it. You take a person who is in pain or frightened, have them wait in a cold lobby for hours, don’t allow them any family support, don’t communicate with them at all,  and add hunger to their situation. It’s going to boil over.”  I don’t know what the solution is, other than hiring more people (and building more hospitals or something?). And of course trying to reroute people to urgent care, PCP, or specialist instead of sending everyone to the ED would help too.

I’ve never worked in an ED. Those of you who do, what needs to happen? 

[Emergent, RN]

7 minutes ago, CommunityRNBSN said:

I’ve never worked in an ED. Those of you who do, what needs to happen? 

If you don't want people to die in the lobby, you need a designated healthcare worker rounding on those people. Someone who is posted in the lobby whether it's busy or not. Someone with good people skills who can explain things to the waiting patients.

I don't know if it needs to be a nurse but there needs to be someone in the lobby keeping tabs on things. Not reception Clerk, not a security guard, but someone who has some medical knowledge and would be able to address spot potential trouble.

Of course there probably should be a security guard who can actually do something, especially in big-city hospitals that are quite busy.

[Tweety, BSN, RN]

One part of the article stood out at me:

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The report stated the woman died in the lobby on June 6, the same day the hospital sent out a mass casualty alert because all five emergency departments were at surge capacity. Hospital officials wanted all staff not currently on shift to report to their respective emergency departments immediately.

It's really easy to point the finger at what a bad ER they are and that you wouldn't work there, but sometimes the conditions are nearly impossible to manage and if you're not a trauma, stroke alert, or STEMI you sit and wait and wait and wait.  

This happens around here in our Winter "snowbird" season and covid surges. Often the ERs in town are so busy they all go on divert at the same time and the ambulances have to go on a rotation so as not to overburden one ER.  Patient's don't like this because they lose their choice of ER to go or have to go to one further from home.

The other part of the article that stands out is the burden of ER staff because there are no nurses to accept admitting patients on the floor.  This is currently happening where I work.  People spend sometimes up to 12 to 24 hours in the ER waiting for a staffed bed on the floors.  

Still, no one should die in the ER waiting room and that's a tragic situation.

[MEDFET, CNA]

Bad wrap? What exactly is suppose to happen in hospitals? Many are far from perfect! Nobody talks about why they transfer patients to us from “those” places most are DOA before arrival. Sounds like a coverup and the hospital will be facing some changes much like legislation these days

[Kooky Korky, BSN, RN]

On 6/16/2022 at 9:42 AM, Emergent said:

I don't know why anybody is shocked by this. A lot of nurses like me have left the hospital setting. It's not necessarily the hospital itself at fault, there are many many factors pushing nurses out of Nursing.

All these factors have been brewing for a while and then we got hit by the pandemic. The system got stressed to the limit. I'm so glad I am out of the hospital setting.

I don't know what the public expects. You have a waiting room stuffed to the gills, and the staff running around like chickens without a head trying to keep up with very sick people, plus they have to cater to the malingerers. They don't have time to round on every person in the waiting room who hasn't been evaluated. It's physically impossible.

Maybe a CNA could be assigned to the waiting rooms to check patients every 15 to 30 minutes and alert nurses if someone appears to be going south.

Checking patients means, to me, systematically eyeballing everyone waiting.  No yacking on the phone or watching TV or reading or doing one's nails.  Truly watching.  The aides could change posts q 1 hour or so.

Not in-depth checking but watching for changes in respiratory status or color changes,  but keeping an eye and ear open for imminent trouble so that tragedies could be avoided.

The age-old problem of people using the ER like a doc's office needs to be addressed in the community, for starters, by using the schools and  places of worship, Kiwanis, etc. to educate people about appropriate use of the ER (severe bleeding, severe pain, SOB, chest pain, strokes, and the like) and about home remedies and their appropriate usage.  Educate.  Teach.  Inform.  Perhaps once every semester.  Bring in a dentist, school nurse, other interested nurses, informed parents, (especially those who are raising kids and have encountered scrapes, cuts, etc.) nursing students, maybe PT, OT, whoever else could help educate people on simple home remedies and on when to seek ER care.  And what about using Urgent Care if one really does need some outside help?  Or calling one's doc, getting through the night or weekend and seeing the doc next biz day instead of running to the ER.

I used to see many patients brought to the ER because their pediatrician didn't prescribe a rescue inhaler.  Or maybe parents couldn't afford it?  

Not everyone knows about ice packs, OTC pain relief and other meds, Warm salt water soaks/gargles for various ailments, baking soda paste or vinegar/water application for mild burns (like sunburn) and stings, Calamine at least once or twice for itchy rashes, and the like.  My Mama was so smart.  She knew all of these things and treated most of our troubles with them.  And Granny believed in the enema for mild abd pain or constipation.  Yes, the bowels were monitored for diarrhea, gas, constipation by a vigilant, loving Granny, who kept us while parents worked.

Parish nurses, nurses who are involved in a community group or church/synagogue/mosque/etc.,  and Public Health Nurses could do much of this teaching.  If we did more of this in the community, it could help alleviate the crush in the ER's.

Meantime, nurses must not be silenced by employers, but should inform legislators and everyone they know, even if they do so anonymously.

[Kooky Korky, BSN, RN]

On 6/16/2022 at 7:20 PM, Susie2310 said:

I think the changes in Admitting procedures that mean patients can spend many hours on Observation status have resulted in a lot of difficulties for patients/family and staff. This, combined with Covid and shortages of certain Providers.

In the ED for over 12 hours recently on Observation.  It didn't appear to me to be especially busy, and we could see staff hugging and grooming each other at shift change.  The staff that we could see appeared to be working at a comfortable, even very relaxed pace for some of the time.  

On another occasion recently in the ED  (great majority of the time spent in the waiting room) for around 3 hours.  The waiting room was very busy and the ED looked packed; patients lying on stretchers not in patient rooms.

I recently read more information about the violence/aggression nurses are subjected to from patients/family members and how nurses are active politically in trying to criminalize violence/aggression (which lacked a descriptor of just what behaviors constitute violence/aggression that is to be criminalized) by patients/family members.   After spending over 6 hours in the ED on a stretcher (on our way to over 12 hours), a staff member (possibly emboldened by the current Movement to criminalize violence/aggression by patients/family members) chose to react to our reasonably stressed under the circumstances, non-threatening, non-violent behavior, by making an unnecessarily unpleasant remark.  I read of a facility that is providing staff with de-escalation training - I think this should be standard practice along with training in treating patients/family members with empathy and kindness; I read a study that showed that the de-escalation training decreased the rates of threatening/aggressive/violent patient/family experienced by nurses. We also experienced some stressed Provider behaviors due to reasons that were out of their control.

My experience as a patient/family member recently is that the above problems/behaviors are affecting vulnerable patients/family members negatively.

What kind of grooming?  ??

[ThePrincessBride, MSN, RN, NP]

On 6/18/2022 at 3:50 PM, Kitiger said:

So everyone starts out with the right to access healthcare, but if they abuse or mistreat the healthcare workers, they lose that access. Their actions have consequences. 

If we're talking about alert and oriented adults, then I agree.

When we're talking about people with mental health disorders, then I don't know the best solution. It'd be nice if we could separate them from the other patients and have them treated by doctors and nurses with who have extra skill in dealing with these problems. How to do that? I don't know.

Well I did exclude psych and other mentally incompetent patients. And we already have people for them...psych nurses. Psychiatrist. Psychologist. BERT.

But the vast majority of the abusive patients are not mentally ill, they are aholes.

[Kitiger, RN]

On 6/19/2022 at 9:05 PM, ThePrincessBride said:

Well I did exclude psych and other mentally incompetent patients. And we already have people for them...psych nurses. Psychiatrist. Psychologist. BERT.

But the vast majority of the abusive patients are not mentally ill, they are aholes.

I agree with you that alert and oriented adults can make choices, and their actions have consequences (like losing access to care.) I just wanted to be clear - as you were - that mentally incompetent patients don't face the same consequences.

We can't punish them for not doing that which they are unable to do, as long as they are doing their best.