Saw a news special on ER crisis...opinions?

[sharann]

Hey all,

This news thing was about the emergency room crisis in Los Angeles county and talked about the delay in care and the long waits mainly. It sorta steamed me but as I work in PACU and not E.R. I thought I'd run this by you all. The news person interviewd several "patients"(ex-pts or those waiting by the ER)and asked how long they waited. The average response was "8 or 9 hours". My beef was that if these people are such emergencies then why are they standing around outside the ER getting on TV? I believe that the FOCUS of the story should have been "Abuse of the ER services is causing a crisis". Am I off track? What is the solution (besides what we do now which is treat everyone anyhow). More public clinics so the people go there? 24 hours urgent care places? It scares me that one day I may need to take my family or self to the ER for a real life threatning emergency and have no where to go because my local ER's are closed or diverting!

Thanks

[Energizer Bunny]

It's definitely an article that provokes a lot of thought as to the direction that Emergency Care is headed, but at the same time, it makes me think about a couple of things. I have a dedicated Minor/Urgent Care area in my ED that is open until midnight and that is staffed with an ED attending, a PA and 2 RNs. I think triaging out, like the article describes, defeats the purpose of having that area (as many ED's do). Also, we have a Walk-In Clinic directly across the ED that is open during business hours that our medical and surgical residents rotate through to provide continuity of care for many of our chronically ill patients. Are we still constantly overcrowded and inappropriately utilized? Of course. Part of the problem there is that many of the Attending Physicians with admitting priveleges in our hospital constantly tell their patients things like "well, if we want to get these tests done faster, go to the ER" or "if you can't get ahold of me, then just run over to the ER and we'll get you patched up" even if it's not a medical emergency. Many times, I can't help but feel like i'm treated like the 7 Eleven of the healthcare industry - cheap, open 24 hours and most convenient for all involved. Of course, many physicians who dont work in an ED fail to tell their patients how expensive it is be seen by us, particularly for non-urgent matters. I believe that if misuse of EDs is to be tackled, then there has to be a concerted effort between all medical disciplines who constantly view our departments as the paths of least resistance and thus advise their patients to "go there".

You make perfect sense with this post. I have had dr's tell me to go to the ER in the past as well. Now, my new dr. just tells me that if the pain I have gets excruciating, to call and leave her a message and she'll meet me there, but that's a different situation.

We used to go to the ER on weekends instead of calling the dr. because I didn't want to bother him. Can you imagine? I would NEVER, EVER do that now. Firstly, as you said, the ER is very expensive and secondly, it is my dr's job to be there when I need him (or someone in his practice).

I agree that it has to be a concerted effort from everyone involved to get these ER's used for what they are intended and not just as a 24 hr. "clinic".

[sevans]

One problem with this type of situation is that the person who decides whether or not an emergency exists is looking at it from THEIR experience - not the patient's. Our hospital does not have any kind of urgent care or clinic option - the nearest place for treatment after 5pm is an hour away. Now for myself, I will take a chance and wait until morning when I can call a doctor - but I won't take a risk when it is my son's health at stake.

Last year he was injured during football practice - he was 12, the high school trainer was called over to the middle school - told the coach to call me and have me take him up to the emergency room - that his finger was broken, and needed to be checked out. Now if it was me, I would have buddy-splinted it and waited until the next day. But it was his right hand, it had swelled and discolored immediately, and the finger was crooked - I was not going to take a chance that something was going on in there that could have permanently affected the mobility in his dominant hand. After a 3 hour wait to be seen, I immediately got attitude from the staff when we were taken back - "it's just a finger!" "we'll send you back to xray as soon as we can, but we have some REAL injuries to take care of first" etc.

Now I understand that in the major scheme of things, a broken finger is not a life-threatening emergency. But as a mother, I am not going to make my child lay around in pain for 16 hours from an obviously broken bone, waiting for the doctor's office to open at 9am. The emergency room just needs to accept the fact that as long as they are the only medical care available after 5pm, and as long as they have the only xray machine available, they are going to get things like this. Especially when it comes to children - most mother's will err on the side of caution when it comes to their kids - this is a fact of life, not a desire to mis-use the emergency room. The same goes for the new deductibles that insurance companies have started to charge for "non-emergency" emergency room visits. They need to make sure that they are basing their decisions and attitudes on whether or not it is reasonable from the patient's or parent's point of view - not the point of view of a doctor or nurse that is comparing it to a heart attack or MVA.