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Old 05-26-2009, 05:03 PM   #41
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The problem is multifactorial The main culprits are fewer Emergency Dept's, (they lose money in most locales), increased number of ED visits and fewer inpatient beds for admitted patients to go to. These all lead to overcrowded ED's with increased wait times. Now try to imagine if a true flu pandemic were to strike - it would be a national disaster as there is no capacity to handle it.

DD
Yes, I am aware of hospitals that have looked into conversion into specialty hospitals with no ED.
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Old 05-26-2009, 05:19 PM   #42
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The problem is multifactorial The main culprits are fewer Emergency Dept's, (they lose money in most locales), increased number of ED visits and fewer inpatient beds for admitted patients to go to. These all lead to overcrowded ED's with increased wait times. Now try to imagine if a true flu pandemic were to strike - it would be a national disaster as there is no capacity to handle it.

DD
I find it hard to believe this line of reasoning is true.

What caused these to happen?
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Old 05-26-2009, 05:24 PM   #43
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Old 05-26-2009, 06:54 PM   #44
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I find it hard to believe this line of reasoning is true.

What caused these to happen?
This is 2 years old - it has only worsened: CDC report backs emergency department overcrowding charges - FierceHealthcare

The causes are many but ultimately this is a symptom of the collapsing health care "system" in the US.

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Old 05-26-2009, 10:01 PM   #45
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Anyone anywhere near the front lines knows this is a longstanding and spiraling disaster. Lack ok insurance coverage contributes greatly as patients use ERs for primary care. There is an obligation (legal and moral) to see all comers and "triage" is very difficult in this setting (it's easier, ironically, on the battlefield). There is little or no reimbursement for many visits. There is defensive practice including big league testing for issues which might be approached more gingerly by a PCP with little or no loss of quality, in part due to the buck-stops-here demands of all parties.

I do everything I can to help my patients avoid the ER other than in true life-endangering issues. The ER docs are doing a heroic job but are in a very tough situation.
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Old 05-27-2009, 12:56 AM   #46
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Well, boys and girls, my wife says I have 12 new screws inside my body and a hunk of metal to keep them company and close together.

Thanks for all the sympathy! It was a big help the last few days. I have also outlined a nice letter to the CEO of the hospital and will offer to take him to lunch to help improve his business. I hope he accepts ... maybe I can arrange food poisoning and take him to his own ER.
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Old 05-27-2009, 07:19 AM   #47
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Well, boys and girls, my wife says I have 12 new screws inside my body and a hunk of metal to keep them company and close together.

Thanks for all the sympathy! It was a big help the last few days. I have also outlined a nice letter to the CEO of the hospital and will offer to take him to lunch to help improve his business. I hope he accepts ... maybe I can arrange food poisoning and take him to his own ER.
Glad to hear that you finally got the treatment you needed! Your post was indeed a horror story for those of us who THINK we are living in civilization and not out in the jungles of a third world country. One would hope that the CEO would respond with something beyond CYA, but who knows.

12 new screws and a hunk of metal? Whew! So much for getting through the metal detector at airports easily. What bone was it? Sounds like a fairly big one, or else the damage was such that very tiny screws were required.

Anyway, take care and thanks for the update.
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Old 05-27-2009, 09:39 AM   #48
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Anyone anywhere near the front lines knows this is a longstanding and spiraling disaster. Lack ok insurance coverage contributes greatly as patients use ERs for primary care. There is an obligation (legal and moral) to see all comers and "triage" is very difficult in this setting (it's easier, ironically, on the battlefield). There is little or no reimbursement for many visits. There is defensive practice including big league testing for issues which might be approached more gingerly by a PCP with little or no loss of quality, in part due to the buck-stops-here demands of all parties.
"There is an obligation (legal and moral) to see all comers" - this is where the real market fails. There is no such thing as a "cash/insurance" line and an "uninsured/indigent" line. That is not how the triage is done. In a strictly market based environment without the legal obligation to treat all and the legal liability for failure to treat, the "cash/insurance" customers would get service first then the "uninsured/indigent" patients may get service the doc/hospital is feeling charitable.

What opponents of "socialized medicine" or "universal healthcare" fail to realize is that the ER IS a form of universal healthcare. But a very inefficient form and one for which we all bear the costs (in the form of longer waits and higher costs for those that DO pay). It is rationing treatment at its best/worst.
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Old 05-27-2009, 11:37 AM   #49
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Well, boys and girls, my wife says I have 12 new screws inside my body and a hunk of metal to keep them company and close together.

Thanks for all the sympathy! It was a big help the last few days. I have also outlined a nice letter to the CEO of the hospital and will offer to take him to lunch to help improve his business. I hope he accepts ... maybe I can arrange food poisoning and take him to his own ER.
LOL! - glad your getting better.

DD
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Old 05-27-2009, 05:47 PM   #50
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Well, boys and girls, my wife says I have 12 new screws inside my body and a hunk of metal to keep them company and close together.

Thanks for all the sympathy! It was a big help the last few days. I have also outlined a nice letter to the CEO of the hospital and will offer to take him to lunch to help improve his business. I hope he accepts ... maybe I can arrange food poisoning and take him to his own ER.
Great to hear you are back in one piece, and kept your sense of humour!
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Old 05-27-2009, 05:49 PM   #51
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Most of the knocks on our Canadian medicare system are about the waiting times,looks like OP is getting the worst of both worlds ,having to wait and having to pay.
This is a very interesting thread for me to watch. Many Canadians assume that in the US there are no wait times. NOT!

I think none of us can take a "holier than thou" attitude. Wherever you look, healthcare systems are under severe stress. And the ER is a difficult place to exercise market forces.
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Old 05-27-2009, 07:35 PM   #52
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The problem is multifactorial The main culprits are fewer Emergency Dept's, (they lose money in most locales), increased number of ED visits and fewer inpatient beds for admitted patients to go to. These all lead to overcrowded ED's with increased wait times. Now try to imagine if a true flu pandemic were to strike - it would be a national disaster as there is no capacity to handle it.

DD

Another problem I think having worked in hospitals for many years is the ever increasing documentation . I recently took my Mom to the ER and I could not believe the charting required . We arrived at one a clock were taken into a treatment room quickly and were there for five hours for six stitches . The last hour was spent waiting for them to finish the paper work. It was the most inefficient use of equipment I've ever seen . One of my last jobs was in Endoscopy at a hospital and I also worked at an Outpatient Endoscopy Center . The difference in paper work was mind boggling at the hospital we had at least six different forms we had to have the patients sign including giving them instructions on the flu vaccine ,smoke ending and Living will . At the outpatient is was two papers permit and insurance info ...
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Old 05-28-2009, 11:27 AM   #53
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Another problem I think having worked in hospitals for many years is the ever increasing documentation . I recently took my Mom to the ER and I could not believe the charting required . We arrived at one a clock were taken into a treatment room quickly and were there for five hours for six stitches . The last hour was spent waiting for them to finish the paper work. It was the most inefficient use of equipment I've ever seen . One of my last jobs was in Endoscopy at a hospital and I also worked at an Outpatient Endoscopy Center . The difference in paper work was mind boggling at the hospital we had at least six different forms we had to have the patients sign including giving them instructions on the flu vaccine ,smoke ending and Living will . At the outpatient is was two papers permit and insurance info ...
You are correct, there is much more paperwork. JCAHO keeps adding further burdens. In recent years we have added screening for domestic violence, vaccination status (and have started vaccinating patients in the ED) and most recently medication reconciliation. While they do add value to the patients care (in some cases) they have all been essentially "unfunded mandates" and burden an already overwhelmed system.

Looking to the future we have electronic order entry touted by many as a cure all for inefficiencies and medication errors. My experience to date has been abysmal. Errors continue - they are just made in different ways - and it is much less efficient. I now spend more time clicking a mouse and watching an hourglass then with direct, hands on patient care .

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Old 05-28-2009, 06:02 PM   #54
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You are correct, there is much more paperwork. JCAHO keeps adding further burdens. In recent years we have added screening for domestic violence, vaccination status (and have started vaccinating patients in the ED) and most recently medication reconciliation. While they do add value to the patients care (in some cases) they have all been essentially "unfunded mandates" and burden an already overwhelmed system.

Looking to the future we have electronic order entry touted by many as a cure all for inefficiencies and medication errors. My experience to date has been abysmal. Errors continue - they are just made in different ways - and it is much less efficient. I now spend more time clicking a mouse and watching an hourglass then with direct, hands on patient care .

DD
Oh boy, DD, Moe and I can really relate on this! I'm sure Rich in Tampa can too.

Our ER volumes are skyrocketing. We do medication reconciliation on patients who are slated for admission, but frankly, we can't do it on the other 90%.

When it comes to electronic order entry, the devil is in the details. When Children's Hosptial, Pittsburgh initially installed it, their ER mortality and morbidity went UP because the RNs and MDs were forced to spend so much time on the computer that they could not care adequately for the patients who were sickest. I think they had to switch it off. And the design of the decision support systems is key too. CPOE may reduce some errors, but it can introduce a whole new array of errors too.
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Old 05-28-2009, 06:39 PM   #55
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It's a good time to think about early retirement .
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Old 05-28-2009, 06:41 PM   #56
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It's a good time to think about early retirement .
Or at least upping your percentage...
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Old 05-28-2009, 06:54 PM   #57
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I vote RiT up his retirement percentage to 98%.
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Old 05-28-2009, 06:58 PM   #58
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It's a good time to think about early retirement .
I think, therefore I am?
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Old 05-28-2009, 07:13 PM   #59
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There is nothing like a locked medication system for all meds . Imagine being in the middle of an important surgery and you have to run out enter your code enter the patients name , the medication you want , the amount and how many are left while the surgeons are waiting . Wonder why I'm retired ?
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Old 05-28-2009, 08:27 PM   #60
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I'm working on it...
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