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I read this yesterday: "Portrait of an ER at the Breaking Point".… - Silicon Rose [entries|archive|friends|userinfo]
Silicon Rose

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[May. 11th, 2007|08:14 am]
Silicon Rose
I read this yesterday: "Portrait of an ER at the Breaking Point". Here, it's not bad, but we also live in a fairly wealthy area. genedefect says it was accurate as far as his time spent as a firefighter/EMT. It worries me.
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[User Picture]From: froborr
2007-05-11 03:36 pm (UTC)
Yeah, that seems to accord pretty well with my experience from the other side, during my years of having to go to the ER whenever I needed a doctor*. Understaffed, overworked, and pressured to be profitable: a recipe for disaster anywhere, especially a public service.

*No, I didn't go to the ER whenever I had a cold. I went to the ER whenever I was seriously ill (pneumonia one time; another I was unable to swallow fluids and needed to be put on an IV to prevent death by dehydration, etc). I just wanted to clarify that I'm not one of those people you hear about in anecdotes, whom I strongly suspect don't actually exist. I have never encountered anyone going to the ER for a cold, except for the babies of panicky yuppies.
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[User Picture]From: dragonoflife
2007-05-11 04:10 pm (UTC)
They exist.

They exist in large numbers.

They come in for chest pain they won't go to their own doctor for (144 times in six months, we counted). They come in for "shots on their head to grow hair." They come in for refills of their medication, because they forgot to ask their doctor and now the office is closed. They come in for minor cysts. They come in for back pain they've had for three years, and I do mean that literally. They bring their child in for a fever -- because if they gave their child fever-reducing medicine and the fever went down, their doctor wouldn't believe the child had a fever to begin with. (Oh, and that Children's Hospital we have down the street? Apparently parents just plain haven't heard of it.)

I could go on, but... well, just take it from someone who spends half his life watching these people come through. They very much exist.
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[User Picture]From: froborr
2007-05-11 05:17 pm (UTC)
Huh. Well, I stand corrected.

I was referring more to the anecdotal "people who don't have health insurance and go to the ER for hangnails", but gah, I had no idea ERs were as abused as you say here and below. I thought the pressure was coming almost entirely from budget and staffing constraints imposed from above.
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[User Picture]From: dragonoflife
2007-05-11 06:13 pm (UTC)
To be fair to our patients, the majority of them do have legitimate complaints, and many of these complaints are those that the health care field does prioritize getting seen. Chest pain, shortness of breath, etc.

However, as an example of what we have to deal with, right now is here with neck pain. From last Sunday. For which he saw his bloody orthopedic doctor for on MONDAY and recieved pain medicine for. Did he follow up with the doctor? No. Did he even give him a call and say, "Hey, still hurts"? Nope. He came here, and now it's on us to x-ray him, medicate him, get him PT... for a condition already known to patient and physician, already treated. He wants it magically fixed and fixed now.

Let me put it this way: The pressure on us is from all sides. Yes, budget and staffing constraints are huge -- as are the elimination of bonus pay for people who come in to pick up short hours. The administration wants us constantly to do more with less; whereas once our in-house departments performed respiratory treatments and EKGs, now those fall on the heads of the nurses and aides. They fired the person tasked with ripping charts unexpectedly, then transferred that duty onto us HUCs. They want to do the same with charges, ignoring that we have no TIME for this. Of course, no one sees a drop of extra money for these new duties.

But clinically, all pressure is on us as well. The floors won't take our patients; they stall and delay as long as they can. They refuse for the smallest reasons, and all of our patients have to be ludicrously stable before we're permitted to send them. But when they need to borrow supplies or equipment, we're first on their list. The nurses can't even be bothered to electronically discharge their patients in the voice report system; we have to do that ourselves from the ER, which requires three more phone calls to verify that the patient IS gone. Now, in all fairness, the administration has cut down on some of this in the past -- but that leaves a lot more pure BS that they didn't, and won't, touch.

Worse, when the hospital is full, we do not get help. Not one iota. We sit and hold our patients, no matter how critical; sit and argue with residents who refuse to come down and write orders despite it being *spelled out in hospital policy that they must*. We pile patients into the halls, overload our nurses because the administration cracks down on us when patients are waiting outside for more than half an hour. Administrators *watch our tracking screen from their homes* for the sole purpose of calling us and criticizing our wait times. But only ours. Critical patients have waited in the ER upwards of 24 hours without even being seen by an in-house physician.

And on top of that, patients come in who just plain shouldn't be here, by ignorance or abuse of their own or by their doctors. And all the while other ERs are closing. I could go on about the "hospital on red" system and its use! *This* is why we have wait times. *This* is why we have news articles on swamped ERs, crises, how bad our care is.

But you know what our patient satisfaction was, for February? Around *eighty percent.* We're talking people who recieved these surveys in the mail, and thus we probably have a larger proportion of angry people sending 'em back than happy, and we still get *eighty percent* satisfaction. That is our work. That is entirely on the staff of the ER, and you can only imagine the effort we put in to make four out of five responding people reasonably satisfied with their visit, under all this.
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[User Picture]From: dragonoflife
2007-05-11 03:47 pm (UTC)
Speaking as someone who works in an ER? Yeah, I bloody well agree. We may not be trauma, but we get more than our share of things like cardiac arrests, respiratory failures, etc. If the hospital is full, which it is more often than not, we sit with every room full of patients and overflow in the hall, with the administration yelling at us to get people out of the waiting room while providing no actual support to us whatsoever. They've expanded the ER, but cut staffing on all levels, removed all the incentives that once rewarded us for picking up extra time, and increased duties across the board.

First thought: This is bloody UPMC. Money is NOT a problem. I can only attribute this persistant systemic failures to a complete inability on the part of admistrative management to understand how an ER actually works. The system is broken and the people who can change it, like virtually all management, prefer to yell and scream at the people who work it rather than actually providing them with the resources necessary to do their job. The theory, I suppose, is that if they make us do it, they get rewarded for not giving us more money. This is the attitude in an "nonprofit" organization.

Second: People abuse the system. Patients treat the ER as a clinic, coming in for back pain they've had for a year or coughs that they want magically repaired, rather than going to their doctor. Doctors, rather than admitting patients directly to the hospital, send their patients to the ER to be admitted, because it's less work for them, and who cares if the ER is overloaded? Nursing and care homes take ANY excuse to ship a person off to the ER, even if it's blatantly and patently false. Nor do we have any resources for people who persistently and knowingly abuse the system. Drug seekers. People who come in 144 times in six months for the same chronic noncardiac chest pressure. We have to take care of all of these people, no matter the strain it puts on our system, because no one will work to stop these events from recurring.

In the news all people hear is "The ER is overloaded. The ERs can't provide for their patients. The ER leaves people in the waiting room to die." The reality is, of course, different: We do the best we can. The damn best, with what we have. Give us better resources, a better system. Give us a system that doesn't place, quite literally, all the burden on us. Give us changes that WE IN THE ER CANNOT MAKE, and the ERs will improve.
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[User Picture]From: froborr
2007-05-11 05:12 pm (UTC)
*applause*

You mind if I quote your second paragraph for something tangentially related I'm working on?
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[User Picture]From: dragonoflife
2007-05-11 05:42 pm (UTC)
Sure. I could go on and on about things if you really wanted me to.
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[User Picture]From: froborr
2007-05-11 06:29 pm (UTC)
Maybe, dunno. It's still in the idea-I'm-kicking-around phase -- an essay on the inadequacy of hierarchical social organizations, and the evolutionary-historical reasons we strongly tend to arrange ourselves that way anyway. When and if it progresses to the active-planning phase, I'll have a better idea what sort of information I need and what sort of sources I want to use.
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[User Picture]From: dragonoflife
2007-05-11 06:46 pm (UTC)
Oh, bloody hell, can I talk about getting fired by management in a previous job solely for the purpose of them covering their butts? 'Cuz I can do that too. Hardcore.
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[User Picture]From: froborr
2007-05-11 07:37 pm (UTC)
I'm sure you can. It's another good example of how much hierarchies suck. The problem is, in the absence of strong flattening forces, we tend to naturally arrange ourselves in them. Those two sentences are more or less the thesis of my possible essay.
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[User Picture]From: dragonoflife
2007-05-11 07:44 pm (UTC)
True dat. Let me know what you need, I'm feeling inspired.
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