Friday, July 17, 2009

Bemoaning The ER....7/20

Don't know if you caught the Snooze article on ERs.
Emergency room challenges

By Sally Boswell

Published July 12, 2009

We’ve all heard the horror stories.

A friend, a loved one, is injured or falls ill. They go to the emergency room at the local hospital and once there, are forced to wait — and suffer — an interminable length of time until they are seen and treated by a physician. In the most extreme versions of the story, the patient dies of neglect, sitting unattended in a chair in the emergency department waiting room, hours later.

Sadly, the story — at its base — is rooted in an undeniable truth: Emergency room wait times have gone up.

According to a report issued earlier this year from information gathered at more than 7,000 hospitals across the nation, the average wait time in emergency departments across the country went up to 4 hours and 3 minutes, an increase of 27 minutes since 2002. In Texas, wait times in 2008 averaged 4 hours and 8 minutes, putting Texas 31st in the nation in that ranking.

In August 2008, the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and the National Center for Health Statistics, issued a report on the state of emergency departments nationally. The report linked patients’ inability to access a primary care provider in a timely fashion with the increasing frequency of ED visits. This was compounded by a decreasing number of EDs across the country as well as decreasing numbers of inpatient beds.

“EDs nationwide are under increasing pressure to provide care for more patients,” the report reads, “resulting in crowding and increased waiting times for minor illnesses.”

“What most people don’t realize is that the term ‘wait time’ is considered the total time spent in the ER,” said Chris Dux, CEO of Paris Regional Medical Center. “At this hospital, the total wait time is 3 hours and 10 minutes. The time from when a patient comes in the door until they are seen — not by a triage nurse, but by the nurse that is going to care for them — averages 42 minutes.”

“These numbers are just averages,” Dux continued. “Some waits will be much shorter, some longer.”

“The ER is not a primary care provider,” Dux said. “An ER is designed to treat medical emergencies. Patients with a true emergency will be seen right away. Non-emergencies, where there is no danger of loss of life or limb, no danger of bodily system failure, will wait while more critical patients are seen.”

“The reality is that the sicker a patient is, the faster they will get seen,” Dux said.

Many who complain about long wait times at the ER cite a lack of staff as part of the problem. Dux and other hospital officials dispute that claim.

“Our numbers show that our busiest days are Sundays and Mondays,” said Connie Murchison, CNO at PRMC. “and afternoon hours are the busiest. We try to anticipate the need and have appropriate staffing for known peak times, but there are never less than five nurses on duty at any time in the ER. And the nurses work overlapping shifts so there is no lack of coverage.”

“There are patients who get it into their minds that if they come by ambulance they automatically go to a room,” added Phyllis McDaniel, nurse manager of the ER. “That is not the case. Someone who comes in an ambulance goes through triage just like anyone else. They are assessed and if it is determined they do not have a true emergency, they get triaged back out to the waiting room just like everyone else.”

So what is the solution to increased wait times in hospital emergency rooms?

“To start off, every person, if they don’t already have one, needs to establish a relationship with a primary care physician,” Dux said. “If they have a chronic condition such as diabetes or a pulmonary or coronary condition, the physician will be familiar with their case. If problems arise, the patient should call their PCP first. The PCP can advise them if they need to go to the ER or if they can wait and come to the office the next day.”

“A physician’s office visit is also going to be infinitely less expensive than a visit to the ER,” Dux added. “It’s not cheap to staff an ER with physicians and nurses and therapists and lab techs 24 hours a day, seven days a week. People think, well, it’s the ER, it’s free.’ It’s not free. We’re going to bill you for it and we’re going to expect to get paid. Our doctors and nurses have to put food on their table as well.”

Calling a PCP first also has other benefits, according the Dux.

“The doctor may advise the patient to go to the ER,” Dux said. “He can call the ER and give them a heads up and instruction for the patients care when he arrives.”

“The PCP can also call the hospital and order the patient to be admitted directly into the hospital,” added McDaniel. “The patient can bypass the ER and all that expense.

Patients should bring an updated list of all medications when they come to the ER, Dux added, as well as a list of all allergies the patient may suffer. The patient should, if at all possible, never come to the ER alone.

“Bring someone with you who can see that you get home safely when you are released,” Dux said. “Someone who is in a position to act as your surrogate and can help the staff understand your condition and communicate for you. However, the patient should not be accompanied by a large group of people. There is a limited amount of space in the ER. There can be problems with issues of contagion and privacy if there are a lot of unnecessary people in the ER.”

PRMC is also implementing ways to help make wait times at the ER more bearable.

“We encourage people to make use of the hospital’s Wet Paris Clinic at 2224 Bonham St.,” Dux said. “We would like them to call for an appointment but if the show they will be seen. It’s also cheaper than a visit to the ER.”

“We are also making sure that our patients and their families are informed about the process,” he said. “If you know why you are waiting, it’s easier to wait, than if you are sitting there with no information.”

Dux noted that PRMC has formed an Emergency Department task force, consisting of Murchison, McDaniel and several staff physicians to examine process issues in the ED and look for ways to streamline the way patients are cared for. Hospital officials are also studying the use of rapid testing modalities, which can be done in the ER itself and make lab work faster.

“We want the people of this area to know that, according to the numbers, we are 20 percent better than most of the people out there,” Dux siad. “And we are working to get even better than that.”
I don't know, maybe their average is better than most...when you factor in the patients that arrive at 5AM....and in some hospitals, even 5AM is busy. Staffing needs to meet the needs of the customers, the patients...and when ER rooms are closed to patients because of staffing shortfalls, then one has to worry about management. And the West Paris Clinic isn't open on a lot of the peak times.

So pull up the intake statistics (that's what Meditech and computers are for, after all) and do some flexing. We'll get happier patients, and a happier staff, that's for sure.


Anonymous said...

PRMC is not the only facility that has to deal with this problem- there are plenty of hospitals all over the country whose ER is seen as a free clinic, and a magnet for the so-called "frequent fliers" who show up with the least little problem.

It would be nice of there were a couple of more "Doc-in-the-box" urgent care clinics for the little stuff, with lower fees than the hospital ERs and longer hours. Or even better, a separate urgent care facility on-site to deal with the little things, freeing the ER to deal with the MIs, fractures, strokes, MVAs, and so on.

And once again, the south campus fails us here. Cramped ER facilities, tiny waiting room...perhaps submariners migt be more at home there that the typical ER visitor.

A possible solution could be to expand the ER facilities on the north campus to make room for a "fast-track" facility.

So, on-site or off-site? This is one for you ER nurses and docs to chime in on. No complaints, but brainstorming for solutions.

(please, no comments about "Essent won't go for it"- most likely they won't, but imagine what would happen if they did?) This is just us- no department heads, administrators, etc. to stifle input. And hey, this is YOUR hospital- don't you want it better?

The floor is open, ladies and gentlemen..............

Anonymous said...

I like the new ER policy that if a patient falls or is having a seizure in the waiting room after being triage, to call 911 and get a ambulance to transport patient up the ramp into the ER. Latest incident was a patient fell. 911 called and EMS transported pt to ER. After the call EMS asked why they were called. EMS was told that they (PRMC ER staff of TNCC RN's and ER Doctors) were not trained in c-spine spinal immobilization. What a cop out! There have been other instances also. What about EMTALA? Guys and gals lets discuss.

Anonymous said...

Oh don't worry. North ER is going to open up as a Fast Track/Minor Care which means more patients and less staff to deal with them! Can't wait....
And speaking of EMTALA what this I hear about an EMTALA violation by PRMC?

One Small Voice said...

Why can't there be an off-hours clinic that takes the load off the ER? Kind of like what Salas's place does and what Minor Care is supposed to do.

Locate it close to the ER, so that if something is more serious, the transfer is easy. Make the computers talk to the ones at the hospital so you don't have to re-register.

Obama wants to use paid 'volunteers' for community work, so why not utilize this as a test-bed. That concept, along with a clinical setting for PJC health care students, and possibly a little county help might make it float. If Camp Maxy is still preping troops for overseas deployments, do they have medical folks that need to brush-up clinical skills?

Equipment from the closed clinics could be donated (tax-break). Possibly solicitations from corporations that need to better their images (GE, Siemens, and others) might generate some results.

It crosses a bunch of spheres of authority, but it could lessen the ER burden, provide an off-hours clinical site for non-traditional students, and it could be a way of keeping a handle on our own health care services in this city.