Anyone else's ED on fire?

[nikolaite]

The dude I admitted last night had degloved his penis in the past.

That’s called a “super-circ” 😆

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[nikolaite]

Basically one ED, if you showed a pt to a room, they’d fix themselves up. RN walked in on a former MP sewing up his wife’s scalp after wifey put her head through her car window with the help of a drunk driver. The RN griped that the MP ruined her sterile field and pointed out where he laid the glass bits he pulled out of his wife’s crown. MP said they’d been waiting an hour after setup in the room (after four hours in waiting room) and that his methods served fine in Iraq. Doc declined to do X-rays, noted no injury on physical. Haha. Fun times.

 

[emergentmd]

Violent Psych/drunk pts were my only dread working in the ER. I could handle anything else, but I didn't sign up to put myself in self harm. I would barely watch them from 10 feet away, put in orders until we got some disposition. I felt bad for the staff who actually had to get close to them, they surely didn't sign up for potential injuries making $30/hr.

When I left the hospital 5 yrs ago pre covid, winter was essentially 50-100%+ holds in a 30 bed ER. If we had only half the rooms holding pts, it was a good day. Many times we had pts held in all rooms and created beds throughout the hallway. I hear nothing is better and much worse with old stalwarts jumping ship.

Looking on the better side of EM has given me a better perspective on how truly bad the ED is dumped on.

 

[Dred Pirate]

Today we had 44 patients holding in a 39 bed ED. We actually were sending patients to the floor before their room was ready- they got to spend a couple of hours in the hallway of the med/surg floor.

 

[allantois]

Today we had 44 patients holding in a 39 bed ED. We actually were sending patients to the floor before their room was ready- they got to spend a couple of hours in the hallway of the med/surg floor.

What a way to further burn out nurses/other healthcare staff and make them quit

 

[emergentmd]

Today we had 44 patients holding in a 39 bed ED. We actually were sending patients to the floor before their room was ready- they got to spend a couple of hours in the hallway of the med/surg floor.

If this continues and becomes the norm in most big city ERs, the system will implode. Who wants to work in the hospital with constant abuse.

 

[allantois]

If this continues and becomes the norm in most big city ERs, the system will implode. Who wants to work in the hospital with constant abuse.

Especially with lawsuits against nurses recently, they really seem to pay attention to protecting their licenses and not working in these conditions

 

[Franzd'Epinay]

Jeez
Maybe another way to do this is just have the fed and state give everyone "$X" (adjusted for age) every year in a health care spending account and the govt pays for NOTHING ELSE.
Like we get rid of Medicare.

I know...it will never fly. However fraud issues and improprieties seem to be mitigated when people spend their own money the way they see fit. We don't see an explosion of administrators for all the lawyers, grocery store operators, and waste management companies.

I don't see how John Doe paying from his HSA will prevent HCA and the like from fraudulent practices. In fact, it will likely embolden them, as they will be happy to take on individual citizens as opposed to CMS and the federal government.

 

[thegenius]

I don't see how John Doe paying from his HSA will prevent HCA and the like from fraudulent practices. In fact, it will likely embolden them, as they will be happy to take on individual citizens as opposed to CMS and the federal government.

The hope is, whether it materalizes is another issue, is that insurance markets are more or less efficient way more than health care. The problem with health care is we will never let anyone die, someone will always end up paying the bills...so there is little incentive to really alter behavior.

I still would rather have people buy their own insurance than get it through employment. Efficiencies would probably take a generation but we would get there. I'm not some free market shill guy anyway...but this current model is terrible.

When people get sick they have to learn to stay home. Or see their PCP. They can't just come to the ER. No-one is incentivized to say that other than ER docs.

 

[VA Hopeful Dr]

The hope is, whether it materalizes is another issue, is that insurance markets are more or less efficient way more than health care. The problem with health care is we will never let anyone die, someone will always end up paying the bills...so there is little incentive to really alter behavior.

I still would rather have people buy their own insurance than get it through employment. Efficiencies would probably take a generation but we would get there. I'm not some free market shill guy anyway...but this current model is terrible.

When people get sick they have to learn to stay home. Or see their PCP. They can't just come to the ER. No-one is incentivized to say that other than ER docs.

The problem as is usually mentioned is EMTALA. $10 copay at the door for anyone not in active distress would fix this.

Or $50 copay for non emergent patients or they don't get the prescription you were going to send to their pharmacy. Flu positive? $50 before you send in Tamiflu. Broken wrist? $50 for that Norco prescription.

Or if a patient goes to the ED for something obviously stupid that turns out to be something stupid and not a legitimate problem, their insurance bills them $100.

 

[CoolDoc1729]

The problem as is usually mentioned is EMTALA. $10 copay at the door for anyone not in active distress would fix this.

Or $50 copay for non emergent patients or they don't get the prescription you were going to send to their pharmacy. Flu positive? $50 before you send in Tamiflu. Broken wrist? $50 for that Norco prescription.

Or if a patient goes to the ED for something obviously stupid that turns out to be something stupid and not a legitimate problem, their insurance bills them $100.

I definitely don’t mind the broken wrists , as realistically there’s no other way to get care (at least in my area) between like 1530 and 0900 the next day. The urgent cares seem to have oddly lost the ability to handle even very minor injuries since covid started.
If you could take away the drunks the police don’t feel like dealing with, the homeless people who didn’t get to the shelter before curfew, BP med refills, and those sent in for abnormal labs drawn 3-6 days ago … now we’re talking 🤣

 

[thegenius]

The problem as is usually mentioned is EMTALA. $10 copay at the door for anyone not in active distress would fix this.

Or $50 copay for non emergent patients or they don't get the prescription you were going to send to their pharmacy. Flu positive? $50 before you send in Tamiflu. Broken wrist? $50 for that Norco prescription.

Or if a patient goes to the ED for something obviously stupid that turns out to be something stupid and not a legitimate problem, their insurance bills them $100.

I think in theory this might work, but most of the people we see who are there for nonsense complaints don't carry Aetna, United, BCBS, and Cigna, for example. They are Medicaid, Medicare, or don't have any insurance. And trying to collect premiums from them would be very hard.

It's not hard though to say that all prescriptions cost $$$ to be dispensed (whether needed or not), but someone else would cry foul with that.

EMTALA is a problem but the root problem is the hospital makes money with every sniffle, itch, and minor ache that comes in. Until hospitals back us up...the problem will never end.

 

[allantois]

Speaking from the psych side the government doesn’t give a flying f about those patients; hence they end up boarding in your emergency rooms. They get 30 day supply of meds after discharge from psych facility then they have no money/resources for outpatient follow up/meds and the cycle repeats every month. If you think these patients are capable of purchasing insurance for themselves, you are delusional

 

[thegenius]

Speaking from the psych side the government doesn’t give a flying f about those patients; hence they end up boarding in your emergency rooms. They get 30 day supply of meds after discharge from psych facility then they have no money/resources for outpatient follow up/meds and the cycle repeats every month. If you think these patients are capable of purchasing insurance for themselves, you are delusional

No I don't, ergo...I'm not delusional.

 

[wareagle726]

I may be naive, I'm sure someone will follow this with a reply that I am, but I feel like significant med/mal reform would fix a large majority of it. We over-test so much because we can't/won't trust our teaching and exam because of the 1^nth chance of a life threat that we could face litigation for. For example I wonder what the actual rate of CTAs being positive for clinically significant PEs are after mildly elevated dimers. Just in that one scenario leads to so many extra hours in ED beds and then admissions for small PEs(I know they can go home, this is not a specific case argument, it happens a lot many places though).

 

[RustedFox]

I may be naive, I'm sure someone will follow this with a reply that I am, but I feel like significant med/mal reform would fix a large majority of it. We over-test so much because we can't/won't trust our teaching and exam because of the 1^nth chance of a life threat that we could face litigation for. For example I wonder what the actual rate of CTAs being positive for clinically significant PEs are after mildly elevated dimers. Just in that one scenario leads to so many extra hours in ED beds and then admissions for small PEs(I know they can go home, this is not a specific case argument, it happens a lot many places though).

Nobody is going to argue that med-mal reform is not useful.

 

[Siggy]

What a way to further burn out nurses/other healthcare staff and make them quit

As compared to the ED burning out?

 

[Siggy]

Especially with lawsuits against nurses recently, they really seem to pay attention to protecting their licenses and not working in these conditions

Strange, physicians get sued and no one seems to be worried about physicians leaving.

 

[sylvanthus]

Strange, physicians get sued and no one seems to be worried about physicians leaving.

Cuz were so in debt due to student loans they know they have us by the scrotum.

 

[GonnaBeADoc2222]

There's really no excuse to not be able to pay down 100k+/yr of medical school debt on an average EPs pay. Unless you refinanced to some very low rate and you have a mortgage at a higher rate, med school debt should be gone within a few years of residency graduation at the most.

The bigger problem I see is the ridiculously inflated lifestyle I see many of my colleagues living.

Cuz were so in debt due to student loans they know they have us by the scrotum.

 

[Siggy]

There's really no excuse to not be able to pay down 100k+/yr of medical school debt on an average EPs pay. Unless you refinanced to some very low rate and you have a mortgage at a higher rate, med school debt should be gone within a few years of residency graduation at the most.

The bigger problem I see is the ridiculously inflated lifestyle I see many of my colleagues living.

I had way too much Med school and grad school debt. I refinanced earlier this year at 2.25%. Now I just buy BSV (vanguard short term bond fund, 4% yield currently) with the extra money and will consider it paid off once the bond fund is higher than the loan amount.

 

[sylvanthus]

There's really no excuse to not be able to pay down 100k+/yr of medical school debt on an average EPs pay. Unless you refinanced to some very low rate and you have a mortgage at a higher rate, med school debt should be gone within a few years of residency graduation at the most.

The bigger problem I see is the ridiculously inflated lifestyle I see many of my colleagues living.

Not quite that simple though, also have to toss in a good 100k in retirement per year to play catchup for wasting a decade. Itll take 5 attending years at least to be in a semi ok spot, another 5 to be comfortable where you could rage quit and not worry terribly much. Way worse than the RN with minimal debt and a decade ahead in retirement.

 

[TooMuchResearch]

I may be naive, I'm sure someone will follow this with a reply that I am, but I feel like significant med/mal reform would fix a large majority of it. We over-test so much because we can't/won't trust our teaching and exam because of the 1^nth chance of a life threat that we could face litigation for. For example I wonder what the actual rate of CTAs being positive for clinically significant PEs are after mildly elevated dimers. Just in that one scenario leads to so many extra hours in ED beds and then admissions for small PEs(I know they can go home, this is not a specific case argument, it happens a lot many places though).

1. There is data on this. I believe it shows that testing didn't really decrease to the anticipated degree after major med mal reforms. Don't recall the paper or which state or states it was from.
2. In states with med mal reform, there have been more cases of criminal charges brought against Doctors when their wallets/insurance policies are no longer available for harvest.

 

[wareagle726]

1. There is data on this. I believe it shows that testing didn't really decrease to the anticipated degree after major med mal reforms. Don't recall the paper or which state or states it was from.
2. In states with med mal reform, there have been more cases of criminal charges brought against Doctors when their wallets/insurance policies are no longer available for harvest.

Well that sucks. So much for my hope. Back to the masses I go.

 

[Druggernaut]

Did you have to medically clear him again?

No, they brought him from his ED to my (unaffiliated, with no access to his records) ED.

Seriously happens several times a year. I once had a patient brought to me for clearance who had been discharged after an ICU and several week inpatient stay and taken directly from that hospital to jail, who then said he needed to be cleared at my hospital.

Meanwhile, I've been working with 1-4 actual ED beds to see new patients while the remaining 16-19 are filled with boarding inpatients.

 

[NYEMMED]

1. There is data on this. I believe it shows that testing didn't really decrease to the anticipated degree after major med mal reforms. Don't recall the paper or which state or states it was from.
2. In states with med mal reform, there have been more cases of criminal charges brought against Doctors when their wallets/insurance policies are no longer available for harvest.

Of course. The physicians are still trained and scarred into a certain practice pattern.

Also tort reform does not mean you won’t be sued, it just limits how much you are on the hook for. Most people still do CYA even in tort reform states because they don’t want to get sued period.


We need true tort reform, send all cases to a medical panel, true jury of your peers, etc…
That is the only path other than completely banning all lawsuits

 

[Boatswain2PA]

Good article on fentanyl vs meth addiction.

How Frighteningly Strong Meth Has Supercharged Homelessness

Journalist Sam Quinones on the radically transformed picture of drug addiction in America.

nymag.com

 

[Brigade4Radiant]

Strange, physicians get sued and no one seems to be worried about physicians leaving.

Nurses aren't shackled like doctors are they can do different fields like nursing home, admin, travel, sales a doctor has to do a new fellowship or residency

 

[emergentmd]

Med mad reform will do little to curb overutilization. Just because they can sue me for less doesn't mean they won't still sue. Pissed off pts have higher tendency to sue even if just to make your life miserable. I rather order that extra wasted xray/CT, labs than deal with an unhappy pt complaining to admin or sue me if something bad happens.

Take away any chance for lawsuit other than obvious gross negligent, pt satisfaction and most docs will start to show you how the ER should be utilized. 30 yr old with CP that is clearly anxiety does not need a full cardiac work up. Pt in an MVC with clearly no major injuries do not need xrays then CT. Every belly pain over 40 does not need a CT. Not most CP over 50 needs cardiac admission. Only then would the ER be utilized correctly with workups for sick pts and everyone else can follow up in the clinic once they set this up.


The ER is prob the most abused overutilized care area and this will likely never change.

 

[ScepticSkeksis]

Med mad reform will do little to curb overutilization. Just because they can sue me for less doesn't mean they won't still sue. Pissed off pts have higher tendency to sue even if just to make your life miserable. I rather order that extra wasted xray/CT, labs than deal with an unhappy pt complaining to admin or sue me if something bad happens.

Take away any chance for lawsuit other than obvious gross negligent, pt satisfaction and most docs will start to show you how the ER should be utilized. 30 yr old with CP that is clearly anxiety does not need a full cardiac work up. Pt in an MVC with clearly no major injuries do not need xrays then CT. Every belly pain over 40 does not need a CT. Not most CP over 50 needs cardiac admission. Only then would the ER be utilized correctly with workups for sick pts and everyone else can follow up in the clinic once they set this up.


The ER is prob the most abused overutilized care area and this will likely never change.

But you work at/own a freestanding right? You know that that part of the scam is encouraging more overutilization so you can charge people a facility fee for their hypochondrias.

 

[emergentmd]

But you work at/own a freestanding right? You know that that part of the scam is encouraging more overutilization so you can charge people a facility fee for their hypochondrias.

Sure. I guess you can say that for every Chick Fila or Mcdonalds b/c it encourages obesity. Or gas station that encourages Greenhouse. Or Plastic surgeon that encourages body Dysmorphia. I just call it business ownership and not working for the man.

 

[RustedFox]

Of course. The physicians are still trained and scarred into a certain practice pattern.

Also tort reform does not mean you won’t be sued, it just limits how much you are on the hook for. Most people still do CYA even in tort reform states because they don’t want to get sued period.


We need true tort reform, send all cases to a medical panel, true jury of your peers, etc…
That is the only path other than completely banning all lawsuits

I've actually said this in pre-trial council to the attorney representing me.

"Jury of my peers?! These people aren't my peers. At the risk of sounding terrifically narcissistic, it took me hours to explain to you, an educated man with a terminal degree, how this bit of medicine works. John the Plumber and Sally the elementary school teacher are not my peers; they had to cheat their way to a C+ in high school chemistry and then complained that the teacher 'grades too hard'. No, these are not my peers. They won't sit and wrap their heads around any of what I just said. They reject anything that they can't understand as 'wrong' by default. They can't be bothered to understand why (x) doesn't work, but is done anyway. No, man. I'm not above reproach, but I can't teach algebra to these folks, let alone medicine."

 

[kumatie]

I've actually said this in pre-trial council to the attorney representing me.

"Jury of my peers?! These people aren't my peers. At the risk of sounding terrifically narcissistic, it took me hours to explain to you, an educated man with a terminal degree, how this bit of medicine works. John the Plumber and Sally the elementary school teacher are not my peers; they had to cheat their way to a C+ in high school chemistry and then complained that the teacher 'grades too hard'. No, these are not my peers. They won't sit and wrap their heads around any of what I just said. They reject anything that they can't understand as 'wrong' by default. They can't be bothered to understand why (x) doesn't work, but is done anyway. No, man. I'm not above reproach, but I can't teach algebra to these folks, let alone medicine."

I remember in my malpractice case years ago, at jury selection the lawyers debating whether not one of the potential jurors could read. And this is who could be deciding your medical career and life. I agree with you, the general public does not have a knowledge base sufficient to judge physicians for medical malpractice. Hell, the general public doesn’t have the knowledge base to do anything for that matter. This country is filled with idiots and people who cannot think intelligently about anything.

 

[allantois]

I remember in my malpractice case years ago, at jury selection the lawyers debating whether not one of the potential jurors could read. And this is who could be deciding your medical career and life. I agree with you, the general public does not have a knowledge base sufficient to judge physicians for medical malpractice. Hell, the general public doesn’t have the knowledge base to do anything for that matter. This country is filled with idiots and people who cannot think intelligently about anything.

Half of my day is explaining to patients how their insurance works. The free market for health care/insurance does not work for a population that does not grasp basic health concepts

 

[RustedFox]

Half of my day is explaining to patients how their insurance works. The free market for health care/insurance does not work for a population that does not grasp basic health concepts

Bro. You've got some good things to say.
However, I sense that you're not an EP.
Are you FM-IM-Psych?

I ask collegially. No shade.

 

[allantois]

Bro. You've got some good things to say.
However, I sense that you're not an EP.
Are you FM-IM-Psych?

I ask collegially. No shade.

Yep psych. I don’t deal with uninsured unless they are well off lol

 

[bravotwozero]

In residency, we had a talk from a med mal defense attorney. I asked the same question about ‘jury of my peers’. He mentioned that legally/historically, this has not been interpreted in the manner we all think it should be.

A jury of your peers under the constitution equates to a jury of your fellow citizens/civilians, so that the court can’t stack the deck against you by filling the jury with law enforcement or military etc.

Don’t shoot the messenger.

 

[RustedFox]

Yep psych. I don’t deal with uninsured unless they are well off lol

Psych? Sweet.

So. Why do I hate my mom so much? Like, not HATE hate, but kinda yeah.

 

[BoardingDoc]

Yep psych. I don’t deal with uninsured unless they are well off lol

God that sounds nice.

 

[miacomet]

If this continues and becomes the norm in most big city ERs, the system will implode. Who wants to work in the hospital with constant abuse.

Yep, there will be no nursing. Residencies keep churning out docs, but why would a nurse stay?

 

[Dr Mantis Toboggan]

Yep, there will be no nursing. Residencies keep churning out docs, but why would a nurse stay?

Maybe the norm will be like these NYC hospitals where the residents draw all the blood, push the patients to X-ray etc

 

[RustedFox]

I've been off for a few days. Got an email from the CMO with the census and such. We have a 22-bed ED. We have 30 ED holds.
MyBuddyIM just told me that he accepted a third-degree heart block from the waiting room and Dr.Pissybitch whiffed on the EKG.

 

[alpinism]

Hell its certainly been interesting to hear about the system collapsing for those of us in NYC emergency departments.

I remember one night FDNY bought in 3 GSWs found dead because the scene was unsafe or whatever nonsense reason.

The medics just dumped them in the last 3 beds and of course soon afterwards we received 3 MVAs who needed the beds.

We didn't have transporters for the morgue so I put all of the bodies in a pile on the floor in the back of the resus room.

 

[CajunMedic]

We've reached a new level of dumpster fire. Christmas Eve started a 4 night stretch for me.

Night 1: Total of 5 Nurses. 1 charge/triage. 4 Nurses total for 26 beds, 20 of them are boarders. Bed 3 is a Post-op, Open Laparotomy that was brought back to the ED to board after the PACU. Actively trying to die. 2 Mental Health holds-one of them is full of crap trying to avoid Jr. Jail. Other has COVID and waiting 5 days for placement. 2 other ICU holds.

Night 2: Same nurse census. Now up to 5 ICU holds, and same amount of boarders. Bed 3 still trying to die. Same 2 mental health holds waiting. Administration graciously allows up to be on EMS diversion. Toss one of the mental health boarders into a hall bed to work a cardiac arrest.

Night 3: Still only 5 Nurses. 8 ICU holds. Have 3 beds to work out of. Charge/Triage is taking hall beds. Roll a hall bedded septic shock into the Triage box in the waiting room to have central line placed and back to the hall. ICU Hold pending transfer back to their liver transplant center is in Neuroleptic Malignant Syndrome with a temp of 106.3. Jenny Mcjennyson FNP at transplant center talks smack to hospitalist because we don't have Ofirmev here. Toxicology recommends giving Dantrolene and Bromocriptine. Winds up Tubed, lined, A-Lined, Bair-Huggered, Ice-packed, All the things and eventually out by critical care ground due to weather. Night hospitalist on verge of breakdown. Still on EMS diversion. Oh, and a stroke in the waiting room.

Night 4: Finally have enough nurses to open up hall beds again. Who knows how many ICU boarders anymore? One being terminally extubated as I walk in, Bed 3 is most stable of all of them. Working strictly out of triage and hall beds, everything else is boarders. Promptly toss our least favorite malingerer out of triage after MSE. Thanking God I have 2 strong senior residents with me on the overnight to help me ringmaster the ****show. Hospitalist goes home and opens a bottle of Glenlivet 18, I crack the rum when I finally get back home.

 

[NYEMMED]

We've reached a new level of dumpster fire. Christmas Eve started a 4 night stretch for me.

Night 1: Total of 5 Nurses. 1 charge/triage. 4 Nurses total for 26 beds, 20 of them are boarders. Bed 3 is a Post-op, Open Laparotomy that was brought back to the ED to board after the PACU. Actively trying to die. 2 Mental Health holds-one of them is full of crap trying to avoid Jr. Jail. Other has COVID and waiting 5 days for placement. 2 other ICU holds.

Night 2: Same nurse census. Now up to 5 ICU holds, and same amount of boarders. Bed 3 still trying to die. Same 2 mental health holds waiting. Administration graciously allows up to be on EMS diversion. Toss one of the mental health boarders into a hall bed to work a cardiac arrest.

Night 3: Still only 5 Nurses. 8 ICU holds. Have 3 beds to work out of. Charge/Triage is taking hall beds. Roll a hall bedded septic shock into the Triage box in the waiting room to have central line placed and back to the hall. ICU Hold pending transfer back to their liver transplant center is in Neuroleptic Malignant Syndrome with a temp of 106.3. Jenny Mcjennyson FNP at transplant center talks smack to hospitalist because we don't have Ofirmev here. Toxicology recommends giving Dantrolene and Bromocriptine. Winds up Tubed, lined, A-Lined, Bair-Huggered, Ice-packed, All the things and eventually out by critical care ground due to weather. Night hospitalist on verge of breakdown. Still on EMS diversion. Oh, and a stroke in the waiting room.

Night 4: Finally have enough nurses to open up hall beds again. Who knows how many ICU boarders anymore? One being terminally extubated as I walk in, Bed 3 is most stable of all of them. Working strictly out of triage and hall beds, everything else is boarders. Promptly toss our least favorite malingerer out of triage after MSE. Thanking God I have 2 strong senior residents with me on the overnight to help me ringmaster the ****show. Hospitalist goes home and opens a bottle of Glenlivet 18, I crack the rum when I finally get back home.

$&*%

 

[EctopicFetus]

We've reached a new level of dumpster fire. Christmas Eve started a 4 night stretch for me.

Night 1: Total of 5 Nurses. 1 charge/triage. 4 Nurses total for 26 beds, 20 of them are boarders. Bed 3 is a Post-op, Open Laparotomy that was brought back to the ED to board after the PACU. Actively trying to die. 2 Mental Health holds-one of them is full of crap trying to avoid Jr. Jail. Other has COVID and waiting 5 days for placement. 2 other ICU holds.

Night 2: Same nurse census. Now up to 5 ICU holds, and same amount of boarders. Bed 3 still trying to die. Same 2 mental health holds waiting. Administration graciously allows up to be on EMS diversion. Toss one of the mental health boarders into a hall bed to work a cardiac arrest.

Night 3: Still only 5 Nurses. 8 ICU holds. Have 3 beds to work out of. Charge/Triage is taking hall beds. Roll a hall bedded septic shock into the Triage box in the waiting room to have central line placed and back to the hall. ICU Hold pending transfer back to their liver transplant center is in Neuroleptic Malignant Syndrome with a temp of 106.3. Jenny Mcjennyson FNP at transplant center talks smack to hospitalist because we don't have Ofirmev here. Toxicology recommends giving Dantrolene and Bromocriptine. Winds up Tubed, lined, A-Lined, Bair-Huggered, Ice-packed, All the things and eventually out by critical care ground due to weather. Night hospitalist on verge of breakdown. Still on EMS diversion. Oh, and a stroke in the waiting room.

Night 4: Finally have enough nurses to open up hall beds again. Who knows how many ICU boarders anymore? One being terminally extubated as I walk in, Bed 3 is most stable of all of them. Working strictly out of triage and hall beds, everything else is boarders. Promptly toss our least favorite malingerer out of triage after MSE. Thanking God I have 2 strong senior residents with me on the overnight to help me ringmaster the ****show. Hospitalist goes home and opens a bottle of Glenlivet 18, I crack the rum when I finally get back home.

My latest move is to call the admin on duty. I skip the house sup cause they are basically useless idiots. The admin on duty is similar but I make sure they know. They know me from my group admin duties. It’s probably time to follow up with an email so I can keep my own record of this when a lawsuit hits. I would advise the same for you guys. My call goes like this “hey it’s EF in the ED. Wanted to make sure you knew the ED is a disaster. We have 40 in the WR and 45 holds. The nurses are overwhelmed. I don’t know if you can do anything but if you could I would appreciate it and wanted to be certain you were aware of the conditions in the ED. They don’t seem very safe. “
i also document any delay in my chart on any patient who leaves due to wait, Ama or has a bad outcome.
“patient waited for 6 hours before seen by me. I didn’t get their lactate of 9 until 10 hours into their Ed visit due to prolonged holds and lab / nursing delays”.
idgaf.
i don’t do this part often but on occasion. I also document how I did everything I could. Remember the hospitals pockets are much much deeper than my own.

 

[NYEMMED]

My facilities have a strict no diversion policy.
It doesn’t matter, they will not allow diversion (they have a verbal deal with the competing hospital system that neither will go on diversion)

So the response we get is:
“All the beds are open, nurses upstairs each have extra patients, what would you like to be done?”

 

[NITRAS]

We've reached a new level of dumpster fire. Christmas Eve started a 4 night stretch for me.

Night 1: Total of 5 Nurses. 1 charge/triage. 4 Nurses total for 26 beds, 20 of them are boarders. Bed 3 is a Post-op, Open Laparotomy that was brought back to the ED to board after the PACU. Actively trying to die. 2 Mental Health holds-one of them is full of crap trying to avoid Jr. Jail. Other has COVID and waiting 5 days for placement. 2 other ICU holds.

Night 2: Same nurse census. Now up to 5 ICU holds, and same amount of boarders. Bed 3 still trying to die. Same 2 mental health holds waiting. Administration graciously allows up to be on EMS diversion. Toss one of the mental health boarders into a hall bed to work a cardiac arrest.

Night 3: Still only 5 Nurses. 8 ICU holds. Have 3 beds to work out of. Charge/Triage is taking hall beds. Roll a hall bedded septic shock into the Triage box in the waiting room to have central line placed and back to the hall. ICU Hold pending transfer back to their liver transplant center is in Neuroleptic Malignant Syndrome with a temp of 106.3. Jenny Mcjennyson FNP at transplant center talks smack to hospitalist because we don't have Ofirmev here. Toxicology recommends giving Dantrolene and Bromocriptine. Winds up Tubed, lined, A-Lined, Bair-Huggered, Ice-packed, All the things and eventually out by critical care ground due to weather. Night hospitalist on verge of breakdown. Still on EMS diversion. Oh, and a stroke in the waiting room.

Night 4: Finally have enough nurses to open up hall beds again. Who knows how many ICU boarders anymore? One being terminally extubated as I walk in, Bed 3 is most stable of all of them. Working strictly out of triage and hall beds, everything else is boarders. Promptly toss our least favorite malingerer out of triage after MSE. Thanking God I have 2 strong senior residents with me on the overnight to help me ringmaster the ****show. Hospitalist goes home and opens a bottle of Glenlivet 18, I crack the rum when I finally get back home.

Damn. That sucks.

 

[GonnaBeADoc2222]

We've reached a new level of dumpster fire. Christmas Eve started a 4 night stretch for me.

Night 1: Total of 5 Nurses. 1 charge/triage. 4 Nurses total for 26 beds, 20 of them are boarders. Bed 3 is a Post-op, Open Laparotomy that was brought back to the ED to board after the PACU. Actively trying to die. 2 Mental Health holds-one of them is full of crap trying to avoid Jr. Jail. Other has COVID and waiting 5 days for placement. 2 other ICU holds.

Night 2: Same nurse census. Now up to 5 ICU holds, and same amount of boarders. Bed 3 still trying to die. Same 2 mental health holds waiting. Administration graciously allows up to be on EMS diversion. Toss one of the mental health boarders into a hall bed to work a cardiac arrest.

Night 3: Still only 5 Nurses. 8 ICU holds. Have 3 beds to work out of. Charge/Triage is taking hall beds. Roll a hall bedded septic shock into the Triage box in the waiting room to have central line placed and back to the hall. ICU Hold pending transfer back to their liver transplant center is in Neuroleptic Malignant Syndrome with a temp of 106.3. Jenny Mcjennyson FNP at transplant center talks smack to hospitalist because we don't have Ofirmev here. Toxicology recommends giving Dantrolene and Bromocriptine. Winds up Tubed, lined, A-Lined, Bair-Huggered, Ice-packed, All the things and eventually out by critical care ground due to weather. Night hospitalist on verge of breakdown. Still on EMS diversion. Oh, and a stroke in the waiting room.

Night 4: Finally have enough nurses to open up hall beds again. Who knows how many ICU boarders anymore? One being terminally extubated as I walk in, Bed 3 is most stable of all of them. Working strictly out of triage and hall beds, everything else is boarders. Promptly toss our least favorite malingerer out of triage after MSE. Thanking God I have 2 strong senior residents with me on the overnight to help me ringmaster the ****show. Hospitalist goes home and opens a bottle of Glenlivet 18, I crack the rum when I finally get back home.

How is transferring a post op patient to the ED from the PACU not an EMTALA violation?

 

[Apollyon]

How is transferring a post op patient to the ED from the PACU not an EMTALA violation?

Because it's in the same hospital? And you might be thinking of COBRA.