Article: Death after two-hour ER wait ruled homicide

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http://www.cnn.com/2006/US/09/15/er.homicide.ap/index.html

...You knew this article would find its way here...

Death after two-hour ER wait ruled homicide
POSTED: 1:01 p.m. EDT, September 15, 2006
WAUKEGAN, Illinois (AP) -- A coroner's jury has declared the death of a heart attack victim who spent almost two hours in a hospital waiting room to be a homicide.

Beatrice Vance, 49, died of a heart attack, but the jury at a coroner's inquest ruled Thursday that her death also was "a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation."

A spokeswoman for Vista Medical Center in Waukegan, where Vance died July 29, declined to comment on the ruling.

Vance had waited almost two hours for a doctor to see her after complaining of classic heart attack symptoms -- nausea, shortness of breath and chest pains, Deputy Coroner Robert Barrett testified.

She was seen by a triage nurse about 15 minutes after she arrived, and the nurse classified her condition as "semi-emergent," Barrett said. He said Vance's daughter twice asked nurses after that when her mother would see a doctor.

When her name was finally called, a nurse found Vance slumped unconscious in a waiting room chair without a pulse. Barrett said. She was pronounced dead shortly afterward.

Barrett said he subpoenaed records after finding discrepancies in the hospital's version of events.

It wasn't immediately clear if the ruling would lead to criminal charges. Dan Shanes, a chief of felony review for the state attorney's office, said his division needed to review the case.

Vista Medical Center spokeswoman Cheryl Maynen said the hospital, just north of Chicago, cooperated with the coroner's investigation and had also investigated the incident. She declined to comment on the homicide ruling.

 

[Miami_med]

Yeah, charge the doctors with homicide. This will definitely ease the crowding in ERs, not to mention that it definitely deserves charges similar to stabbing someone 🙄 .

How can this be ruled a homicide!? It may be negligent, but nobody killed the man; his heart killed him.

 

[SolidGold]

Shouldn't the blame be on the incompetent triage nurses there?

 

[Bobblehead]

In the places I've worked at, if you say the magic words "chest pain" you get more attention than was given, at least according to what was in that press release. Some places you get put into a room right away with a couple of nurses swarming over you for vitals, EKG, nitro, etc. Other places you at least get an EKG, asked a couple of important questions by the triage nurse (Have you had a heart attack? Has anyone in your family had a heart attack? Do you have high blood pressure/diabetes?) and a physician reviews the EKG before you get triaged to a lower priority.

I do wonder if they had gotten an EKG whether it would have showed gross ST changes on arrival to the ER.

Also note in the CNN article they didn't say they had charged a DOCTOR with homicide. They had ruled it a homicide but they had not placed the blame, at least not with what we know so far.

Here's another article:
http://www.chicagotribune.com/news/local/chi-060914inquest,1,2118960.story?coll=chi-news-hed

she also died "as a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation,"

This is going to burn them.

At the hearing, in the county administration building in downtown Waukegan, Deputy Coroner Robert Barrett testified that he subpoenaed the records after noticing discrepancies in the hospital's version of events after Vance arrived at the emergency room at 10:15 p.m. July 28.

And if someone altered the records after the event that's really going to burn them. But again, not enough information released to make a judgment of any kind so far.

 

[Apollyon]

How can this be ruled a homicide!? It may be negligent, but nobody killed the man; his heart killed him.

In a general sense, it's the idea that one person in distress acceded to another that could possibly render assistance that was not rendered. "Homicide" is VERY general - this is not saying "manslaughter" or "murder". It is akin to "involuntary manslaughter" or "negligent homicide" in that it is a crime of omission. In THAT sense, the person was "killed" - although it is not certain the person would have survived, the condition that brought them to seek attention was what killed them, and there is ample evidence that accepted interventions have benefited others in the same state.

The person most on the hook (and yet, barely for that) is the triage nurse. This is how it will shake out: the nurse (regardless of reality) will be depicted as not having the medical knowledge, and so, will be held to a lower standard, and not culpable. Any physician (who, "due to a higher level of education") will not have had knowledge of the patient, since the patient wasn't in their purview, and therefore not culpable.

Reality, as you notice, does not come into play here. No one will be charged.

 

[EctopicFetus]

Agreed. At places I have been the words chest pain get you an ekg done in triage and the ekg brought to the ED doc. Not perfect for sure but it is a start.

 

[imagin916]

Shouldn't the blame be on the incompetent triage nurses there?

This is an unfair statement. Unless you have done triage, you cannot point a finger. Anyone who has not done triage has no right to place any blame. You have a lot of people who are sick, all signing in, yelling in your window when they will be seen while you are with another patient. You are alone in that booth with sometimes irate patients/families. If you havent had the triage experience, I dare you to spend one day in that booth with the triage nurse and then come back and make this statement. When you have 10 people sign in at the same time all with c/o chest pain, you have to prioritize who is at most risk for becoming unstable. This patient was a 49 y/o woman. We do not know what her hx was, how she appeared, what her v/s were, etc. It says in the article that she was triaged within 15 minutes of arrival. After that point the doctor is responsible to see the patient. If this woman is well appearing and you as the doctor have 10 other chest pain patients who came before her with significant hx or bad looking, you will see them first. That is exactly what you should do, and what anyone would have done. This is an unfortunate incident, but the truth is, I dont think anyone is at fault here. If she was in the waiting room for 2 hours it must have been pretty busy there if no doctor picked up a chest pain. I would LOVE to know what they say was "gross negligence" leading up to this event. It makes me wonder why they didnt release any details on this 🙄

 

[basementbeastie]

It says in the article that she was triaged within 15 minutes of arrival. After that point the doctor is responsible to see the patient. :

usually the patient still has to be brought back...hard to see patients in the waiting room....

 

[leviathan]

The standard I've seen in the emerg where I volunteer is we get a 12 lead ECG and blood work usually within 45-60 mins for those with vague complaints of chest pain. Those coming in pale as a ghost and dripping with sweat are in the trauma room immediately. People in between get that initial workup usually within 10-30 mins.

 

[positiveaob]

This is B.S. It's absolutely not homicide. You can say it was negligent or malpractice maybe, I wasnt there to know what they really did or what the situation was like, but them ruling this a homicide is pretty scary to me. Can you imagine a crazy night in the ER and not only worrying that one of those charts in the rack might be the patient that causes you to lose your license, but also gets you sent to Ryker's Island for hard time.

I am curious if the patient had an EKG done and if so did it show any ischemic changes. Because if the EKG was done within 10 minutes of the patient arriving and the physician in charge saw it and didnt see anything concerning, it wouldnt be unheard of at all for the patient to be triaged category B (which I am assuming what semi-emergent means) and have to wait for hours before further evaluation. Probably not the best of care or what I would want for my loved one, but sort of the reality of a busy emergency room.

 

[leviathan]

This is B.S. It's absolutely not homicide. You can say it was negligent or malpractice maybe, I wasnt there to know what they really did or what the situation was like, but them ruling this a homicide is pretty scary to me. Can you imagine a crazy night in the ER and not only worrying that one of those charts in the rack might be the patient that causes you to lose your license, but also gets you sent to Ryker's Island for hard time.

I am curious if the patient had an EKG done and if so did it show any ischemic changes. Because if the EKG was done within 10 minutes of the patient arriving and the physician in charge saw it and didnt see anything concerning, it wouldnt be unheard of at all for the patient to be triaged category B (which I am assuming what semi-emergent means) and have to wait for hours before further evaluation. Probably not the best of care or what I would want for my loved one, but sort of the reality of a busy emergency room.

Sounds like she was just turfed to a chair for 2 hours. Of course, we know how much news agencies love to omit important facts, so who knows.

 

[positiveaob]

I actually hadnt see the second article, where it says she hadnt had an EKG done within 10 minutes. I dont know that all ERs are able to do this for all patients with chest pain, but that is the standard of care. As busy and chaotic as we are at my ER, and dysfunctional at times, we are able to meet this requirement. We had a patient die a while back in the waiting room (wasnt similar to this), and one of the corrective actions was to have a EKG tech assigned to the triage area for this specific purpose. Whether or not this is the best use of resources, who knows. But we are as busy and chaotic as any ER and all our patients with chest pain get an EKG within 10 minutes that is immediately shown to a physician.

But after the EKG, it is totally a judgement call based on alot of clinical variables whether or not they get the rest of the things the article mentions, such as cardiac monitor, "thinners and other medications," etc. I mean who knows what this lady looked like and what her risk factors were. Being a 49 yo female alone certainly isnt a major red flag.

 

[imagin916]

usually the patient still has to be brought back...hard to see patients in the waiting room....

I agree with you, however we dont know how this ER is run. The ER I work in now, we dont use the waiting room for adults no matter what they are there for. They are triaged and placed in a stretcher or a chair in one of two areas. It is not uncommon to have no stretchers available, or even if they are in a stretcher, to wait 2 or more hours to be seen anyway. Another ER that I worked in, they were triaged, sat in waiting room until there was a bed available unless they looked bad. I would be the first to point the finger at the triage nurse IF the patient appeared in distress, had a medical history that would put this patient at risk for MI, etc. However, we have all seen patients that look better than you and I sit there looking pretty and then the next second drop like that.

Its sad that some overworked MD/RN will get hung for this in court. I dont think anyone will be convicted of murder, but you know this family will sue for damages and win. Maybe this will be a wakeup call for those in a position of power to do something about ER overcrowding so patients with emergent complaints can be seen first instead of wasting time with BS ones.

 

[basementbeastie]

I agree with you, however we dont know how this ER is run. The ER I work in now, we dont use the waiting room for adults no matter what they are there for. They are triaged and placed in a stretcher or a chair in one of two areas. It is not uncommon to have no stretchers available, or even if they are in a stretcher, to wait 2 or more hours to be seen anyway.

i guess that counts as being 'brought back'....we use chairs, halls, etc, still it would be absolute chaos to not have the apparently stable lower acuity patients wait in the waiting area...maybe a function resources, volume, patient's personalities (or maybe axis II issues)...

 

[turtle md]

This needs to be turned back to the public so that they are aware of the overcrowding, etc. and to educate them on the proper use of the emergency department. Primary Care docs need to be take charge as well, since they should help to educate the populace about the conditions of one's illness which should prompt an ED visit and which can wait until an office visit squeezed in the next day. And don't forget the general state of affairs with regards to availability of health care for the indigent, etc. And edu-ma-cation of certain people that faking abdominal pain just to get a pregnancy test is killing people.

New Zealand made a public campaign to try to educate their citizens about the proper use of the ED, i.e., don't go for a cold! Does anyone else see this a possibility? I don't, but I am a pessimist.

😀

 

[basementbeastie]

sure...."i'm cold...can i have a pregnancy test?"😡

 

[FoughtFyr]

Guys, everyone is wigging out for no reason. This finding is from a coroner's jury. It speaks only to the cause of death. They basically decided that something untoward occured that lent substanially to the patient's demise. Given the few "facts" as reported, that seems true. It does not mean anyone will be charged. Here is another example, if a SWAT team member shoots a gun totin' bad guy who is threatening to shoot a pregnant woman in the head, and that shooting occurs after a "green light" by the on-scene commander, the perp's death is still a "homocide". Will the sniper be charged? Heck no. Here, the coroner's jury found that it is a significant alteration from the standard of care to leave a person with serious signs and symptoms of a heart attack waiting in the waiting room. Where's the argument? It doesn't mean anyone will be charged, but they could be. Let's save the outrage until they are.

- H

 

[Apollyon]

Here, the coroner's jury found that it is a significant alteration from the standard of care to leave a person with serious signs and symptoms of a heart attack waiting in the waiting room. Where's the argument? It doesn't mean anyone will be charged, but they could be. Let's save the outrage until they are.

Didn't I say that above? You're right, of course.

 

[MirrorTodd]

I would imagine triage is a difficult assignment. I'm sure some hospitals have a better method than others. Without actually talking with the patient and getting some physical information from them, how can you effectively treat them? I took my brother to a hospital a couple of weeks ago, because of severe abdominal pain and they had him write his chief complaint on a piece of paper. No vitals taken, no other information gotten out of him. Is this 'standard' for an ER. I cannot imagine trying to make desicions about someoe's health based on a couple of words. Nor can I imagine a civilian knowing the best words to choose to properly describe what they're feeling. Anyway, he didn't want to wait, so I ended up taken him to a different hospital where he got seen right away and by right away I mean like 5 minutes. Was this the right thing to do? I have no idea.

 

[deleted109597]

They are triaged and placed in a stretcher or a chair in one of two areas. It is not uncommon to have no stretchers available, or even if they are in a stretcher, to wait 2 or more hours to be seen anyway.

I laugh at this. Here at this busy county center, it is not uncommon for people to wait 8 hours to be seen. Of course, there are different levels of acuity. But I would guess that the volume of the ED you are at probably doesn't crest 100K.

There just isn't enough space to hold everybody that comes in. The triage nurse should have been able to keep tabs on the people in the waiting room, and if they weren't, then there needs to be more people up front watching the room. But it is absolutely not the doctor's fault. There is no way that people can expect the MD (DO, whatever) to come out front when there are people in the back that need to be seen.

A bigger problem than the wrong people coming in is the misuse of the ED as a holding are for admitted patients.

 

[imagin916]

I laugh at this. Here at this busy county center, it is not uncommon for people to wait 8 hours to be seen. Of course, there are different levels of acuity. But I would guess that the volume of the ED you are at probably doesn't crest 100K.

There just isn't enough space to hold everybody that comes in. The triage nurse should have been able to keep tabs on the people in the waiting room, and if they weren't, then there needs to be more people up front watching the room. But it is absolutely not the doctor's fault. There is no way that people can expect the MD (DO, whatever) to come out front when there are people in the back that need to be seen.

A bigger problem than the wrong people coming in is the misuse of the ED as a holding are for admitted patients.

I dont think it was the doctor's fault at all, and if I came across that way I didnt mean to. However, I dont think its possible for the triage nurse or any one person to be able to monitor all the patients in the waiting room at one time. If there are 30 people outside in the waiting room, no one in thier right mind can say that one nurse or doctor could safely monitor these people. My ED does see 100k a year, and we only use the waiting room for pediatrics, all adult patients either go to the acute area or fast track when it is open. It would be better if there were nurses to watch the patients in the waiting room, but that is not possible. There are barely enough nurses to care for the patients already in the ED, god knows there is not one to spare for one to sit in the waiting room and watch people out there. You hit the nail on the head with the fact that we are holding too many admitted patients with no beds. We commonly hold at least 20 at any given time, most of the time its between 30 and 40. This is misuse of the ER, and it takes away from physical space and nursing availability to ER patients. Again, I dont feel that anyone can place blame anywhere now without knowing more about what happened. It very well could be the triage nurse's fault and have nothing to do with the doctor, the doctor could have misread the EKG if one was done, or the patient could have omitted vital info. There are many possibilities to what the situation actually was and I dont think its fair to blame ANYONE yet. No matter what the case, I dont think there is any way that this is homicide under any circumstances. Like we all have said, I hope that this does send a message to people and the powers that be to do something about ER overcrowding.

 

[SolidGold]

This is an unfair statement. Unless you have done triage, you cannot point a finger. Anyone who has not done triage has no right to place any blame. You have a lot of people who are sick, all signing in, yelling in your window when they will be seen while you are with another patient. You are alone in that booth with sometimes irate patients/families. If you havent had the triage experience, I dare you to spend one day in that booth with the triage nurse and then come back and make this statement. When you have 10 people sign in at the same time all with c/o chest pain, you have to prioritize who is at most risk for becoming unstable. This patient was a 49 y/o woman. We do not know what her hx was, how she appeared, what her v/s were, etc. It says in the article that she was triaged within 15 minutes of arrival. After that point the doctor is responsible to see the patient. If this woman is well appearing and you as the doctor have 10 other chest pain patients who came before her with significant hx or bad looking, you will see them first. That is exactly what you should do, and what anyone would have done. This is an unfortunate incident, but the truth is, I dont think anyone is at fault here. If she was in the waiting room for 2 hours it must have been pretty busy there if no doctor picked up a chest pain. I would LOVE to know what they say was "gross negligence" leading up to this event. It makes me wonder why they didnt release any details on this 🙄

I didn't mean to bash all triages in the world, just that one in that particular case. I have done triage before, and the words "chest pain" would have gotten me more excited because woman even at age 49 tend to have atypical presentations of chest pain during an MI. All the places I've rotated in, chest pain is taken seriously even if they aren't going to be unstable immediately. I've seen 100s of cases of chest pain turn out to be nothing, but seen dozens of cases where we all thought would be benign, turn out to be a full blown STEMI. My point is, this particular triage blew it, especially if there was enough specific information for a judge to rule it gross negligence. We don't know what those specifics are, but they were probably pretty obvious to be labeled as "gross."

 

[AR1776]

I was a triage tech in a small ER which meant I did the triage and made the decision which catagory the patient fell into. Even if she didn't present as emergent for whatever reason, we were still required to check on our patients in the waiting room. I can't remember how often but it was at least every 15-20 mins to make sure nothing had changed with their symptoms or vitals. That meant I took their pulse and blood pressure again.

So, if I actually checked on my non-emergent patients in the waiting room I would realize at some point during this 2 hours that this lady with an MI slumped in a chair was critical - hopefully before she didn't have a pulse.

So, no I don't understand how this flew under the radar. The triage tech must have neglected her. I definately understand how this can happen in a busy ER, but I guess I just don't think it's acceptable.

 

[imagin916]

I was a triage tech in a small ER which meant I did the triage and made the decision which catagory the patient fell into. Even if she didn't present as emergent for whatever reason, we were still required to check on our patients in the waiting room. I can't remember how often but it was at least every 15-20 mins to make sure nothing had changed with their symptoms or vitals. That meant I took their pulse and blood pressure again.

So, if I actually checked on my non-emergent patients in the waiting room I would realize at some point during this 2 hours that this lady with an MI slumped in a chair was critical - hopefully before she didn't have a pulse.

So, no I don't understand how this flew under the radar. The triage tech must have neglected her. I definately understand how this can happen in a busy ER, but I guess I just don't think it's acceptable.

If this were the case and a "triage tech" were available in this ER plus the triage nurse really monitoring the patients then I understand why you feel this is unacceptable. Most ER's do not have such a thing so unfortunatly, people sitting in the waiting room will get a quick once over at best by the triage nurse if he/she is unable to come out in the waiting room to reassess the patients. I think this would be a good idea for ER's to have a tech who would be able to do this, but I still wonder what the liability would be having a "tech" reassess patients. The law states that an RN, PA or MD must be the only person to triage the patients, and it is out of the scope of practice for any tech to assess a patient. Sure they can do v/s, but they are not trained to assess anyone. Patients can have stable v/s but still be in danger of becoming unstable as we know, and writing in the chart "the tech told me that the patient looked fine" while we are sitting in court is not going to cut it. If I remember correctly in the article, she was not found at a later time slumped over in the chair, she was sitting with a family member and suddenly slumped over and became pulseless. Its not like they left her sitting out there for hours like that.

 

[dchristismi]

A bigger problem than the wrong people coming in is the misuse of the ED as a holding are for admitted patients.

AMEN!

 

[SoCuteMD]

I was a triage tech in a small ER which meant I did the triage and made the decision which catagory the patient fell into. Even if she didn't present as emergent for whatever reason, we were still required to check on our patients in the waiting room. I can't remember how often but it was at least every 15-20 mins to make sure nothing had changed with their symptoms or vitals. That meant I took their pulse and blood pressure again.

So, if I actually checked on my non-emergent patients in the waiting room I would realize at some point during this 2 hours that this lady with an MI slumped in a chair was critical - hopefully before she didn't have a pulse.

So, no I don't understand how this flew under the radar. The triage tech must have neglected her. I definately understand how this can happen in a busy ER, but I guess I just don't think it's acceptable.

I have to say that I am envious of any ED that has the resources (and the ingenuity) to create such a system. Having spent time in quiet suburban EDs and in a busy inner-city ED, I've never seen the system in place. At the ED I worked at this summer I could see this happening to someone (actually I think a similar thing did one time, with less dramatic resolution). Any patient who says those magic words "Chest pain" ("shortness of breath" also works) does not sit in the waiting room, though. They are brought back and the chief resident is alerted to their presence in the ED as well as their condition. Often the nurses are in the room getting an EKG, putting them on oxygen, and drawing blood so quickly that they actually aren't in the system as a registered patient yet!!! It's quite a miracle in an ED where the door-to-discharge times are obscene.

Suffice it to say, the system is BROKEN. We as current ED docs, future ED docs, nurses, WHATEVER we are, need to be our OWN advocates and say, "Gosh, we REALLY would have liked the opportunity to save this woman's life. Unfortunately, the system failed her AND it failed US. Someone help us fix it."

 

[bulgethetwine]

🙄

I was a triage tech in a small ER which meant I did the triage and made the decision which catagory the patient fell into. Even if she didn't present as emergent for whatever reason, we were still required to check on our patients in the waiting room. I can't remember how often but it was at least every 15-20 mins to make sure nothing had changed with their symptoms or vitals. That meant I took their pulse and blood pressure again.

So, if I actually checked on my non-emergent patients in the waiting room I would realize at some point during this 2 hours that this lady with an MI slumped in a chair was critical - hopefully before she didn't have a pulse.

So, no I don't understand how this flew under the radar. The triage tech must have neglected her. I definately understand how this can happen in a busy ER, but I guess I just don't think it's acceptable.

Weird that MS1 and nurses do triage and yet we emphasize all the time that what we want our PGY-1s to learn during intern year is "sick vs. not sick". 🙄

I am sorry the patient died. I don't think anyone was negligent. No one will be charged as discussed above.

Next case.

 

[waterski232002]

MS1's??? You mean, first year medical students are doing triage??? They shouldn't be. They don't know anything about clinical medicine.

 

[totalbodypain]

MS1's??? You mean, first year medical students are doing triage??? They shouldn't be. They don't know anything about clinical medicine.

Apparently neithor did the person doing triage in this article....

 

[GeneralVeers]

Apparently neithor did the person doing triage in this article....

Not far off of our triage nurses who can't tell which is more emergent: Foot pain x 8 years, or ripping chest pain radiating to the back. One gets rushed into the ER, the other stays out in the waiting room and dies. Guess which one is which?

 

[deleted109597]

Triage nurse put a GI bleed puking blood into fast track the other day. 90/60, pulse 120. Puked blood in the floor of the unit. We moved him pretty quickly.

She was basing it on the fact that he had been in fast track earlier that day for an asthma exacerbation, and she assumed it was related.

 

[imagin916]

Not far off of our triage nurses who can't tell which is more emergent: Foot pain x 8 years, or ripping chest pain radiating to the back. One gets rushed into the ER, the other stays out in the waiting room and dies. Guess which one is which?

If this is happening in your ER than there needs to be retraining of the nurses there. There is a reason why triage is supposed to be done by nurses with at least a year of experience, and at least in my hospital, those who have shown that they do not have good judgement are not assigned to triage. Unfortunatly, due to short staffing, sometimes you do get people working triage that really shouldnt be there. The situation that you are describing I have seen many times. Some nurses are influenced by the drama, and will upgrade a patient based on how well they perform, and not by how sick they are. We all know that a lot of the times the patient with the foot pain/back pain/whatever for 7 years will often put on a nice display, whereas the man with the MI will sit there patiently and wait. We used to put PA's in triage, and I have also seen this done in other hospitals, but it has shown that they are no better at triage than experienced nurses are. I cant speak for every place, but I know we have had more inappropriately triaged patients from the PA's than the nurses.

 

[deleted109597]

There is a reason why triage is supposed to be done by nurses with at least a year of experience...

Not to say that this isn't a start of a good idea, but isn't this like letting a july PGY-2 perform surgery without an attending in the room? One year of experience isn't a whole lot. Often it isn't anything. One year on a med/surg floor?
A year of ICU might be good, because most ICU's require experience before hiring. Or at least they did until we ran out of nurses.

 

[imagin916]

Not to say that this isn't a start of a good idea, but isn't this like letting a july PGY-2 perform surgery without an attending in the room? One year of experience isn't a whole lot. Often it isn't anything. One year on a med/surg floor?
A year of ICU might be good, because most ICU's require experience before hiring. Or at least they did until we ran out of nurses.

I agree with you that 1 year of ER experience is not a lot of time. In an ideal situation it would be at least 2 years, but we know that with the shortage that is not always possible. I started my first RN job in this crazy ER, and I know that first year comes and goes, but is not enough time to fully develop judgement required to work triage in an ER with a lot of sick patients. It may not be the best thing to hire new grads in the ER, but I have found that myself along with others that started out there, were trained specifically to ER, and we were not "tainted" by the way they do things in the ICU or the floors. The year of ICU would be better than a year of med surg, but a good ICU nurse doesnt necessarily make a good ER nurse. In my ER, if there is one particular nurse that is "mistriaging" a lot of patients, believe me the doctors complain and they do not put that nurse in triage, unless there is no way there is anyone else who can do it. Of course I have had doctors disagree with me on people I have upgraded, and sometimes I have been right on and they have complimented me on my good judgement, and sometimes I have been wrong. I do not take it personally if they get mad, I feel that if I think this person is too sick to wait, I upgrade them. If they are seen by the doctor and they feel that they are not as urgent as I thought they were, then I am satisfied with that. I would rather have that happen than have someone die or because I didn't want to get yelled at by the doctor. If I did not upgrade someone who was obviously in distress and something happened, that is my fault and my fault alone. The docs I work with are great, we work well together, and they know that if an upgrade is coming from certain nurses than they should pay attention. Believe me, if a patient is undertriaged we hear about it, its not let go just like that.

 

[totalbodypain]

I agree with you that 1 year of ER experience is not a lot of time. In an ideal situation it would be at least 2 years, but we know that with the shortage that is not always possible. I started my first RN job in this crazy ER, and I know that first year comes and goes, but is not enough time to fully develop judgement required to work triage in an ER with a lot of sick patients. It may not be the best thing to hire new grads in the ER, but I have found that myself along with others that started out there, were trained specifically to ER, and we were not "tainted" by the way they do things in the ICU or the floors. The year of ICU would be better than a year of med surg, but a good ICU nurse doesnt necessarily make a good ER nurse. In my ER, if there is one particular nurse that is "mistriaging" a lot of patients, believe me the doctors complain and they do not put that nurse in triage, unless there is no way there is anyone else who can do it. Of course I have had doctors disagree with me on people I have upgraded, and sometimes I have been right on and they have complimented me on my good judgement, and sometimes I have been wrong. I do not take it personally if they get mad, I feel that if I think this person is too sick to wait, I upgrade them. If they are seen by the doctor and they feel that they are not as urgent as I thought they were, then I am satisfied with that. I would rather have that happen than have someone die or because I didn't want to get yelled at by the doctor. If I did not upgrade someone who was obviously in distress and something happened, that is my fault and my fault alone. The docs I work with are great, we work well together, and they know that if an upgrade is coming from certain nurses than they should pay attention. Believe me, if a patient is undertriaged we hear about it, its not let go just like that.

You ever thought of coming to NY. We could sooooo use you......😉

 

[imagin916]

I think it would be a good idea to put a resident in triage with the nurse so that they can see how difficult it actually is, as well as being able to see the care of the patient from beginning to end. You would not believe what believe what people do. People will sign in with c/o toe pain, and then they walk into your booth diaphoretic and pale as a ghost and look like they are about to drop. Others will sign in with "chest pain" and then tell you that thier knee hurts but put chest pain down because they want to be seen faster. Sometimes I get one story and then when the doctor interviews them with the same or similar questions, they tell a completely different story. There was an article in Good Housekeeping in November of 2005 titled "What doctors wish you knew: 75 surprising tips--from heading off a headache to avoiding a heart attack". A lot of the contributions were from an anonymous doctor (who I am guessing does not work ER). I am unable to provide a link of the actual article without paying for a subscription service. Here is a link that mentions some of the "health tips" from a nursing advocacy website. Please no flaming about the fact that this article is geared toward defending nurses, but the information in this article tells you what kind of BS the media is telling patients. http://www.nursingadvocacy.org/news/2005nov/good_housekeeping.html

If anyone has a subscription to a service that allows you to look at this archived article, please post?

 

[GeneralVeers]

I think it would be a good idea to put a resident in triage with the nurse so that they can see how difficult it actually is, as well as being able to see the care of the patient from beginning to end. You would not believe what believe what people do. People will sign in with c/o toe pain, and then they walk into your booth diaphoretic and pale as a ghost and look like they are about to drop. Others will sign in with "chest pain" and then tell you that thier knee hurts but put chest pain down because they want to be seen faster. Sometimes I get one story and then when the doctor interviews them with the same or similar questions, they tell a completely different story. There was an article in Good Housekeeping in November of 2005 titled "What doctors wish you knew: 75 surprising tips--from heading off a headache to avoiding a heart attack". A lot of the contributions were from an anonymous doctor (who I am guessing does not work ER). I am unable to provide a link of the actual article without paying for a subscription service. Here is a link that mentions some of the "health tips" from a nursing advocacy website. Please no flaming about the fact that this article is geared toward defending nurses, but the information in this article tells you what kind of BS the media is telling patients. http://www.nursingadvocacy.org/news/2005nov/good_housekeeping.html

If anyone has a subscription to a service that allows you to look at this archived article, please post?

I repeatedly tell the nurse to please focus on the main complaint in their triage notes. A lot of time a patient is there for "toe pain" primarily but will have a litany of complaints including chest pain which the nurse will dutifully write down. If "chest pain" makes it on the triage note, then my hands are tied, and I may have to do a $1 million workup, when the patient really is there just for toe pain.

All triage nurses should focus on one complaint on their note. Most of them should be able to tell BS chest pain from the guy having the real MI who also has toe pain.