If anything it is getting worse. Press Ganey scores and lightneing quick dispos mean that the ED docs are being pulled in various direction. Speed is everything and they are monotored on how long it takes to see the patient, order tests, admit vs d/c, etc. This leaves this less time to pour through old charts, etc. I've had COPD admissions for patients on less home O2, but the ED doctor didn't have time (or maybe jsut didnt care to look) to see they are on 4L at home. They wanted to admit for new O2 requirement. Another admit for patient with end starge renal and bad heart failure. He complained of 2 episodes NV, and doc thinks he may be dehydrated and gives 1 L bolus of sailine................ oops now patient is SOB, admit for iatrogenic heart failure, patient may need urgent dialysis because they dont make urine.
I am sure if the doctor had time to look at history he would've done a better job treating. All docs do stupid things at times, in the ED you won't have the luxury of fixing it yourself.
The new thing to get around the ACA's no pay policy for readmsissions is to set up 23 hour observation units for "iffy" admits. They will probably be managed by ED physicians, so it will be interesting to see where it goes. Some of these problems are alleviated by staying at large academic centers, most of the pressure on ED has nothing to do with their intelligence, etc. It's about money and politics. Adding a year of training probably wont change this.
I'm PM&R, so I only have an outsiders vision but these are things you will see as a student and resident.
