Question about EM operation in US

[userguide]

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Hey guys!
I have some questions about EM in US.In Turkey,in most of rural hospital or some university hospitals,we usually examine over 500 patients/24 hours in ER! It may sound crazy but it is.Most of these patients have mostly upper resp. tract infections,cystites,.. I mean nothing emergent.How is the EM patient population in USA? How many patients do you examine in 24 hours shift?

 

[filhodeinferno]

5000

 

[Birdstrike]

Hey guys!
I have some questions about EM in US.In Turkey,in most of rural hospital or some university hospitals,we usually examine over 500 patients/24 hours in ER! It may sound crazy but it is.Most of these patients have mostly upper resp. tract infections,cystites,.. I mean nothing emergent.How is the EM patient population in USA? How many patients do you examine in 24 hours shift?

Let me guess: no free-coffee and turkey sando meal-trays to boost Press-Ganey scores, no giving a --- about "return within 48 hr" metrics, no predatory lawyers to ward off, and no list of government mandated b--- s--- boxes to check to prove "meaningless use"?

I could see 500 in a double, too.

 

[userguide]

Still waiting meaningfull answers 🙂

 

[Birdstrike]

Still waiting meaningfull answers 🙂

There's plenty of "meaning" in my above answer, but also a lot of sarcasm. I suppose you'd have to know plenty about EM in the US to get the joke.

In the US, one generally sees somewhere in the range of 2-3 patients per hour on average, though it can vary based on acuity, location, or from day to day. I don't know if you're joking/trolling or not, but if serious, 500 patients in 24 hr is not possible in our system given the acuity, and burdensome level of required charting requirements necessary to meet insurance, government and medical-legal requirements.

500 patients in 24 hr is about 20 sec per patient. Hell, it takes longer to log into our government mandated computer charting system than that, let alone document enough to get payed or protect from a lawsuit.

 

[The Buff]

I think he probably meant per hospital, not per physician. 500 is still a lot, but I guess it depends on how many docs are on, how big the department is, etc. Obviously the varying legal and cultural factors also play a role.

 

[GeneralVeers]

If I wasn't worried about customer satisfaction, patient complaints, and charting, I could see and dispo most patient within 20 seconds.

 

[userguide]

Yes I meant per hospital but usually there are only 2 doctors on 24 hours shift!.I am not joking really! While I was doing my intership in my university hospital which was located in most crawded place of Istanbul and there were approximately 1500 patients on 24 hours and still there were 4 residents and 1 attending.EM medicine operation is very bad in Turkey thanks to our government!

 

[DocEspana]

Even with a ton of attendings, I dont think 500 a day is possible at any hospital in the US. 500 x 365 is over 180k visits per year. The busiest hospital in the US is (AFAIK) Lincoln and its seeing 173,000

St. Joseph's in Paterson NJ sees 168k and they have 6-8 attendings on simultaneously during the day and 3 on at night. With oodles of residents. idk of any other hospital staffing an ED that well. And without those staff memebers dividing the workload 10 ways, you're not gonna get close to 500 per day.

 

[userguide]

What type of patients do the US docs examine in ER?

 

[DocEspana]

What type of patients do the US docs examine in ER?

1) patients who are acutely dying (trauma, acute MI, stroke, Poisoning, anaphylaxis)
2) patients who are subacutely dying (CHF, COPD, Renal diseases, debilitating intestinal issues, seizure)
3) Patients who are not dying (people who should have visited their primary care doctor but chose not to and definitely have NO emergent component to their problem)
4) patients who we wish would die (those who are using the ER as a $2,000 a pop convenience store. The people who want a pregnancy test, or come in for a prescription for ibuprofen or for a warm bed or a sandwich)


Realistically the ED serves three roles.
1) bring us the acutely dying and we will save them... Most of the time
2) bring us everyone who is sick and we will sort out who deserves admission from who can go to clinic
3) we can't turn away anyone (legally we cant) so we also serve as both the psychiatrist for all the crazies and the minor pharmacy for every minor injury real or imagined.

 

[deuist]

What type of patients do the US docs examine in ER?

Too fat to live.
Too old to live.
Too stupid live.

 

[userguide]

1) patients who are acutely dying (trauma, acute MI, stroke, Poisoning, anaphylaxis)
2) patients who are subacutely dying (CHF, COPD, Renal diseases, debilitating intestinal issues, seizure)
3) Patients who are not dying (people who should have visited their primary care doctor but chose not to and definitely have NO emergent component to their problem)
4) patients who we wish would die (those who are using the ER as a $2,000 a pop convenience store. The people who want a pregnancy test, or come in for a prescription for ibuprofen or for a warm bed or a sandwich)


Realistically the ED serves three roles.
1) bring us the acutely dying and we will save them... Most of the time
2) bring us everyone who is sick and we will sort out who deserves admission from who can go to clinic
3) we can't turn away anyone (legally we cant) so we also serve as both the psychiatrist for all the crazies and the minor pharmacy for every minor injury real or imagined.

Thank you.We also have type 3 and 4 patients but the point is they are too much.That is why we examine over 500 patients! approximately 50 of them are really emergent.This really disturbs EM physician in Turkey.Alsa what about violence againts doctors,nurses? We have lots of😀

 

[userguide]

Too fat to live.
Too old to live.
Too stupid live.

great 😀

 

[It'sElectric]

This is the best thread ever...