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Medicfletch

Senior Member
15+ Year Member
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http://www.cnn.com/2008/HEALTH/01/15/ep.emergency.room/index.html#cnnSTCText?iref=werecommend

The video is deeply disturbing.

Experts attribute long emergency rorom waits mostly to situations no one can control.

In it, former CNN Headline News anchor Glenn Beck describes going to the emergency room in intense pain -- so overwhelming, he wept.

He says that for two hours, no one gave him pain medication. In fact, he says, no one lifted a finger to help him at all for 40 minutes.

Beck says his wife literally held him up in the emergency room, while nurses looked on and chatted about their holidays. He does not identify the hospital.

"I'm in massive, massive pain," Beck writes on his Web site. "This guy, this triage nurse, is 250, 300 pounds, big guy. Not only does he not go to help my wife help me up, he actually had the audacity to stand there and drum his fingers against the door and look at us like, come on, come on, come on." Video Watch the video of Glenn Beck on his sickbed »

The video, which has had more than 800,000 hits on YouTube, brings to mind the case of Edith Rodriguez. Last year, she was on the floor of a Los Angeles hospital emergency room vomiting blood, and witnesses say no one did anything to help her. Her boyfriend actually called 911, which refused to help since she was already in a hospital. Rodriguez died in the emergency room.
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These cases, while unusual, certainly happen, say emergency room doctors.

"There are truly situations where it's so busy there are sick patients who are waiting. I will admit that," says Dr. Assaad Sayah, who runs three emergency rooms for Cambridge Health Alliance in the Boston, Massachusetts, area.

"Ridiculously long wait times are a huge issue," says Dr. David Beiser, an emergency medicine physician at the University of Chicago Medical Center. "Recently we've had over 40 patients in our waiting room. When I was in training [five years ago], it was rare to see more than 20 patients in our waiting room."

Donna Mason, an emergency room nurse for 33 years, says sometimes, she'd have 75 patients waiting for 54 beds -- and she knew very sick patients were in the waiting room needing care.

"The greatest fear of every doctor or nurse is that [a situation like Beck's] is going to happen in our emergency department," says Mason, the immediate past president of the Emergency Nurses Association.

Released this week, a Harvard University analysis of more than 90,000 U.S. emergency room visits found that one in four heart-attack patients waited 50 minutes or more to be seen by a physician in an emergency room.

These experts attributed long waits mostly to situations no one could control -- too many patients and too few beds. But they also acknowledged that ERs could be better organized.

Sayah said reorganizing his ERs has led to dramatic decreases in waiting time.

"Beck would've been in a bed in less than two minutes in my hospitals," he says. Waiting times are longer for patients who aren't very sick, but even for them, it's better than it used to be. "The average time from door to physician used to be about an hour. Now it's 21 minutes," Sayah said.

His staff -- especially those who greet patients -- receive customer service training. "It's just like the training they give in restaurants or entertainment places -- it's how to be pleasant to people," he says.

But what if you find yourself in an emergency room that has long waits and nasty employees? Mason and the emergency room doctors have this advice about what not to do while navigating the ER:

1. Don't forget to call your doctor on the way to the ER

When ER doctors hear from a fellow physician, they listen, says Beiser at the University of Chicago. "They'll talk to me professionally and put a bug in my ear," he says. "This guy will now be on my radar screen."

2. Don't use an ambulance unless you really need it

"There's a myth out there that if you arrive in an ambulance, you'll go straight back to the doctor," Mason says. "But it's not true. If we can see that you can walk, you may get asked to get off that gurney and go to the waiting room."

3. Don't be quiet

If the triage nurse -- that's who makes the decisions about who needs care first -- isn't helping you, don't stop there, says Sayah. "Speak up. Say, 'I need to see the person in charge,'" he says.

4. Don't get angry, and don't lie

While it's important to make yourself heard, it's also important to use basic etiquette.

"We're all human, and usually when people are nice to us, we're nicer back to them," Sayah says.

Lying about your symptoms -- making them seem worse than they really are in hopes of getting attention faster -- can backfire, says Dr. William Bozeman, an emergency room doctor at Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina.

"We have people saying they have crushing sub-sternal chest pain, that they're having a heart attack, when in reality they're trying to get Vicodin for chronic back pain," he says. When the staff figures it out, "They may not be very pleased at all and may not treat you nicely."
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5. Don't forget the phone

If things get really bad, and no one is helping you, look for a house phone, dial zero, and ask for the hospital administrator on call, Sayah says. "Even the smallest hospitals have a hospital administrator or a patient advocate on call 24/7," he says. "Hospital administrators don't want to hear patients are unhappy. Their job is to break the hurdles and move forward."
 
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Beck should blame the drug seekers, etc. Blah, what's the point of even trying to defend ourselves. Oh, he should blame this guy I saw the other day.

CC: "my Albuterol inhaler ran out and I need a refill".

SOB, uses inhaler 4-5/day, ran out of Advair 1.5 months back.
Does not have a PMD because, and get this, "my mother brought me up not to go to doctors".
What do you call the people working here? "Well, but it's an emergency room".
But this costs so much more than simply following with a PMD... "That's why I have insurance" (as he shows off the Medicaid card).
OK, we're going to give you one Albuterol inhaler and a script for one month of Advair. You need to follow up with the clinic; here's their info.
"You're not giving me refills? OK, watch this, you're going to see me back here in a month"
 
There's literature that demonstrates that the main issues lie on the floors above the ED. Lack of beds and/or adequate staffing on the floors and units account for much of the delays. Simply expanding the ED does not help. So yes, while most EDs can run more efficiently the crux of the problem in most hospitals is outside (i.e. above) the ED.
 
"Great, thanks for the heads up. I'll post a note in your chart that you get no more refills because you were advised to follow up with a primary care physician."

On Ibex, you can put a permanent note on a pt's file, which shows up whenever they register under their name/med rec number, with just such information. It's for frequent fliers, drug seekers, people who've been given no trespass orders, and so on. Very frequently, there is a note that more will not be given because strident efforts have been made to establish primary care.

Between this and the controlled substance registry, the net is tightening around the secondary gain people. Are there people smarter than us? Sure - but, if they are, they are not getting their narcs through the ED.
 
On Ibex, you can put a permanent note on a pt's file, which shows up whenever they register under their name/med rec number, with just such information. It's for frequent fliers, drug seekers, people who've been given no trespass orders, and so on. Very frequently, there is a note that more will not be given because strident efforts have been made to establish primary care.

Between this and the controlled substance registry, the net is tightening around the secondary gain people. Are there people smarter than us? Sure - but, if they are, they are not getting their narcs through the ED.

LOVE the note option on Picis. Not only can you comment that "pt seen for toothache x 9" but you can also add "DNR Scanned on x date" so you might actually be able to find said document.
 
Definitely. Now that there's a web-accessible controlled substances database in our state, I'm sure that people are going to start jumping the border. "I know I'm far from home...but I'm in town visiting a friend...and I left oxycontin at home"

Incidentally, Glenn Beck is exactly the sort of histrionic prick who would fantasize about the staff getting their rocks off by making some complete stranger wait. Since mister B grade media celebrity is at the center of the universe, there can't be anything else going on which might demand more attention than his musculoskeletal back pain.

My only wish is that the DEA create a website to track narcotic prescriptions nationwide.
 
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So, Glenn realizes the health care system needs repair due to his first hand experience. Surely he has some down to earth, realistic suggestions that can help?

""The politicians are right that we have a health care crisis in this country," he said. "Where they're wrong is that it's not going to be solved by government, it's not going to be solved by getting the HMOs out, it's not going to be solved by a new marbled-lobby health center," he said. "It's by hiring people that understand about caring for people.""

*Sigh*
 
Narcotic overuse is a problem, but tracking is impossible because patients frequently come up with fake names, fake IDs, etc. You'd have to fingerprint everyone who fills a prescription (and even then they often pay someone else to fill their script for them).
 
Narcotic overuse is a problem, but tracking is impossible because patients frequently come up with fake names, fake IDs, etc. You'd have to fingerprint everyone who fills a prescription (and even then they often pay someone else to fill their script for them).

Not in my state. You have to present a valid photo ID to get an Rx filled for a controlled substance. These people don't get fake driver's licenses/ID cards. They can't have someone else fill it.
 
Legalize all drugs. Then tax them like we do with tobacco and alcohol. The minimum standards to practice autonomous medicine have been lowered. If society really wants fast cheap healthcare we'll give it to them. They should now have the option to play doctor themselves. All drugs should now be over the counter.

*In one fell swoop the war on drugs has ended.
*Our prisons will decrease with the decriminalization of drug abuse/addiction.
*The healthcare system will breath a sigh of relief like an obese person shedding 100lbs overnight. People who seek out the healthcare system will be the people who actually want a solution to their problem. They will be people who are actually motivated to seek changes necessary for their diseases. They will have the respect for physicians knowledge/experience by knowing they could really hurt themselves or already have.

Personal responsibilty. Let's encourage it.
 
I love #5. Yeah, go ahead and dial up the hospital administrator. They could come and see firsthand what type of mess is at hand. Maybe we should install a red phone at the triage desk that connects directly to administration in case we aren't completely meeting our patients needs quickly enough. Unbelievable.
 
I did a lot of moonlighting in rural Kentucky. There was a system in place I think called KASPER to track RX info for patients. The problem is that just because you have the info doesn't mean you can act on it. I had the cops in there more times than you can shake a stick at for out of control patients. It was a dry county so they all went to the ER for oxycodone instead. It got to the point where they would drive by the ER parking lot and they knew the cars of all the doctors. Certain docs would show up and the ER would have a 24 hour stretch of constant back pain. Eventually I talked the hospital into instituting a drug seeking policy that we would not give narcotics for chronic pain, with an exception claus for physician judgement. That was in place for about a month and all the drug seekers figured it out and went over to the next county instead.

The other thing to think about is that since they have limited the amount of time you can spend on welfare, the trick is to get disability. If you are in the ER for back pain, migraines, etc enough times you can build a case for disability and then you're on easy street. There were whole families in that business in Kentucky.
 
I just laugh at stuff like this. I want to tell Mr. Beck to come work a shift with me so that he can see how stuff goes.

Mr. Beck would be just as happy to make a shock video about the homeless guy who died because doctors didn't take him seriously on his 95th visit for 10/10 chest pain andbythewaycanigetahamsandwhich?

On the other hand this stuff is good for the country to know. You may die in an ER waiting room someday because the rooms are full of ambulance runs for "knee pain x 3 years." We had three or four pretty sick people in the waiting room last night while we spent an extra 20 minutes arguing with a lady on her 15th ER visit in this last 3 months about why we weren't going to write her Percs or just "give her a few to get her home."
 
I just laugh at stuff like this. I want to tell Mr. Beck to come work a shift with me so that he can see how stuff goes.

Mr. Beck would be just as happy to make a shock video about the homeless guy who died because doctors didn't take him seriously on his 95th visit for 10/10 chest pain andbythewaycanigetahamsandwhich?

On the other hand this stuff is good for the country to know. You may die in an ER waiting room someday because the rooms are full of ambulance runs for "knee pain x 3 years." We had three or four pretty sick people in the waiting room last night while we spent an extra 20 minutes arguing with a lady on her 15th ER visit in this last 3 months about why we weren't going to write her Percs or just "give her a few to get her home."

It all comes down to Tort reform. I could clear all of those BS people out in Dr. House style if I wasn't afraid of getting sued.
 
Tort reform & PG scores that is...
Seriously, medicine would be so much better (for patients and healthcare workers) if we eliminated patient satisfaction scores and instituted massive tort reform. Healthcare costs would go down, patients would be seen quicker (less documentation, less time spent with drug seekers), and healthcare workers would have more job satisfaction.

Sadly, this will not occur in the next few years.
 
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I think Mr. Beck could make a great special if he went down to our ED and went through the waiting room asking why they came to the emergency department.

"Oh, my back has been hurting me for a month."
"I haven't slept more than 3 hours a night in a week."
"Medication refill."
"I was in a car accident 3 days ago and now my fingers are tingly."
"Pregnancy test."

The story could be how much of a scavenger hunt it is to find someone with an actual emergency.
 
I know this is old, but may be a sign -

Texas physician group credits tort reform legislation with increase in emergency physicians.

The Dallas Business Journal (2/4) reports, "A house bill that passed the Texas Legislature in 2003 is now receiving credit for getting emergency physicians back into the" emergency department (ED). The Texas College of Emergency Physicians thanked "lawmakers for the passage of House Bill 4 six years ago -- a move they credit for establishing the tort reforms needed to revamp medical malpractice suits in a fashion that would encourage more physicians to practice emergency medicine in the state." In fact, data indicate that "76 Texas counties have reported gains in emergency physicians since the bill's passage," of which 39 "were previously considered underserved."
 
It all comes down to Tort reform. I could clear all of those BS people out in Dr. House style if I wasn't afraid of getting sued.

Agreed. There would be some bad outcomes certainly but it would allow me to discharge so many patients so quickly.

I think part of rational national legislation needs to be the screening exam followed by doing nothing. I.e. you are here for a pregnancy test and you did not a) call your primary or b) buy one at the pharmacy. Here are your discharge instructions and please follow up with someone who cares.

The scary thing is that people are, on average I suspect, going to get sicker as the population ages. We are going to have more and more bad outcomes/waiting room deaths until something gives. I mean 20 years from now when us residents/students are practicing we are probably going to be running little mini-geriatric intensive care units.

You think your waiting time for back pain is long now? Wait until I am putting IJs in 3 septic, demented, bedbound grandmas because the family wants me to "do everything."
 
The scary thing is that people are, on average I suspect, going to get sicker as the population ages. We are going to have more and more bad outcomes/waiting room deaths until something gives. I mean 20 years from now when us residents/students are practicing we are probably going to be running little mini-geriatric intensive care units.

You think your waiting time for back pain is long now? Wait until I am putting IJs in 3 septic, demented, bedbound grandmas because the family wants me to "do everything."

I completely agree with the above sentiment. The aging population of millions of baby boomers will far outpace the thousands of EM residency trained graduates in the next 15 years. I think the amount of sepsis/MIs/strokes/hip fractures and other age associated maladies is going to grow dramatically in the coming decades and the system is stretched to its limits right now.

I couldn't have said it any better myself about the waiting times. Better deal with your cough cold congestion at home while I intubate, put in lines, have lengthy family discussions all while documenting everything I do should someone pursue litigation because I couldn't save their 99 y/o parent with MODS.
 
I completely agree with the above sentiment. The aging population of millions of baby boomers will far outpace the thousands of EM residency trained graduates in the next 15 years. I think the amount of sepsis/MIs/strokes/hip fractures and other age associated maladies is going to grow dramatically in the coming decades and the system is stretched to its limits right now.

I couldn't have said it any better myself about the waiting times. Better deal with your cough cold congestion at home while I intubate, put in lines, have lengthy family discussions all while documenting everything I do should someone pursue litigation because I couldn't save their 99 y/o parent with MODS.

Just remember that even though you get grandad to the cath lab with heparin going and bring grandma's MAP up to 70 w/ norepi the only person who is going to get a satisfaction survey is the dude with the cough x 1 day who is "waiting forever" to be seen.
 
Just remember that even though you get grandad to the cath lab with heparin going and bring grandma's MAP up to 70 w/ norepi the only person who is going to get a satisfaction survey is the dude with the cough x 1 day who is "waiting forever" to be seen.

And therein lies the poor satisfaction of EPs with satisfaction surveys.

Take care,
Jeff
 
And therein lies the poor satisfaction of EPs with satisfaction surveys.

Take care,
Jeff

Until EVERY EP and EP group bands together, we are stuck with these surveys. My group thinks they are completely FOS, however we can't refuse to take them seriously. If we told the hospital admins that we don't care about the surveys they'd cancel the contract with my group in a second, and bring in one of the evil corporate giants like EmCare.
 
Legalize all drugs. Then tax them like we do with tobacco and alcohol. The minimum standards to practice autonomous medicine have been lowered. If society really wants fast cheap healthcare we'll give it to them. They should now have the option to play doctor themselves. All drugs should now be over the counter.

*In one fell swoop the war on drugs has ended.
*Our prisons will decrease with the decriminalization of drug abuse/addiction.
*The healthcare system will breath a sigh of relief like an obese person shedding 100lbs overnight. People who seek out the healthcare system will be the people who actually want a solution to their problem. They will be people who are actually motivated to seek changes necessary for their diseases. They will have the respect for physicians knowledge/experience by knowing they could really hurt themselves or already have.

Personal responsibilty. Let's encourage it.

I completely agree, although I feel the "War on Drugs" is too profitable to our politicians to let go of.
 
Until EVERY EP and EP group bands together, we are stuck with these surveys. My group thinks they are completely FOS, however we can't refuse to take them seriously. If we told the hospital admins that we don't care about the surveys they'd cancel the contract with my group in a second, and bring in one of the evil corporate giants like EmCare.
Hmmm. You know I can think of 2 hospitals that are closer to my house than where I am right now😀.
 
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Gah. We can't have Glen Beck sitting in some suburban ER. We need him in the War Room:

[YOUTUBE]http://www.youtube.com/watch?v=n49hEsj9mCA[/YOUTUBE]