The following is an excerpt from MedPage Today.
A special session of Congress was called 35 years ago to make lawmakers and the public aware of stories of patients left to die in hospital parking lots for lack of insurance.
Around the time of that congressional testimony, called "Equal Access to Health Care: Patient Dumping," a new guarantee came about: that any individual who comes to the emergency department (ED) must be given a medical screening evaluation and appropriate stabilization. This codifies the ED, by federal law, as the front door to hospital-based care in the U.S.
Patients are now waiting hours, days, and sometimes weeks in the ED. It's like asking a teacher to take on a whole new class of students when last year's class hasn't left yet.
New data from two studies we recently published in JAMA Network Open document what patients, nurses, and doctors already know: the levees have broken. The system has collapsed under the weight of acute care needs.
At the end of 2021, in the hardest-hit hospitals, more than one in 10 ED patients left without care. Half of the sickest patients in the department -- those requiring admission -- waited 9 or more hours for an inpatient bed.
More and more, patients are placed in hallways: patients who need sensitive exams, patients with highly infectious respiratory viruses, and elderly patients with sepsis who must endure the bright hall lights through the night.
The problem isn't just physical space -- it's staff. Nurses, crushed under the weight of a profit-driven staffing crisis years in the making, must now care for both admitted boarding patients and new patients.
In practice, there are often no limits on staffing ratios for ED nurses. On the medical floor, a single nurse may have four to five patients. In the ICU, two patients. In the ED, a single nurse is often asked to cover 10 patients or more, some critically ill who are "admitted" but in the ED waiting for an ICU bed, without regard for the safety or sustainability of this arrangement.
A recent survey by the American College of Emergency Physicians (ACEP) invited ED doctors to share what they've seen happen as a result of ED boarding. Patients with brain bleeds, hip fractures, and even necrotizing genital infections are being treated in the waiting room because there are no rooms or even hallway beds available in the ED.
Multiple physicians shared stories of patients dying in the waiting room because the ED was so overwhelmed, they had to wait for hours to see a physician. (Continued...)
Link to article here.
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Janine M Largent says
Well done. As a 10 year ED nurse you hit all the right notes. The ED has now become the most dangerous place for a patient to be. Add in vaccine mandates that had experienced nurses (myself included) saying "goodbye" and it is a recipe for disaster. Whenever possible patients should utilize their primary MDs or go to freestanding urgent care centers for evaluation or to order a urinalysis, xray, ultrasound or other diagnostic test on an outpatient basis for urgent but not lifethreatening symptoms. Any chest pain, change in mental status, shortness of breath, heavy bleeding or significant trauma should still be evaluated in the ER
Cathy Hill says
My 9 yr old grandson sat in the ER waiting room with a ruptured appendix for about 8 hours and then was in an ER room for another 2 hours before he was transported by ambulance to a larger hospital. It was a nightmare!
Bill Andrews says
Sharyl this Article ???, I herd NBC today say the Law passed to Hold some responsible For excessive practices is also not being Followed like what your talking About and or procedure excessive Fee's not being followed by Law changes ? As your describing ? Seem's like these States Attorney General"s and other Gov offices not getting involved despite Law changes and New elderly abuses and New Laws passed to protect the elderly as well in many States ? Boy if it's not Home predatory loan scandals of 2008, and or Fanny Mae, or Enron, Tyco scandals. Bitcoin scandals... There's never a shortage of peoples corruption Weaponizing anything in this country in past 30 years ?? All these States Elected people and Gov Agencies needs to get involved, this is why there in those Jobs ? or, we have Too Many other Wanna Be Bernie Madoff's types running around ? " What Kind of Future are they setting for Future Generations and your Grand kid's here in Mocking the Laws ???
Just had a elderly relative end up in ER with "grave neurological impairment". I didn't know what happened, There was no one around to tell me. And if I did find someone, they all had to be wearing masks and I could not understand a word they were saying.
But they rush me to sign a DNR order and were ready to pack her off to a permanent board and care facility as a hopeless brain damaged case, after putting her on heavy anti-psychotic drugs to keep her calm since she was in her state being very disruptive and taxing all the hospital staff.
Several days later, she "woke up" and is now functioning normally. This is what "Medicare" is providing for seniors so let's stop any fantasies a bout seniors getting "free health care" as a model for what everyone else should be getting for "free".
Health care is a commodity; not a right. We buy it and we sell it. Health care depends 99% on the services of others. We buy and sell those human services. We have no demand they are provided since we did outlaw slavery 150 years ago.
Think long and hard about what government intervention and "free health" care has actually done for all of us -for those who refuse to take care of themselves because they get "free health care"; doctors who write prescriptions and procedures which form their basis for reimbursement whether they are needed or even appropriate. and all the third parties who are now overlooking the patient bedside, all with their hands out to be paid for this "free health care".
I honestly don't know the answer, but I do know we are not asking the right questions. Nor has the dream of "universal free health care" even come close to providing anything other than a cash cow for the medical industrial complex, and now lazy patients who have lost all touch with their own duties of care and prevention too.
In trauma care, we continue to excel. In general health care needs and the aging population we are very, very out of touch and refuse to even ask the right questions. Senior poly-pharmacy and drug interactions play too large a role in the "health of seniors" --for what net benefit? This relative presented finding 19 prescriptions written by a dozen or so doctors - she had become a toxic chemical soup. All for "free".