ER wait times
This recent article sent to me by a friend defines a problem not uncommon to any local hospital. Hospitals work to improve ER wait times - Nightly News with Brian Williams - MSNBC.com “The wait can seem unbearable when you need help. Across the country, the average emergency room wait time is now 222 minutes — that's 3 hours, 42 minutes.”
The facts are clear. Emergency rooms are busier than ever and patients are waiting longer than ever before in most hospitals. The problem is compounded when you have a bed shortage on the floors, the OR’s and other outpatient centers and cannot efficiently move patients from the ER.
The problem therefore is not just an emergency room issue, but a system wide hospital problem that has to be addressed in a multidisciplinary approach.
Fast-tracking, color coding, appropriate triaging, increased staffing and bed expansion are all part of the immediate ER fixes, but every other area and department in the hospital has to do their part to turn over the beds and become better utilizers of limited resources.
Since ER is one of the areas quoted by the CEO as being overstaffed, cuts in this department at Floyd will assure us that wait times here will be increased.
The facts are clear. Emergency rooms are busier than ever and patients are waiting longer than ever before in most hospitals. The problem is compounded when you have a bed shortage on the floors, the OR’s and other outpatient centers and cannot efficiently move patients from the ER.
The problem therefore is not just an emergency room issue, but a system wide hospital problem that has to be addressed in a multidisciplinary approach.
Fast-tracking, color coding, appropriate triaging, increased staffing and bed expansion are all part of the immediate ER fixes, but every other area and department in the hospital has to do their part to turn over the beds and become better utilizers of limited resources.
Since ER is one of the areas quoted by the CEO as being overstaffed, cuts in this department at Floyd will assure us that wait times here will be increased.
posted by Anonymous at 6:05 PM
17 Comments:
ER wait times are extremely frustrating. While traveling in Wisconsin a few weeks ago, our child became ill and we went to the hospital and were back in a exam room within minutes and had good care. Floyd would be insane to cut staff in the ER, we'll see what happens.
Following up on another issue. What happened at the Commissioner's meeting? Were new board members appointed. Also, did you submit your name to be a member. I hope you did and were selected.
I will have to admit to being confused about this whole issue of Emergency Room economics and utilization. Everything I read indicates that overutilization of Emergency Rooms is a huge and expensive problem--one of the most expensive ways to deliver health care. Apparently, every hospital is burdened with droves of people who use the ER as their primary medical resource. From that I would guess that hospitals have a tough time finding the right balance between providing necessary care and just making it that much easier for patients to abuse the resource. Sounds like a really tough problem that doesn't lend itself to easy answers. From what I have heard from people in Louisville, the waits in most of the ERs there make Floyd's situtation look good by comparison.
There was an article on this same subject in the Wall Street Journal recently which was a lot more detailed than the NBC story. It also mentioned that one of the biggest problems is finding beds for patients ready to move out of the ER. It talked about people lining the halls on stretchers waiting for a bed to open up. Apparently, the most successful hospitals have been the ones most aggressive at getting patients discharged on a timely basis. The article mentioned that doctors are sometimes a roadblock because they aren't always available on a timely basis and they don't like to be pressured to release patients. I remember that there have been comments on this blog about docs at Floyd complaining about that very thing. Again, a tough complex problem that requires a full "systems" approach rather than a lot of finger pointing.
There has been several times of late where patients have been held over for many hours in the ER at FMHHS while waiting for beds to become available. The sad question is, What is the right solution? There is plenty of room for additional beds upstairs (empty old ICU, TCU & 3rd/4th floors in new section), but with the hospital talking about cutting hours they can't staff the area. The new ER has a hold over area designed for these situations, but they don't have enough staff to cover it. Claims that the ER is overstaffed raises questions because there have been occasions when they have had to call staff from the floors to come down and cover the holdover area due to a lack of ER staff. When this happens then the floor is shorter than it already is. Case Managers start pressuring doctors to release patients to make beds available. Sadly enough, many of these patients then go home only to return within a few days either just as sick or sicker than when they were discharged. Where does it all stop? Unfortunately, I feel we live in a society where money rules and patient care drools. I praise the staff at FMHHS for hanging in there and doing the job they're trying to do. I praise the doctors for their service to patients when they have a lot of thumbs pressing down on them as well.
Agree with all of the comments. After my meeting with the Board and CEO 3 months ago, we did implement a multidiscplinary team and worked out specific diversion criteria to help facilitate this exact problem. I presented it to the Medical Staff tuesday night.
Having adequate hospital staff is the only way it will even partially be successful and that is why the cuts will be so difficult.
The commissioners did appoint two new Board members bringing the total to nine. Still no physicians appointed.
The two new members look very promising.
Guy Wall from IUS http://homepages.ius.edu/GWALL/
and a Mr. Miles who I have heard wonderful things about although do not know either of these people personally. His wife, I think, used to be a school nurse in the NAFC school system, but I am not absolutely sure on that.
I know from first-hand experience that the staff of the ER works very hard. There is a problem, however, with inexperience. A lot of them have been nurses for five years or less. They are also understaffed especially at this time when they are so busy. Cutting staff will not only pose a safety risk for patients, but increase an already high frustration level. Does Mr. Hanson have a pair of scrubs ready? I have a feeling he is going to need them. I pray for all of you naysayers out there that when it's your family's turn to visit the ER that you don't have to look up and see a nurse who's understaffed and overtaxed.
Don't worry, I won't be going to Floyd.
My mom, who is 83, fell and was in the Floyd ER yesterday. Her injuries turned out to be minor, but she was there for many hours, thus, so was I.
I saw first-hand how overworked each nurse/aid and doctor are. The ER is UNDERSTAFFED, not overstaffed. The only thing that saves them (and the patients)is the compassion and talent that each staff member seems to possess.
A tip of the hat goes to Floyd's ER staff. But they cannot afford cuts and neither can patients.
HB,
Do you think the Board will ever consider another CEO besides Hanson? His decisions are more ridiculous every day and I was once a huge support of his.
One blogger said:
Apparently, the most successful hospitals have been the ones most aggressive at getting patients discharged on a timely basis.
Another one said:
Case Managers start pressuring doctors to release patients to make beds available.
Varied perceptions all around!
The wait time at Floyd ER is long but so his the wait time in Boston where I was an ER patient a few weeks ago. It was 2 hours from when I arrived till being seen by a surgeon and by then I'd lost enough blood to need a transfusion. People were on stretchers in all the halls. It's just insane everywhere maybe. My unfortunately rather extensive experience of ER's is they are way UNDERSTAFFED.
As a nurse in Floyd's ER I think I should comment. You will find inexperienced nurses everywhere you go. That is the problem with the current nursing shortage. There are many older nurses whose positions must be filled by younger inexperienced nurses, this does not mean that they don't know what they are doing. Nursing education today is far better than it was in the past.
The "hold unit" in the ER was not intended to be a "hold unit." It was inteded to be a cardiac observation unit. I'm not certain about the next comment, but I believe that the request for FTEs to staff the unit were rejected around the time of completion of the unit, but as I said I'm am not certain.
The ER is filled with "frequent flyer" and "repeat offenders" who use the ER as a clinic. Sad thing about it is that most of these people will never pay their hospital bill. Some of thim who use city resources, NAFD, will never pay them as well. Who is that ends up paying these bills? Us the taxpayers.
The wait times at Floyd are much better than most places. What people need to understand, is that people with more serious injuries and illnesses will be seen first. That means that someone with belly pain will be seen before someone with dental pain and someone with chest pain will be seen before someone with belly pain. This isn't a restaurant, just because you were the first one through the door you should be the first one seated. Don't come yelling at me because someone with a severed finger got back before you with your tooth that has been hurting for a year and you keep coming back to the ER for more pain medicine instead of following up with a dentist like we told you to the previous 50 visits.
I appologize for the ranting, but I do feel better. Now you see why there are long wait times in the ER though.
To the ER nurse, I agree with 110%.Frequent flyers do take up alot of time in ER and take up beds upstairs for "Belly Pain" for the 200th time this year.Of course nothing really wrong but does need a demerol fix.I love taking care of these patients, when I could be caring for someone who is really needs my time.
I have only had one experience with the ER at FMH, but I can tell you it was one of the most infuriating experiences of my life. I was experiencing pre-term labor during my 5th month of pregnancy, and had not been able to reach my OBGYN before going to the hospital so I had to check-in at the ER. The staff was ridiculously slow, and kept insisting that I was not in labor although there was no physician available to examine me. Had my OB not shown up and admitted me when she did, I might still have been sitting there, hysterical, when the baby was born several hours later. Through no fault of the staff at FMH (the nurses on labor and delivery were wonderful), they were unable to save him, but the whole episode left me wondering if anyone working in the ER understood what the E stands for.
I am deeply sorry that some of you have had bad patient care experiences in the ER. However, I feel that it is only suffering from inadequate staffing. The administration has tied the hands of middle management who are now having to get their scrubs "out of retirement". The patients are the ones who suffer. As an ER employee, I can assure you that in our minds, the patients come first. However, when stretched too thin, it becomes unbearable.
On top of that, the boarding of admissions in the ER will push it out of control. Yes, these beds were built in to accommidate for admission patients, but not nearly that many at a time. Something must be done. AND SOON!!
As always, the FMHHS way.....Reactive never proactive
Its kind of hard to give top notch patient care when you have and E/R Manager that has such a poor attitude which translates into poor employee relations.
It is a fact that the E/R is may be understaffed, but not by choice. The fact is the E/R manager is not respected by most of her own staff and as a result the area has high turnover.
Do we need to look deeper into hosptial issues that just financial. You bet we do.
Our ER is not only understaffed but as a result of this, we have staff members who have low tolerance levels to stress when departments such as lab and x-ray can't meet their demands due to their own understaffing issues. Its a domino effect. All the while, there are staff members from HIM including managers, supervisors and team leaders enjoying breakfast and lunch together appearing to have no pressure to return to their desk. the HIM Director appeared to have a close working relationship with her VP, the prior CFO, keeping him abreast of ALL issues significant, insignificant and otherwise. It will be interesting to see how her and the Senior intertwine/clash as the struggle to be the center of their own power.
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