We spent 10 hours in the ER yesterday...

[Catshrink]

It was packed, as you might expect. My 87 year old Dad had fallen and we needed to get him checked out since he said he couldn't put any weight on one leg. Turns out it is most likely a bone bruise so he's okay -- that's the good news.

He was getting impatient, saying he couldn't figure out why it was taking so long and I told him that because people didn't have insurance they couldn't afford to go to the doc when they felt ill but waited until they were really sick to seek help. I stopped short of saying "you voted for the little idiot." Meanwhile, he was on a gurney in the hallway -- only makeshift privacy when he had to pee.

So, why is the wait so long? Yes, the place was crowded. It just seems it isn't a very efficient setup. Each of the intake areas had one doctor who made the decisions and two or three physician assistants who actually saw the patients. Nurses, as usual, were the lifeblood of ER. Everyone seemed busy but there was a lot of waiting around.

I'm a bit of an ER vet -- Mom went several times for heart attacks and even with her life threatening condition, we waited at least 12 hours each time before she was admitted. I hadn't been back for two years since she died and found it hadn't changed, except for the addition of the PAs.

There probably isn't an answer in Bush's America. In fact, as fewer people are able to afford health insurance and preventative care, it will get worse.

It's so discouraging.

[Warpy]

1. Right, and ERs are also clogged with people who have coughs

and colds or who have screaming toddlers with earaches and no restrictions on ER visits in their insurance plans. Generally speaking, the hours between 3 AM and 7 AM are the best time to get sick enough to visit an ER on weeknights. On weekends, wait until 5 AM and all the drunks who wrecked their cars have been seen.

Some towns have Urgent Care clinics to take the pressure of emergency rooms, and they're a great deal for the uninsured, costing maybe 1/5 of what an ER visit costs. The problem is convincing a sick, scared person that what they have isn't a real emergency and can wait a few hours in the clinic waiting room (as opposed to 10-12 hours minimum in a busy city ER) and that they don't need to be seen by a platoon of specialists, that a family doc will do. Other big cities are seeing storefront clinics opening up to serve folks who have little access to health care. Both need to be expanded.

ERs are simply overwhelmed. Some are expanding, most can't justify the expense, since although they'll eventually get paid one way or another, the process to garnish wages or seize property is an expensive one, making most ERs money losers for hospitals.

It's obvious something has to change. Most healthcare professionals have seen massive speedups, thanks to the additional burdens imposed by nightmarish insurance requirements and dangerously short staffing. The system is broken, and it will take a massive effort to repair.

[Catshrink]

3. Well said...

Available and affordable health care are the answers to most of this.

[FlaGranny]

6. No parent in their right mind

would not take their kid to the ER if he was screaming in pain at 2 in the morning. No person in their right mind wants to sit for 10-12 hours in the ER with a screaming kid, regardless of insurance. Are you saying ERs are crowded because insurance companies are too lenient? That's a new one.

[soothsayer]

19. hospitals should smarten up and put in urgent care clinics right

next door. Then they should triage the incoming patients and spin off those who aren't real emergencies. It'd be a win/win, I think. What's so hard about that?

[rogerashton]

2. ER

I've been working on some research projects with an ER doc. His impression is that if there were more facilities, there would just be more patients coming to the ER for routine care to stand in line. This is not cynicism -- it's worry -- and probably true in a center city ER with a large population of underserved poor people not far away. My colleague is a very committed man who would give a lot to find a solution to this problem.

I don't remember my ER occasion. I had fallen down and cracked my skull and lacular amnesia was a symptom. However I was walking around and responding when spoken to, or so my wife tells me. Because of that she thought my injury might not be too bad, but I was pretty bloody (she tells me) so she got me to change into my unbloody sweats and got me off to the emergency room. Probably saved my life. The folks there criticized her for not calling an ambulance, cut me out of my sweats, wanted her to authorize helicoptering me to a trauma ward. She's a tough lady -- she refused. Probably a lucky decision, but I am not sure it was a smart one. Anyway, they took pretty good care of me -- I am told -- but then it was a suburban hospital and I walked in with blood all over my head and face. That was December 04.

[TahitiNut]

13. Sounds more like traumatic amnesia than lacunar amnesia.

A head injury will sometimes inhibit the short-to-longterm memory process for a time immediately preceding the trauma to some time afterwards, depending upon the severity of the trauma. Lacunar amnesia relates specifically to an event itself. Traumatic amnesia can be psychogenic or physiogenic. Quite a few of us Viet Nam veterans have traumatic amnesia - memory of combat periods that's like a "black out" stage skit ... flash/strobe images almost like isolated still photos. That's how I recall Tet '69 - just a few short images. I have the same kind of memory loss from when I fell off my bicycle, hit my head, and concussed my brain - and was walked home by a teen-age playmate. My grandmother, an LPN, kept me up and under observation afterwards, knowing it was a mild concussion.

Lacunar amnesia is typically related to a stroke or "mini-stroke" (TIA).

[rogerashton]

16. I did have bleeding on the brain

as a result of the injury, but s'far as I know, you could be right.

[renate]

4. glad your dad is okay!

Best wishes for his speedy recovery!

[Catshrink]

5. Thank you...

he hurts, but that's to be expected.

[Catshrink]

15. Thanks!

He hurts a lot, but is taking meds to dull the pain. These of course make him a bit foggy, but it will just be for a few days.

[bobbieinok]

7. 2 visits to ER with mother....wait each time ca 10 hours

once she felt 'very bad'; once EMSA called us b/c Meals on Wheels found her on the floor (that one led to us having to put her in assisted living)....both visits we went to ERA ca 11am

as far as I know the ER was not very busy either time; it was just wait and wait and wait for another test

each time after ca 2 hours all she wanted was 'to go home'

NOTE

--this is a good example of why Meals on Wheels needs to be funded

--mom died 3-31-05, age 92

[Dr. Jones]

8. Parkland Hospital, Dallas TX

Went to their ER once and was simply shocked. Many poor people waiting in several HUGE rooms near the entrance. One low-income individual said at one time he had waited TWO DAYS to get seen by the docs. Another man's wife had a raging fever and was sitting there in agony under a blanket. The man nervously kept going up to the nurse's station and BEGGED for his wife to be seen. All they could tell him was basically "take a number." And yet another lady had a severe infection in her arm and who knows when she was to be seen. Sad, sad indeed.

Once I went to another ER and was told, because I felt better and refused the doctor's treatment, that it sent me up to a "Level III" which caused me to pay more $$$ just because I felt better and thus refused treatment! I think it was around $300.

Luckily we do have clinics around here. The ER really is trouble.

[qanda]

9. I called my doctor the other day

Because I was having numbness in my face, a recurrent problem, and instead of fitting me in they told me to go to the emergency room. I told them that I would not do that-- I have no health insurance and my last trip to the ER resulted in a hospital stay and a bill for over $4000, without the doctor's fee. I think the ER is being used as a primary care center and doctors are fostering this by sending their patients to the ER.

[lovuian]

10. What is going on is you need a reason to admit

and sometimes people are getting treated in the ER

so lets take some typical cases coming in
Room 1 Has a patient with a heart attack
Everything is stat and life threatening
Bloodwork Resp tx and medication and IV'e Chest Xray EKG
All these things take time to do and then read by a doctor and then redone again
then the wait for the room then the transfer upstairs and talking to worried family members

that one patient keeps a nurse busy in ICU for 8 hours

Room 2
Is a head injury bleeding and unconscious
Cat Scan Nuero checks Lab IV stitches patient is vomiting when awakes
if its a cerebral bleed they have to go to surgery immediately

that patient can keep a nurse busy in ICU for 8 hours

Room 3
Is a 2 year old breathing 80 breaths per minute in major resp distress and asthma
IV with a fighting 2 year old is timeconsuming labs needed and respiratory treatments
a two year old isn't cooperative so it takes many hands to hold down
There is the wait to see if the patient can be cured without being admitted I have seen kids given fluids over 6 hours to avoid admission

We are creating more people but not emergency rooms to take care of them...

[Catshrink]

12. And, in our ER, the docs responded to a Code Blue on a patient floor

The doc stood up and said who's going with me? He and one of the nurses took off. That further diminishes the personnel -- but who else is better qualified to deal with life threatening situations?

There is an urgent care center across the street from the hospital but it closes at 8pm.

[jaxx]

11. We need national healthcare.

I know it's not a popular thought, but the idea of sitting in a waiting room for 10 hours to see an ER doctor is nothing but the poor putting off seeing a doctor until it's a crisis. Those coughs and pains could easily be seen at clinics in the daytime, IF they knew it was covered. Look at the jobloss this country has endured in the last few years, and most of those people have found work at less pay, and less benefits. How do you pay for insurance when the rent/house pmt needs paid, or the power bill is due and you're working for minimum wage plus a few bucks? The idea that American citizens go without healthcare is beyond reasoning. Now it's either have insurance or wait to die. Wellness care is only for the insured, and then there are the deductibles.

They say it would cost too much to have national healthcare. I don't think so. If you count in insurance fees, medicare (parts A B & D), medicaid.......it would be paid for.

Thanks for listening.
jaxx

[Catshrink]

14. I think Wal-Mart's purported changes in health care is a beginning

They just asked governors to help make health care "more affordable" for its employees. I think it's the beginning of national health care. (Not an endorsement of Wal-Mart by the way...)

http://news.yahoo.com/s/ap/20060227/ap_on_bi_ge/governors_wal_mart_3

[tyedyeto]

17. My mom had chest pains a couple of weeks ago

ER time was about 6 hours because there was no bed available on the cardiology floor at the time.

Thankfully all tests showed that she has no heart problems, but the waiting did make all of us very im'patient'.

[bigwillq]

18. Hope your dad is on the mend soon enough.

:hi: :hug: