Emergency health care in ‘serious condition’

[liberal N proud]

System in poor capacity to deal with public health disasters, analysis finds
Updated: 12:01 a.m. ET Jan. 10, 2006
WASHINGTON - The nation’s emergency care system itself is ailing, warns a new health care analysis.

“The emergency health care system’s in serious condition. We have a safety net for health care that is frayed,” said Dr. Stephen Epstein, an emergency care physician at Beth Israel Deaconess Medical Center in Boston.
<snip>
The panel found a system that is overcrowded, with access to emergency care declining and with poor capacity to deal with public health or terrorist disasters.

“Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly that isn’t the case,” said Dr. Frederick C. Blum, president of the physicians group.

http://www.msnbc.msn.com/id/10779389/

********************
Nothing about what needs to be done to correct the health care problems this country is facing.

[w8liftinglady]

1. universal health care would fix the problem

a lot of what is seen now are patients with no insurance who have "doctor's office"-type illnesses.They simply have no other option.

[area51]

4. how true.

If we can spend billions & trillions on Iraqnam, we can have universal healthcare.

We have a socialized police force, socialized fire dept, socialized medicare & these things are considered all right; we can also have socialized medicine.

A country that lets people die of treatable diseases isn't civilized.

Whom would Jesus deny treatment to?

[leftchick]

8. 2 Trillion

conservatively.

[Telly Savalas]

15. We already spend more per capita on health care than any other nation

It's just that a huge percentage of that money goes into the bloated private insurance bureaucracy. Other countries can do more with less because they have more streamlined single-payer systems. If we were to commit our resources to such a system, health care in America would be the envy of the world.

[rodeodance]

2. we do not have a 'system"---just a patchwork of public and private

clinics, personal that in many cases function on a shoestring budget--.


...“The emergency health care system’s in serious condition.

[REP]

3. I Avoid The ER At All Costs - Too Dangerous

Too many people with non-emergent URIs, too many interns/residents who can't read a fucking chart.

[no_hypocrisy]

14. Two years ago, I tore my ACL. Nearest ER was 5 minutes away. I drove

with the "bad" leg WITH A CLUTCH 30 minutes DURING RUSH HOUR (stop-and-go traffic), in the dark and rain to see my PCP. I was seen within 30 minutes of arrival versus waiting 4 hours to put my name on the waiting list at the ER.

[loyalsister]

5. Dr. shortage?

Someone told me that the problem with health care is that there is a shortage of Dr.s I have only heard that once and am not sure that I believe it. Even if there is there are two problems with that argument.
A. Doctors are not needed as frequently if adequate preventative care is provided.
B. Much of that care can be provided by a nurse practitioner or P.A.
Thus, access to better preventative care provided by those health care professionals would certainly give physicians the opportunity to spend time with plenty of patients. Particularly since there would be a reduction in the amount of health problems encountered.
The problem is access and delivery. You don't need as many doctors if you don't have as much sickness.

[Horse with no Name]

6. That's a new one

There are plenty of docs out there.
There has been a nursing shortage forever though.

[tavalon]

9. They are behind us (nurses) in their shortage

but they are beginning to have a shortage also. The educator population in both fields are getting old and retiring right along with the baby boomers (and lots of baby boomer doctors as well). Therefore more doctors and nurses are needed for the aging population but no more than are now being shuttled through the education system can be because of the teacher bottleneck.

[mantis49]

16. There is a shortage of docs in rural areas.

Big money in the cities.

[Horse with no Name]

18. There has always been a doc shortage in rural areas

They are considered underserved.
In fact, if you go to school to become a Physician's Assistant and agree to work in an underserved area for two years, then that town will pay for your schooling.

[tavalon]

7. Nurses have a severe shortage now

Doctors are beginning to. Respiratory therapists also have a shortage. Physical therapists do too. The person who mentioned that we have no system is dead on. Universal health care is absolutely, desperately needed but that won't fix the system in and of itself. It's a huge mess.

Edited: for the elusive O ;)

[raccoon]

10. Foreign nurses, etc. will take up the slack.

They'll be brought into the US on work visas.

[tavalon]

11. Oh, that's worked well so far

Not! You don't think our hospitals have tried that? So far, not enough of them have managed to pass our NCLEX. If that was the fix, we wouldn't have been in a shortage for the last 10 years and a severe shortage in the last three and projected to have a critical shortage within 15 years.

As a travel nurse, I have my pick of assignments. OTOH, I hate working with barebones staff where I'm so busy that the best I can say at the end of my shift is that no one died under my watch. That isn't the level of care I want to provide but it is often all I can provide because of the shortage.

[raccoon]

12. Thanks for your post. Another thing I've heard is that

the shortage of nurses is in hospitals, not in other areas where nurses are employed, such as doctors' offices, state health departments, etc. Do you know if there's any truth to that?

[tavalon]

13. Honestly, I don't know

I have noticed that doctor's offices tend to utilize CAs (Clinical Assistants) a lot more than hospitals do. But that's only safe if someone is micromanaging them because they aren't trained to have the critical thinking skills we have.

[Horse with no Name]

17. That is true

But you also have to remember that there is a lot of the shortage in the hospitals intentionally created by the hospitals themselves.
They have all of the cockamamie formulas devised to justify short staffing so that they can save money. They call it acuity. Each patient is assigned a random number of their care. Of course this number never takes into account the fact that some patients are needier than others--although may not be sicker than others. So if you give one nurse a patient that has a low acuity but a patient that demands high maintenance--then you just short staffed that particular nurse.
I had a patient that had a car accident. This patient spent hours with his attorneys every day trying to figure out how to sue someone for his injuries. The main problem was that the man had no injuries. He was scheduled to go home. His attorney told him to troll for a hospital lawsuit. Every time you went in his room, he took your name down and wrote down what time you were there and what you were doing.
This was supposedly my "easy" patient.
I had a postoperative patient start spewing blood--literally--from every orifice.
I was at her bedside for almost two hours solid with a surgeon trying to get her stabilized. We basically ended up running a code, although the woman never actually stopped breathing. While I was in this woman's room, this patient called and wanted his Pepcid. It was the only medication that he received and he was due to receive it at 9 pm and at 9:15 he wanted to know why his medication was late. I asked my charge nurse to please go give him his medication. (Of note, any scheduled medication given in the hospital has a window of an hour that you can give it in so that is not considered late.) Anyway, my charge nurse took this medication and administered it. The patient DEMANDED to see HIS nurse. The charge nurse tried to explain that I was in an emergency situation with another patient and was unavailable. The patient said so "basically I don't have a nurse right now"?
The charge nurse explained to him that he had a nurse--that part of his job as charge nurse was to help pick up the slack when the other nurses got tied up. So basically this patient actually had two nurses, his primary nurse and his charge nurse.
Of course this wasn't good enough for this patient who then telephoned his attorney trying to find out the legal definition of abandonment and trying to ascertain if I--as his primary nurse--had abandoned him.:wtf:
When his attorney advised him that he had not been abandoned, he finally allowed my charge nurse to leave the room after spending almost an hour at this man's bedside.
When I finally finished with my critical patient and got her packaged and sent back to surgery, I telephoned this man's doctor. I told him what had transpired. He told me to discontinue EVERYTHING on this man's chart. He was going home in the am and there wasn't anything wrong with him anyway.
So I wrote the orders to discontinue the IV, discontinue the Pepcid, discontinue q4 hour vital signs and drop them to routine (which was once every 12 hours), and to begin his discharge planning.
So I went in this room to discontinue the IV, the patient refused to let me. Told me that I had abandoned his care and that he wanted another nurse.
So really with nothing left to do--I handed over his care to another nurse. But the point is--that out of a four hour period--this man tied up over two hours of nursing care. Patients like this do exist.
Nurses cope every day with patients like this who insist that their needs --no matter how insane--are met before anyone elses.
Should I tell you the story of the little boy who quit breathing and obviously had most of the staff working on bringing him back to life and another child's mother marching in the room during the code demanding FRESH WATER for her child RIGHT NOW?
You work good nurses short staffed deliberately enough times, then those nurses WILL leave and seek other opportunities.
Part of the problem does also lie with the segment of population (that I would like to think are Republicans) that do not appreciate or value the nursing staff and care only about themselves.

[raccoon]

19. What a dick that patient was. I hope he doesn't get any settlement.

People like that sure make it hard for those who have a REAL injury.

[Horse with no Name]

20. He didn't get a penny

for injuries. He didn't get a penny from the hospital.
The most he might have received was for damages to his vehicle.
People like this are one reason that nursing shortages exist.

[raccoon]

21. Occasionally, there is justice in this world!

And if that man has an SO, I pity the fool.