Posts Tagged ‘emergency rooms’

The Overburdened, Understaffed Emergency Room – Part 2

April 25, 2011

The Medical Center Emergency and Trauma Center's ambulance entrance

  I asked the nurse assigned to me, “How many doctors are on duty tonight?”  She replied , “Two.”  That confirmed my suspicion that The Medical Center’s Emergency and Trauma Center was understaffed that night, Sunday, April 3, 2011. That suspicion had been formed when another nurse, the one assigned to triage, told me that wait times would probably be up to seven  hours for some of the many people sitting in the ETC waiting room, and the average wait would be about five hours.  Because I had a head wound and was on a blood thinner which could have increased the chances of internal bleeding, I didn’t have to wait that long.  I got to see a doctor in about two hours from the time I signed in. 

So,  my impression was the ETC was like emergency rooms all over the country, overburdened and understaffed, but was it? In my opinion, that  night, Sunday, April 3, 2011, it was.  However, it was not a normal night. I learned just how abnormal it was when I posed a few questions to Marion Scott, who is Director of Communications for the Columbus Regional Medical System.  I decided to let her speak for herself unedited. This is what she wrote to me.

On the night you were treated, staffing in the ETC was at the “best practice” standard as set by the national Emergency Nurses Association. Staffing ratio is one nurse to four patients.
There were two emergency physicians in the ETC that evening; again, an appropriate staffing level under routine conditions. Residents from our teaching program do not routinely work in ETC. They do report to the ETC for duty when we call “trauma,” a designation indicating extraordinary and severe patient volume that increases staffing across clinical and non-clinical support areas. We typically have one to three trauma cases in a 24-hour period. In the 24-hour period during which you were treated, we had 20 trauma cases – seven to ten times the normal trauma volume.
You also asked about the number of patients treated in the Emergency and Trauma Center who cannot pay for care. For our last full fiscal year, which ended June 30, 2010, 86 percent of the total patient encounters through the ETC were uninsured and 33 percent resulted in uncompensated care. The Medical Center’s total uncompensated care for last fiscal year was just over $32 million.
As you and I have discussed, the greater issue related to emergency care is the number of people who use an emergency room for minor illnesses and injuries and for primary care. Approximately 40 percent of the patients treated in The Medical Center’s ETC could have been treated in a more appropriate setting, such as their physician’s office or an urgent care center. The result of inappropriate use of an emergency room is overcrowded emergency rooms with long waits, inefficient use of hospital resources and higher costs for patients and insurers.
Also, many people treated in an emergency room for minor illnesses and injuries do not have a physician, or “medical home.” It is so important to have a physician with whom you can establish an ongoing relationship and who will understand your health and medical needs and provide continuity of care.
There are no easy answers or quick fixes to these serious problems. We can address the issues through education, communication, and services to assist the uninsured in finding programs that might help them and to assist people without a physician in finding a medical home. 

The Overburdened, Understaffed Emergency Room – Part 1…Again

April 22, 2011

Since it has taken so long to get the information I wanted to use for part 2 of this series, I figured I would run Part 1 again so it will be fresh on your minds.  I’m shooting for Monday as posting day. I think you’ll find what I have learned interesting. Meanwhile, here’s Part 1 again.  

If you really want to know what an emergency room is like, go as a patient. I did just that when I went to the Columbus Medical Center Emergency Department on  Sunday night, April 3, 2011.  It’s a really nice new facility,  with a professional and friendly staff, which is now a state designated Level Two  trauma center that serves 13 counties in West Georgia and East Alabama. But, there were problems, and they are the same problems emergency rooms face all over the country. 

Since I definitely suffered a trauma when I fell backwards onto a sidewalk, hitting my head, I figured I wouldn’t have to wait long to receive treatment.  After all, there was a really big lump on the back of my head, and I am on a blood thinner for my heart condition atrial fibrillation, which meant I could have been suffering internal bleeding.  I was wrong.

It was on a Sunday night and the emergency room was packed with people waiting to be treated. I knew that all emergency rooms stay very busy because people, who don’t have healthcare insurance and can’t  afford to pay for treatment,  go there to be treated for non-emergency conditions, things like colds and sore throats. But I figured that triage would get me in fairly soon after arrival. After all, a head injury with possible internal bleeding should trump a cold.

I estimate that it took about forty-five minutes from the time I signed in until I saw the triage nurse, a warm, empathetic lady,  who honestly explained the situation.   (Being more concerned about my condition, I didn’t think to advise the staff that served me that I might do a blog on this, so I won’t be using any names.)  She said that some people would be waiting seven hours, and that the average  wait for a night that busy was probably five.  I let her know that with a head injury, on a blood thinner, with possible internal bleeding, I couldn’t wait five hours. She said she knew that and my wait would not be that long since I was a three.  That put me in the middle of the triage line.    There are five triage categories. She explained that five is for people whose condition is the least  urgent.  One, she said,  is for people who need to see a doctor immediately.

Since it was an unusually busy day with a lot of vehicle accidents, including one that involved five motorcycles, there were more number ones than normal.  I would estimate that it took about two hours for me to see a physician, a really nice man, who decided I should have a CT scan.  He said the big bump on the back of my head, an external injury, concerned him a lot less than a possible internal jury.   Fortunately the scan showed my brain had not been injured.  He gave me instructions on caring for a concussion and , after an almost five-hour visit, a friend, who had taken me to the emergency room, drove me home.

Though retired, my reporter’s curiosity , which, after fifty years as a broadcast journalist will probably never go away, inspired me to learn more about  the emergency room situation, not only at the Columbus Medical Center, but nationally.  The common description used by reporters that the facilities are overburdened and understaffed had a true ring to it after my experience.  I’ll tell you what I have learned and discuss some possible solutions in a future post. Stay tuned.