EMS - EC handoffs - ER Hallway patients.

[Krin135 at aol.com]

In a message dated 3/3/2007 10:55:02 AM Central Standard Time,  
KMATTOX at aol.com writes:

I  recognize the EC is overcrowded, often with non -  emergencies.   That is 
a policy and societal problem with which  we MUST  grapple.  I recognize that 
persons call the ambulance and EMS   to expedite getting into the ER, but 
society (consumerism) has assumed  that if  one arrives by ambulance to an 
ER, the 
patient will be seen,  triaged, and cared  for expediciously (? 5 minutes or  
less).   That assumption becomes a  duty when it gets into  a court room, 
especially if a BAD outcome happened after  arrival at  the hospital and 
before the 
hospital and its medical staff assumed   care.  


as I've pointed out before, one major part of this problem (the need to  
'warehouse' patients in the ED waiting for critical care or floor beds), can be  
directly traced to the current nursing shortage and the reluctance of  
administration staff to provide adequate incentives to recruit and retain nurses  at 
all levels. This needs to go to the point of major teaching hospitals forming  
active partnerships with nursing schools to improve the pay rate of nursing  
instructors and figuring out ways to increase the number of nursing preceptors  
who are willing and able to work one on one with junior and senior nursing  
students and new graduates to make sure that the new nurses start out right,  
with not only book knowledge but also the practical knowledge to handle the 
case  load and provide satisfying care to sick patients. This was one of the 
great  advantages of the old Diploma Nursing programs that did not carry over into 
the  more 'professional' requirements developed in the 1970s.
 
Another problem, exacerbated by things like Never 27 and some of the JCAHO  
requirements, is that far too much nursing time is taken up by paper work,  and 
even the use of bedside computers for direct data entry does not seem to  
ease that crunch. Increasing the clerical staff will help some, but getting more  
doctors 'computer savvy' and willing to do at least some of their own data 
entry  (absent a dedicated scribe, another JCAHO requirement...) will help 
reduce the  stress on the nurses and techs who otherwise have to interpret crabbed 
hand  writing and poor spelling.
 
Comments on SNurse-L for many years have shown that the concept that  'nurses 
eat their young' has only grown as the stress levels of floor nurses  have 
also grown over the years. If we can't get more of our young folks  interested 
in, and comfortable with, direct patient care, then having more  doctors, mid 
level practitioners or field Paramedics will not have any  impact on the 
provision of proper Emergency Department or acute inpatient  care.
 
As far as TV setting the standard of care, that has been a problem since  
"Emergency!", "Marcus Welby, MD," and "Rescue 911" always managed to fix the  
patients (often exotic) problem in 50 minutes (time off for commercials),  and 
rarely lost a patient.
 
ck
Charles S. Krin, DO FAAFP
<BR><BR><BR>**************************************<BR> AOL now offers free 
email to everyone.  Find out more about what's free from AOL at 
http://www.aol.com.