Re: Extortion

[Guest guest]

Bob,

I've seen that happen more times than I'd like to mention. I've even seen a

" traffic jam " of stretchers and medics as the charge nurse tells the crews " Wait

here, and I'll give you a bed assignment in a minute. " That is, of course,

followed by an eventual bed assignment. Waiting for the nurse is another thing

in itself as we are first usually greeted by a tech whose first words are, " I'm

not the nurse. " Honestly, I've seen crews get to give a report to the ER doc

before the nurse even comes in. Maybe we need SSM for nurses? <EVIL GRIN>

However, knowing the inherent contrary nature of some on this list, do you

really think that someone wouldn't stand in opposition? ;-)

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

Extortion

I read with great interest, as I have for years now, the call to arms for EMS

providers in Texas to " get on the same page " ; " lay down our differences " ; " come

together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

things, however, there's something missing. A reason to do all of those things!

Some years ago I wrote a sprawling (if not yawning) post to this list that

suggested that a common cause or sentinal issue, if properly defined and

targeted at the gress roots, would serve to rally and galvanize all of the EMS

constituencies. It would provide substantive and beneficial action upon which

EMSAT and its leaders could springboard into a prominent position in the arenas

of Texas healthcare policy and politics.

One example (and there are many) is the growing and pernicious practice of

hospitals using EMS personnel to tend to their patients while in their

facilities - without compensation, and in many cases without appreciation. By

citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

themselves of our " free " services in a setting for which they bear complete

liability for care rendered by people who are not employed by their facilities.

But, is it really " free " ? To the facilities the answer is yes. But, everyone in

EMS is paying - big time! The front line personnel (all of them) are being kept

from their primary dutiy of providing EMS availability and response to the

general public. EMS operators (all of them) are subsidizing these facilities

with free labor (visable costs), while this practice adversely affects

utilization productivity, thus requiring increased staffing and deployment to

cover the down time (invisable costs).

Many EMS managers aren't even aware of this impact because the use of SSM

calculus does not reveal the benign cause of their productivity problems -

short of an ever increasing total trip time. Some even accuse their field

personnel of lollygagging around. Communications centers often boil over as

dispatchers get backlogged with 911 traffic and begin screaming at their crews

to clear the facilities.

All the while, field personnel are being held hostage by hospital managers for

problems that aren't the responsibility of EMS. Our people have been relegated

to the roles of living I.V. poles, vitals takers and panic button hitters when

their patients start to show signs of crashing. The economic impact of this

practice on EMS can do nothing but grow worse going forward.

The overt rediculousness of this dilemma can bst be illustrated by role

reversal. Imagine, if you can, that EMS agencis are granted the ability to go

into facilities; grab a couple of the hospitals ICU nurses; and go run 911

calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way, we're

not going to pay them - or you - a stinking cent for it. What do you think the

hospital managers would do? Well, you know the answer. The Texas Hospital

Association would be all over Austin lobbying for legislative intervention and

protection.

All of these costs and waste were created by administrative fiat on the part of

hospital managers, who use the unspoken fear of losing non-emergency business

if EMS managers refuse to " play the game " . EMS managers - out of paranoia -

agree to " play the game " in the belief that if they don't - their competitors

will. That's why the TAA is the only existing association that could not take

an active part of throwing off this " yoke on the neck of EMS " . But, I'll bet

they would lend indirect support.

Sorry for the rant, but if you want to do something that will have a serious

economic, humanitarian and public health impact - do something about this

problem. Who in the Texas EMS community would rationally stand in opposition?

Bob Kellow

[Guest guest]

Bob,

I've seen that happen more times than I'd like to mention. I've even seen a

" traffic jam " of stretchers and medics as the charge nurse tells the crews " Wait

here, and I'll give you a bed assignment in a minute. " That is, of course,

followed by an eventual bed assignment. Waiting for the nurse is another thing

in itself as we are first usually greeted by a tech whose first words are, " I'm

not the nurse. " Honestly, I've seen crews get to give a report to the ER doc

before the nurse even comes in. Maybe we need SSM for nurses? <EVIL GRIN>

However, knowing the inherent contrary nature of some on this list, do you

really think that someone wouldn't stand in opposition? ;-)

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

Extortion

I read with great interest, as I have for years now, the call to arms for EMS

providers in Texas to " get on the same page " ; " lay down our differences " ; " come

together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

things, however, there's something missing. A reason to do all of those things!

Some years ago I wrote a sprawling (if not yawning) post to this list that

suggested that a common cause or sentinal issue, if properly defined and

targeted at the gress roots, would serve to rally and galvanize all of the EMS

constituencies. It would provide substantive and beneficial action upon which

EMSAT and its leaders could springboard into a prominent position in the arenas

of Texas healthcare policy and politics.

One example (and there are many) is the growing and pernicious practice of

hospitals using EMS personnel to tend to their patients while in their

facilities - without compensation, and in many cases without appreciation. By

citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

themselves of our " free " services in a setting for which they bear complete

liability for care rendered by people who are not employed by their facilities.

But, is it really " free " ? To the facilities the answer is yes. But, everyone in

EMS is paying - big time! The front line personnel (all of them) are being kept

from their primary dutiy of providing EMS availability and response to the

general public. EMS operators (all of them) are subsidizing these facilities

with free labor (visable costs), while this practice adversely affects

utilization productivity, thus requiring increased staffing and deployment to

cover the down time (invisable costs).

Many EMS managers aren't even aware of this impact because the use of SSM

calculus does not reveal the benign cause of their productivity problems -

short of an ever increasing total trip time. Some even accuse their field

personnel of lollygagging around. Communications centers often boil over as

dispatchers get backlogged with 911 traffic and begin screaming at their crews

to clear the facilities.

All the while, field personnel are being held hostage by hospital managers for

problems that aren't the responsibility of EMS. Our people have been relegated

to the roles of living I.V. poles, vitals takers and panic button hitters when

their patients start to show signs of crashing. The economic impact of this

practice on EMS can do nothing but grow worse going forward.

The overt rediculousness of this dilemma can bst be illustrated by role

reversal. Imagine, if you can, that EMS agencis are granted the ability to go

into facilities; grab a couple of the hospitals ICU nurses; and go run 911

calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way, we're

not going to pay them - or you - a stinking cent for it. What do you think the

hospital managers would do? Well, you know the answer. The Texas Hospital

Association would be all over Austin lobbying for legislative intervention and

protection.

All of these costs and waste were created by administrative fiat on the part of

hospital managers, who use the unspoken fear of losing non-emergency business

if EMS managers refuse to " play the game " . EMS managers - out of paranoia -

agree to " play the game " in the belief that if they don't - their competitors

will. That's why the TAA is the only existing association that could not take

an active part of throwing off this " yoke on the neck of EMS " . But, I'll bet

they would lend indirect support.

Sorry for the rant, but if you want to do something that will have a serious

economic, humanitarian and public health impact - do something about this

problem. Who in the Texas EMS community would rationally stand in opposition?

Bob Kellow

[Guest guest]

Bob,

Thank you for posting yet again another motivating post. You have

pointed out one of the many problems EMS is facing today here in our great

State of Texas. Again I tip my hat off to you my friend. Hope to see you at

the Conference. Take care my friend.

Lt./LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext. 3233

Fax

Extortion

I read with great interest, as I have for years now, the call to arms for

EMS

providers in Texas to " get on the same page " ; " lay down our differences " ;

" come

together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

things, however, there's something missing. A reason to do all of those

things!

Some years ago I wrote a sprawling (if not yawning) post to this list that

suggested that a common cause or sentinal issue, if properly defined and

targeted at the gress roots, would serve to rally and galvanize all of the

EMS

constituencies. It would provide substantive and beneficial action upon

which

EMSAT and its leaders could springboard into a prominent position in the

arenas

of Texas healthcare policy and politics.

One example (and there are many) is the growing and pernicious practice of

hospitals using EMS personnel to tend to their patients while in their

facilities - without compensation, and in many cases without appreciation.

By

citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

themselves of our " free " services in a setting for which they bear complete

liability for care rendered by people who are not employed by their

facilities.

But, is it really " free " ? To the facilities the answer is yes. But, everyone

in

EMS is paying - big time! The front line personnel (all of them) are being

kept

from their primary dutiy of providing EMS availability and response to the

general public. EMS operators (all of them) are subsidizing these facilities

with free labor (visable costs), while this practice adversely affects

utilization productivity, thus requiring increased staffing and deployment

to

cover the down time (invisable costs).

Many EMS managers aren't even aware of this impact because the use of SSM

calculus does not reveal the benign cause of their productivity problems -

short of an ever increasing total trip time. Some even accuse their field

personnel of lollygagging around. Communications centers often boil over as

dispatchers get backlogged with 911 traffic and begin screaming at their

crews

to clear the facilities.

All the while, field personnel are being held hostage by hospital managers

for

problems that aren't the responsibility of EMS. Our people have been

relegated

to the roles of living I.V. poles, vitals takers and panic button hitters

when

their patients start to show signs of crashing. The economic impact of this

practice on EMS can do nothing but grow worse going forward.

The overt rediculousness of this dilemma can bst be illustrated by role

reversal. Imagine, if you can, that EMS agencis are granted the ability to

go

into facilities; grab a couple of the hospitals ICU nurses; and go run 911

calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way,

we're

not going to pay them - or you - a stinking cent for it. What do you think

the

hospital managers would do? Well, you know the answer. The Texas Hospital

Association would be all over Austin lobbying for legislative intervention

and

protection.

All of these costs and waste were created by administrative fiat on the part

of

hospital managers, who use the unspoken fear of losing non-emergency

business

if EMS managers refuse to " play the game " . EMS managers - out of paranoia -

agree to " play the game " in the belief that if they don't - their

competitors

will. That's why the TAA is the only existing association that could not

take

an active part of throwing off this " yoke on the neck of EMS " . But, I'll bet

they would lend indirect support.

Sorry for the rant, but if you want to do something that will have a serious

economic, humanitarian and public health impact - do something about this

problem. Who in the Texas EMS community would rationally stand in

opposition?

Bob Kellow

[Guest guest]

Bob,

Thank you for posting yet again another motivating post. You have

pointed out one of the many problems EMS is facing today here in our great

State of Texas. Again I tip my hat off to you my friend. Hope to see you at

the Conference. Take care my friend.

Lt./LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext. 3233

Fax

Extortion

I read with great interest, as I have for years now, the call to arms for

EMS

providers in Texas to " get on the same page " ; " lay down our differences " ;

" come

together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

things, however, there's something missing. A reason to do all of those

things!

Some years ago I wrote a sprawling (if not yawning) post to this list that

suggested that a common cause or sentinal issue, if properly defined and

targeted at the gress roots, would serve to rally and galvanize all of the

EMS

constituencies. It would provide substantive and beneficial action upon

which

EMSAT and its leaders could springboard into a prominent position in the

arenas

of Texas healthcare policy and politics.

One example (and there are many) is the growing and pernicious practice of

hospitals using EMS personnel to tend to their patients while in their

facilities - without compensation, and in many cases without appreciation.

By

citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

themselves of our " free " services in a setting for which they bear complete

liability for care rendered by people who are not employed by their

facilities.

But, is it really " free " ? To the facilities the answer is yes. But, everyone

in

EMS is paying - big time! The front line personnel (all of them) are being

kept

from their primary dutiy of providing EMS availability and response to the

general public. EMS operators (all of them) are subsidizing these facilities

with free labor (visable costs), while this practice adversely affects

utilization productivity, thus requiring increased staffing and deployment

to

cover the down time (invisable costs).

Many EMS managers aren't even aware of this impact because the use of SSM

calculus does not reveal the benign cause of their productivity problems -

short of an ever increasing total trip time. Some even accuse their field

personnel of lollygagging around. Communications centers often boil over as

dispatchers get backlogged with 911 traffic and begin screaming at their

crews

to clear the facilities.

All the while, field personnel are being held hostage by hospital managers

for

problems that aren't the responsibility of EMS. Our people have been

relegated

to the roles of living I.V. poles, vitals takers and panic button hitters

when

their patients start to show signs of crashing. The economic impact of this

practice on EMS can do nothing but grow worse going forward.

The overt rediculousness of this dilemma can bst be illustrated by role

reversal. Imagine, if you can, that EMS agencis are granted the ability to

go

into facilities; grab a couple of the hospitals ICU nurses; and go run 911

calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way,

we're

not going to pay them - or you - a stinking cent for it. What do you think

the

hospital managers would do? Well, you know the answer. The Texas Hospital

Association would be all over Austin lobbying for legislative intervention

and

protection.

All of these costs and waste were created by administrative fiat on the part

of

hospital managers, who use the unspoken fear of losing non-emergency

business

if EMS managers refuse to " play the game " . EMS managers - out of paranoia -

agree to " play the game " in the belief that if they don't - their

competitors

will. That's why the TAA is the only existing association that could not

take

an active part of throwing off this " yoke on the neck of EMS " . But, I'll bet

they would lend indirect support.

Sorry for the rant, but if you want to do something that will have a serious

economic, humanitarian and public health impact - do something about this

problem. Who in the Texas EMS community would rationally stand in

opposition?

Bob Kellow

[Guest guest]

Bob,

Thank you for posting yet again another motivating post. You have

pointed out one of the many problems EMS is facing today here in our great

State of Texas. Again I tip my hat off to you my friend. Hope to see you at

the Conference. Take care my friend.

Lt./LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext. 3233

Fax

Extortion

I read with great interest, as I have for years now, the call to arms for

EMS

providers in Texas to " get on the same page " ; " lay down our differences " ;

" come

together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

things, however, there's something missing. A reason to do all of those

things!

Some years ago I wrote a sprawling (if not yawning) post to this list that

suggested that a common cause or sentinal issue, if properly defined and

targeted at the gress roots, would serve to rally and galvanize all of the

EMS

constituencies. It would provide substantive and beneficial action upon

which

EMSAT and its leaders could springboard into a prominent position in the

arenas

of Texas healthcare policy and politics.

One example (and there are many) is the growing and pernicious practice of

hospitals using EMS personnel to tend to their patients while in their

facilities - without compensation, and in many cases without appreciation.

By

citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

themselves of our " free " services in a setting for which they bear complete

liability for care rendered by people who are not employed by their

facilities.

But, is it really " free " ? To the facilities the answer is yes. But, everyone

in

EMS is paying - big time! The front line personnel (all of them) are being

kept

from their primary dutiy of providing EMS availability and response to the

general public. EMS operators (all of them) are subsidizing these facilities

with free labor (visable costs), while this practice adversely affects

utilization productivity, thus requiring increased staffing and deployment

to

cover the down time (invisable costs).

Many EMS managers aren't even aware of this impact because the use of SSM

calculus does not reveal the benign cause of their productivity problems -

short of an ever increasing total trip time. Some even accuse their field

personnel of lollygagging around. Communications centers often boil over as

dispatchers get backlogged with 911 traffic and begin screaming at their

crews

to clear the facilities.

All the while, field personnel are being held hostage by hospital managers

for

problems that aren't the responsibility of EMS. Our people have been

relegated

to the roles of living I.V. poles, vitals takers and panic button hitters

when

their patients start to show signs of crashing. The economic impact of this

practice on EMS can do nothing but grow worse going forward.

The overt rediculousness of this dilemma can bst be illustrated by role

reversal. Imagine, if you can, that EMS agencis are granted the ability to

go

into facilities; grab a couple of the hospitals ICU nurses; and go run 911

calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way,

we're

not going to pay them - or you - a stinking cent for it. What do you think

the

hospital managers would do? Well, you know the answer. The Texas Hospital

Association would be all over Austin lobbying for legislative intervention

and

protection.

All of these costs and waste were created by administrative fiat on the part

of

hospital managers, who use the unspoken fear of losing non-emergency

business

if EMS managers refuse to " play the game " . EMS managers - out of paranoia -

agree to " play the game " in the belief that if they don't - their

competitors

will. That's why the TAA is the only existing association that could not

take

an active part of throwing off this " yoke on the neck of EMS " . But, I'll bet

they would lend indirect support.

Sorry for the rant, but if you want to do something that will have a serious

economic, humanitarian and public health impact - do something about this

problem. Who in the Texas EMS community would rationally stand in

opposition?

Bob Kellow

[Guest guest]

You this is an interesting topic, I had this discussion with my wife (see

previous post) and from her nursing perspective, it's just an overwhelming

issue with NO solution.

I have explained to her MANY times that diversion, and waiting lines in the

ED is, plain and simply put, a poor management issue. Manage your

resources, manage your nurses, manage your beds.

When the 911 system gets overloaded we don't tell our callers " we're closed "

call someone else, we improvise, adapt and overcome (Happy Birthday USMC,

OOOOHra, BTW)

Mike

Extortion

I read with great interest, as I have for years now, the call to arms for

EMS

providers in Texas to " get on the same page " ; " lay down our differences " ;

" come

together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

things, however, there's something missing. A reason to do all of those

things!

Some years ago I wrote a sprawling (if not yawning) post to this list that

suggested that a common cause or sentinal issue, if properly defined and

targeted at the gress roots, would serve to rally and galvanize all of the

EMS

constituencies. It would provide substantive and beneficial action upon

which

EMSAT and its leaders could springboard into a prominent position in the

arenas

of Texas healthcare policy and politics.

One example (and there are many) is the growing and pernicious practice of

hospitals using EMS personnel to tend to their patients while in their

facilities - without compensation, and in many cases without appreciation.

By

citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

themselves of our " free " services in a setting for which they bear

complete

liability for care rendered by people who are not employed by their

facilities.

But, is it really " free " ? To the facilities the answer is yes. But,

everyone in

EMS is paying - big time! The front line personnel (all of them) are being

kept

from their primary dutiy of providing EMS availability and response to the

general public. EMS operators (all of them) are subsidizing these

facilities

with free labor (visable costs), while this practice adversely affects

utilization productivity, thus requiring increased staffing and deployment

to

cover the down time (invisable costs).

Many EMS managers aren't even aware of this impact because the use of SSM

calculus does not reveal the benign cause of their productivity problems -

short of an ever increasing total trip time. Some even accuse their field

personnel of lollygagging around. Communications centers often boil over

as

dispatchers get backlogged with 911 traffic and begin screaming at their

crews

to clear the facilities.

All the while, field personnel are being held hostage by hospital managers

for

problems that aren't the responsibility of EMS. Our people have been

relegated

to the roles of living I.V. poles, vitals takers and panic button hitters

when

their patients start to show signs of crashing. The economic impact of

this

practice on EMS can do nothing but grow worse going forward.

The overt rediculousness of this dilemma can bst be illustrated by role

reversal. Imagine, if you can, that EMS agencis are granted the ability to

go

into facilities; grab a couple of the hospitals ICU nurses; and go run 911

calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way,

we're

not going to pay them - or you - a stinking cent for it. What do you think

the

hospital managers would do? Well, you know the answer. The Texas Hospital

Association would be all over Austin lobbying for legislative intervention

and

protection.

All of these costs and waste were created by administrative fiat on the

part of

hospital managers, who use the unspoken fear of losing non-emergency

business

if EMS managers refuse to " play the game " . EMS managers - out of

paranoia -

agree to " play the game " in the belief that if they don't - their

competitors

will. That's why the TAA is the only existing association that could not

take

an active part of throwing off this " yoke on the neck of EMS " . But, I'll

bet

they would lend indirect support.

Sorry for the rant, but if you want to do something that will have a

serious

economic, humanitarian and public health impact - do something about this

problem. Who in the Texas EMS community would rationally stand in

opposition?

Bob Kellow

[Guest guest]

You this is an interesting topic, I had this discussion with my wife (see

previous post) and from her nursing perspective, it's just an overwhelming

issue with NO solution.

I have explained to her MANY times that diversion, and waiting lines in the

ED is, plain and simply put, a poor management issue. Manage your

resources, manage your nurses, manage your beds.

When the 911 system gets overloaded we don't tell our callers " we're closed "

call someone else, we improvise, adapt and overcome (Happy Birthday USMC,

OOOOHra, BTW)

Mike

Extortion

I read with great interest, as I have for years now, the call to arms for

EMS

providers in Texas to " get on the same page " ; " lay down our differences " ;

" come

together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

things, however, there's something missing. A reason to do all of those

things!

Some years ago I wrote a sprawling (if not yawning) post to this list that

suggested that a common cause or sentinal issue, if properly defined and

targeted at the gress roots, would serve to rally and galvanize all of the

EMS

constituencies. It would provide substantive and beneficial action upon

which

EMSAT and its leaders could springboard into a prominent position in the

arenas

of Texas healthcare policy and politics.

One example (and there are many) is the growing and pernicious practice of

hospitals using EMS personnel to tend to their patients while in their

facilities - without compensation, and in many cases without appreciation.

By

citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

themselves of our " free " services in a setting for which they bear

complete

liability for care rendered by people who are not employed by their

facilities.

But, is it really " free " ? To the facilities the answer is yes. But,

everyone in

EMS is paying - big time! The front line personnel (all of them) are being

kept

from their primary dutiy of providing EMS availability and response to the

general public. EMS operators (all of them) are subsidizing these

facilities

with free labor (visable costs), while this practice adversely affects

utilization productivity, thus requiring increased staffing and deployment

to

cover the down time (invisable costs).

Many EMS managers aren't even aware of this impact because the use of SSM

calculus does not reveal the benign cause of their productivity problems -

short of an ever increasing total trip time. Some even accuse their field

personnel of lollygagging around. Communications centers often boil over

as

dispatchers get backlogged with 911 traffic and begin screaming at their

crews

to clear the facilities.

All the while, field personnel are being held hostage by hospital managers

for

problems that aren't the responsibility of EMS. Our people have been

relegated

to the roles of living I.V. poles, vitals takers and panic button hitters

when

their patients start to show signs of crashing. The economic impact of

this

practice on EMS can do nothing but grow worse going forward.

The overt rediculousness of this dilemma can bst be illustrated by role

reversal. Imagine, if you can, that EMS agencis are granted the ability to

go

into facilities; grab a couple of the hospitals ICU nurses; and go run 911

calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way,

we're

not going to pay them - or you - a stinking cent for it. What do you think

the

hospital managers would do? Well, you know the answer. The Texas Hospital

Association would be all over Austin lobbying for legislative intervention

and

protection.

All of these costs and waste were created by administrative fiat on the

part of

hospital managers, who use the unspoken fear of losing non-emergency

business

if EMS managers refuse to " play the game " . EMS managers - out of

paranoia -

agree to " play the game " in the belief that if they don't - their

competitors

will. That's why the TAA is the only existing association that could not

take

an active part of throwing off this " yoke on the neck of EMS " . But, I'll

bet

they would lend indirect support.

Sorry for the rant, but if you want to do something that will have a

serious

economic, humanitarian and public health impact - do something about this

problem. Who in the Texas EMS community would rationally stand in

opposition?

Bob Kellow

[Guest guest]

To Bob Kellow,

Sir, you are absolutely correct. When the patient hits the hospital

property he/she is the responsibility of the ED. EMTALA is very clear on

this issue. I know from having served on the San Hospital's EMS

Diversion Task Force for many years and having served as the recent Chairman

of the 5 Baptist hospital Emergency Departments for many years.

You are staying around because you are a nice guy and want to do what is

best for the patient. But I will tell you unequivocally, that by staying

with your patient in the ED you are not helping to fix the problem and you

are neglecting your prime objective ---- to transport patients and practice

medicine in the streets. Is the ED staff going to help you do your job? Of

course not.

Sometimes it takes tough love to get necessary changes made. Overcrowding

in the ED is not our fault. It is not the fault of the ED either, but it is

the fault of the hospital system as a whole. One EMTALA fine and loosing

Medicare Certification will get their attention. They have the resources to

fix the problem.

This practice reminds me of a women that has been abused. The first time

shame on him -- the second time shame on her. Shame on us for allowing the

ED to abuse us over and over.

EMS medical directors (and operation managers) have the power to stop this

abusive practice right now. Write protocols and enforce policies that

require our paramedics to do their job right (drop off the patient and move

on), instead of enabling ED's to continue their dysfunctional operations. I

have done that with my 200+ paramedics and you can do the same. Have the

courage to stand up for what is right.

Best regards,

Larry MD

> I read with great interest, as I have for years now, the call to arms for EMS

> providers in Texas to " get on the same page " ; " lay down our differences " ;

> " come

> together as one voice " ; and, " join EMSAT " . I, too, believe in all of those

> things, however, there's something missing. A reason to do all of those

> things!

>

> Some years ago I wrote a sprawling (if not yawning) post to this list that

> suggested that a common cause or sentinal issue, if properly defined and

> targeted at the gress roots, would serve to rally and galvanize all of the EMS

> constituencies. It would provide substantive and beneficial action upon which

> EMSAT and its leaders could springboard into a prominent position in the

> arenas

> of Texas healthcare policy and politics.

>

> One example (and there are many) is the growing and pernicious practice of

> hospitals using EMS personnel to tend to their patients while in their

> facilities - without compensation, and in many cases without appreciation. By

> citing E.D. overcrowding, nursing shortages, etc., hospital managers avail

> themselves of our " free " services in a setting for which they bear complete

> liability for care rendered by people who are not employed by their

> facilities.

>

> But, is it really " free " ? To the facilities the answer is yes. But, everyone

> in

> EMS is paying - big time! The front line personnel (all of them) are being

> kept

> from their primary dutiy of providing EMS availability and response to the

> general public. EMS operators (all of them) are subsidizing these facilities

> with free labor (visable costs), while this practice adversely affects

> utilization productivity, thus requiring increased staffing and deployment to

> cover the down time (invisable costs).

>

> Many EMS managers aren't even aware of this impact because the use of SSM

> calculus does not reveal the benign cause of their productivity problems -

> short of an ever increasing total trip time. Some even accuse their field

> personnel of lollygagging around. Communications centers often boil over as

> dispatchers get backlogged with 911 traffic and begin screaming at their crews

> to clear the facilities.

>

> All the while, field personnel are being held hostage by hospital managers for

> problems that aren't the responsibility of EMS. Our people have been relegated

> to the roles of living I.V. poles, vitals takers and panic button hitters when

> their patients start to show signs of crashing. The economic impact of this

> practice on EMS can do nothing but grow worse going forward.

>

> The overt rediculousness of this dilemma can bst be illustrated by role

> reversal. Imagine, if you can, that EMS agencis are granted the ability to go

> into facilities; grab a couple of the hospitals ICU nurses; and go run 911

> calls! Oh, we'll bring 'em back in a couple of hours, And, oh by the way,

> we're

> not going to pay them - or you - a stinking cent for it. What do you think the

> hospital managers would do? Well, you know the answer. The Texas Hospital

> Association would be all over Austin lobbying for legislative intervention and

> protection.

>

> All of these costs and waste were created by administrative fiat on the part

> of

> hospital managers, who use the unspoken fear of losing non-emergency business

> if EMS managers refuse to " play the game " . EMS managers - out of paranoia -

> agree to " play the game " in the belief that if they don't - their competitors

> will. That's why the TAA is the only existing association that could not take

> an active part of throwing off this " yoke on the neck of EMS " . But, I'll bet

> they would lend indirect support.

>

> Sorry for the rant, but if you want to do something that will have a serious

> economic, humanitarian and public health impact - do something about this

> problem. Who in the Texas EMS community would rationally stand in opposition?

>

> Bob Kellow

>

>

>

>

>

>

[Guest guest]

In a message dated 10-Nov-05 22:02:31 Central Standard Time, miller@...

writes:

EMS medical directors (and operation managers) have the power to stop this

abusive practice right now. Write protocols and enforce policies that

require our paramedics to do their job right (drop off the patient and move

on), instead of enabling ED's to continue their dysfunctional operations. I

have done that with my 200+ paramedics and you can do the same. Have the

courage to stand up for what is right.

Looking at it from the other side, where are you going to put the bed bound

300 pound patient from the nursing home (that the nursing home, despite being

notified that the ED was NOT able to take their non critical patient with a

fever, sent anyway) when all the beds, including all hallway beds, are filled?

Maybe we need to look at filing EMTALA against some of the facilities who

are contributing to the congestion...like Nursing homes which have professional

nurses on staff, yet cannot handle anything outside the routine...or which

don't want to handle patients with recognized DNRs and insist on calling for

EMS when said patients start dying...

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 10-Nov-05 22:02:31 Central Standard Time, miller@...

writes:

EMS medical directors (and operation managers) have the power to stop this

abusive practice right now. Write protocols and enforce policies that

require our paramedics to do their job right (drop off the patient and move

on), instead of enabling ED's to continue their dysfunctional operations. I

have done that with my 200+ paramedics and you can do the same. Have the

courage to stand up for what is right.

Looking at it from the other side, where are you going to put the bed bound

300 pound patient from the nursing home (that the nursing home, despite being

notified that the ED was NOT able to take their non critical patient with a

fever, sent anyway) when all the beds, including all hallway beds, are filled?

Maybe we need to look at filing EMTALA against some of the facilities who

are contributing to the congestion...like Nursing homes which have professional

nurses on staff, yet cannot handle anything outside the routine...or which

don't want to handle patients with recognized DNRs and insist on calling for

EMS when said patients start dying...

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 10-Nov-05 11:07:34 Central Standard Time,

manemtp@... writes:

I have explained to her MANY times that diversion, and waiting lines in the

ED is, plain and simply put, a poor management issue. Manage your

resources, manage your nurses, manage your beds.

and often times it's NOT the ED which is having a problem managing beds,

nurses, etc....I'm sitting here reading this list with one, soon to be two

admits waiting for discharges to be completed upstairs, beds cleaned, etc...and

hoping that there will not be a slew of direct admits from the doctor's offices

to load those beds before my patients go up...

and I have a grand total of 6 regular beds and one hall bed available...so

1/3rd of my capacity is already filled...and we are starting a holiday

weekend...

S. Krin, DO FAAFP

[Guest guest]

In a message dated 10-Nov-05 11:07:34 Central Standard Time,

manemtp@... writes:

I have explained to her MANY times that diversion, and waiting lines in the

ED is, plain and simply put, a poor management issue. Manage your

resources, manage your nurses, manage your beds.

and often times it's NOT the ED which is having a problem managing beds,

nurses, etc....I'm sitting here reading this list with one, soon to be two

admits waiting for discharges to be completed upstairs, beds cleaned, etc...and

hoping that there will not be a slew of direct admits from the doctor's offices

to load those beds before my patients go up...

and I have a grand total of 6 regular beds and one hall bed available...so

1/3rd of my capacity is already filled...and we are starting a holiday

weekend...

S. Krin, DO FAAFP

[Guest guest]

In a message dated 10-Nov-05 11:07:34 Central Standard Time,

manemtp@... writes:

I have explained to her MANY times that diversion, and waiting lines in the

ED is, plain and simply put, a poor management issue. Manage your

resources, manage your nurses, manage your beds.

and often times it's NOT the ED which is having a problem managing beds,

nurses, etc....I'm sitting here reading this list with one, soon to be two

admits waiting for discharges to be completed upstairs, beds cleaned, etc...and

hoping that there will not be a slew of direct admits from the doctor's offices

to load those beds before my patients go up...

and I have a grand total of 6 regular beds and one hall bed available...so

1/3rd of my capacity is already filled...and we are starting a holiday

weekend...

S. Krin, DO FAAFP

[Guest guest]

In a message dated 11-Nov-05 11:56:21 Central Standard Time,

manemtp@... writes:

True Enough Dr Krin, the bed management you CAN control is discharges home.

Here in the metroplex there is a hospital, which will remain nameless, that

ROUTINELY keeps ambulatory patients in their bed till all paperwork

pertaining to their discharge is completed, instead of moving them, to say a

discharge CHAIR, to free up the bed. One example out of many. When a

paramedic in the " line " suggested that to the nursing staff, they were waved

off and told to mind their business and wait. Management of the facility

was just as eager to dismiss the suggestion. Nurses will do what they want

and how fast they want. That was made very clear.

And I know this is only one story, in one facility, but lets have a show of

hands (figuratively) who's had a similar scenario?

I've also seen the ED, like in your case, call their bed control person and

get irate because they were promised beds 30 minutes or an hour or MORE, ago

and still have patients in the ED. So what's the answer?

well, since this is such a small facility, I have a bit of direct

supervision involved...including bugging nursing supervisors etc...and we do

send what

patients we can to chair waiting...we've also had problems with clearing beds

with patients waiting to return to the Nursing home...to the point of being

stuck with a patient in the ED for 4 hours until the Nursing Home's driver

came on duty...

One thing that comes to mind (since I have in the past worn two hats: ED

doc and EMS director, this idea comes easy...) would be to have your EMS

direction doc sit down with the ED director and ED nurse manager and see what

can

be hashed out...

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 11-Nov-05 11:56:21 Central Standard Time,

manemtp@... writes:

True Enough Dr Krin, the bed management you CAN control is discharges home.

Here in the metroplex there is a hospital, which will remain nameless, that

ROUTINELY keeps ambulatory patients in their bed till all paperwork

pertaining to their discharge is completed, instead of moving them, to say a

discharge CHAIR, to free up the bed. One example out of many. When a

paramedic in the " line " suggested that to the nursing staff, they were waved

off and told to mind their business and wait. Management of the facility

was just as eager to dismiss the suggestion. Nurses will do what they want

and how fast they want. That was made very clear.

And I know this is only one story, in one facility, but lets have a show of

hands (figuratively) who's had a similar scenario?

I've also seen the ED, like in your case, call their bed control person and

get irate because they were promised beds 30 minutes or an hour or MORE, ago

and still have patients in the ED. So what's the answer?

well, since this is such a small facility, I have a bit of direct

supervision involved...including bugging nursing supervisors etc...and we do

send what

patients we can to chair waiting...we've also had problems with clearing beds

with patients waiting to return to the Nursing home...to the point of being

stuck with a patient in the ED for 4 hours until the Nursing Home's driver

came on duty...

One thing that comes to mind (since I have in the past worn two hats: ED

doc and EMS director, this idea comes easy...) would be to have your EMS

direction doc sit down with the ED director and ED nurse manager and see what

can

be hashed out...

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 11-Nov-05 11:56:21 Central Standard Time,

manemtp@... writes:

True Enough Dr Krin, the bed management you CAN control is discharges home.

Here in the metroplex there is a hospital, which will remain nameless, that

ROUTINELY keeps ambulatory patients in their bed till all paperwork

pertaining to their discharge is completed, instead of moving them, to say a

discharge CHAIR, to free up the bed. One example out of many. When a

paramedic in the " line " suggested that to the nursing staff, they were waved

off and told to mind their business and wait. Management of the facility

was just as eager to dismiss the suggestion. Nurses will do what they want

and how fast they want. That was made very clear.

And I know this is only one story, in one facility, but lets have a show of

hands (figuratively) who's had a similar scenario?

I've also seen the ED, like in your case, call their bed control person and

get irate because they were promised beds 30 minutes or an hour or MORE, ago

and still have patients in the ED. So what's the answer?

well, since this is such a small facility, I have a bit of direct

supervision involved...including bugging nursing supervisors etc...and we do

send what

patients we can to chair waiting...we've also had problems with clearing beds

with patients waiting to return to the Nursing home...to the point of being

stuck with a patient in the ED for 4 hours until the Nursing Home's driver

came on duty...

One thing that comes to mind (since I have in the past worn two hats: ED

doc and EMS director, this idea comes easy...) would be to have your EMS

direction doc sit down with the ED director and ED nurse manager and see what

can

be hashed out...

ck

S. Krin, DO FAAFP

[Guest guest]

True Enough Dr Krin, the bed management you CAN control is discharges home.

Here in the metroplex there is a hospital, which will remain nameless, that

ROUTINELY keeps ambulatory patients in their bed till all paperwork

pertaining to their discharge is completed, instead of moving them, to say a

discharge CHAIR, to free up the bed. One example out of many. When a

paramedic in the " line " suggested that to the nursing staff, they were waved

off and told to mind their business and wait. Management of the facility

was just as eager to dismiss the suggestion. Nurses will do what they want

and how fast they want. That was made very clear.

And I know this is only one story, in one facility, but lets have a show of

hands (figuratively) who's had a similar scenario?

I've also seen the ED, like in your case, call their bed control person and

get irate because they were promised beds 30 minutes or an hour or MORE, ago

and still have patients in the ED. So what's the answer?

Mike

Re: Extortion

In a message dated 10-Nov-05 11:07:34 Central Standard Time,

manemtp@... writes:

I have explained to her MANY times that diversion, and waiting lines in

the

ED is, plain and simply put, a poor management issue. Manage your

resources, manage your nurses, manage your beds.

and often times it's NOT the ED which is having a problem managing beds,

nurses, etc....I'm sitting here reading this list with one, soon to be two

admits waiting for discharges to be completed upstairs, beds cleaned,

etc...and

hoping that there will not be a slew of direct admits from the doctor's

offices

to load those beds before my patients go up...

and I have a grand total of 6 regular beds and one hall bed available...so

1/3rd of my capacity is already filled...and we are starting a holiday

weekend...

S. Krin, DO FAAFP

[Guest guest]

Maybe it's because Risk Managers/Legal don't understand it IS a risk?

Re: Extortion

I believe it's important for everyone to attempt to get on the same page,

however the hospital administrator and BOD is responsible for providing

the

hard logistical support. I wonder why the hospital's Risk Managers aren't

concerned about the liability associated with this practice? Perhaps they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs

because

they're still getting paid. The point is, however, that the negative

fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It would

be

a good thing if EMS personnel took a more active role in protecting their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is discharges

home.

> Here in the metroplex there is a hospital, which will remain nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them, to

say a

> discharge CHAIR, to free up the bed. One example out of many. When a

> paramedic in the " line " suggested that to the nursing staff, they were

waved

> off and told to mind their business and wait. Management of the

facility

> was just as eager to dismiss the suggestion. Nurses will do what they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a

show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control person

and

> get irate because they were promised beds 30 minutes or an hour or

MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors etc...and

we

do send what

> patients we can to chair waiting...we've also had problems with

clearing

beds

> with patients waiting to return to the Nursing home...to the point of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two hats:

ED

> doc and EMS director, this idea comes easy...) would be to have your EMS

> direction doc sit down with the ED director and ED nurse manager and see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

[Guest guest]

Maybe it's because Risk Managers/Legal don't understand it IS a risk?

Re: Extortion

I believe it's important for everyone to attempt to get on the same page,

however the hospital administrator and BOD is responsible for providing

the

hard logistical support. I wonder why the hospital's Risk Managers aren't

concerned about the liability associated with this practice? Perhaps they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs

because

they're still getting paid. The point is, however, that the negative

fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It would

be

a good thing if EMS personnel took a more active role in protecting their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is discharges

home.

> Here in the metroplex there is a hospital, which will remain nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them, to

say a

> discharge CHAIR, to free up the bed. One example out of many. When a

> paramedic in the " line " suggested that to the nursing staff, they were

waved

> off and told to mind their business and wait. Management of the

facility

> was just as eager to dismiss the suggestion. Nurses will do what they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a

show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control person

and

> get irate because they were promised beds 30 minutes or an hour or

MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors etc...and

we

do send what

> patients we can to chair waiting...we've also had problems with

clearing

beds

> with patients waiting to return to the Nursing home...to the point of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two hats:

ED

> doc and EMS director, this idea comes easy...) would be to have your EMS

> direction doc sit down with the ED director and ED nurse manager and see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

[Guest guest]

Maybe it's because Risk Managers/Legal don't understand it IS a risk?

Re: Extortion

I believe it's important for everyone to attempt to get on the same page,

however the hospital administrator and BOD is responsible for providing

the

hard logistical support. I wonder why the hospital's Risk Managers aren't

concerned about the liability associated with this practice? Perhaps they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs

because

they're still getting paid. The point is, however, that the negative

fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It would

be

a good thing if EMS personnel took a more active role in protecting their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is discharges

home.

> Here in the metroplex there is a hospital, which will remain nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them, to

say a

> discharge CHAIR, to free up the bed. One example out of many. When a

> paramedic in the " line " suggested that to the nursing staff, they were

waved

> off and told to mind their business and wait. Management of the

facility

> was just as eager to dismiss the suggestion. Nurses will do what they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a

show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control person

and

> get irate because they were promised beds 30 minutes or an hour or

MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors etc...and

we

do send what

> patients we can to chair waiting...we've also had problems with

clearing

beds

> with patients waiting to return to the Nursing home...to the point of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two hats:

ED

> doc and EMS director, this idea comes easy...) would be to have your EMS

> direction doc sit down with the ED director and ED nurse manager and see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

[Guest guest]

I know of a few hospitals that call EMS for their Code 99s. They have

the EMS crew run the entire code!! Whenever you tell the CEO that this

is NOT a good practice they tend to ignore you - until lawsuits,

liability, COBRA-EMTALA. and reimbursement are brought up.

-MH

>>> bkellow@... 11/11/05 1:40 PM >>>

I believe it's important for everyone to attempt to get on the same

page,

however the hospital administrator and BOD is responsible for providing

the

hard logistical support. I wonder why the hospital's Risk Managers

aren't

concerned about the liability associated with this practice? Perhaps

they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs

because

they're still getting paid. The point is, however, that the negative

fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It

would be

a good thing if EMS personnel took a more active role in protecting

their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is

discharges

home.

> Here in the metroplex there is a hospital, which will remain

nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them,

to

say a

> discharge CHAIR, to free up the bed. One example out of many. When

a

> paramedic in the " line " suggested that to the nursing staff, they

were

waved

> off and told to mind their business and wait. Management of the

facility

> was just as eager to dismiss the suggestion. Nurses will do what

they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a

show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control

person

and

> get irate because they were promised beds 30 minutes or an hour or

MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors

etc...and we

do send what

> patients we can to chair waiting...we've also had problems with

clearing

beds

> with patients waiting to return to the Nursing home...to the point

of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two

hats: ED

> doc and EMS director, this idea comes easy...) would be to have your

EMS

> direction doc sit down with the ED director and ED nurse manager and

see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

[Guest guest]

I know of a few hospitals that call EMS for their Code 99s. They have

the EMS crew run the entire code!! Whenever you tell the CEO that this

is NOT a good practice they tend to ignore you - until lawsuits,

liability, COBRA-EMTALA. and reimbursement are brought up.

-MH

>>> bkellow@... 11/11/05 1:40 PM >>>

I believe it's important for everyone to attempt to get on the same

page,

however the hospital administrator and BOD is responsible for providing

the

hard logistical support. I wonder why the hospital's Risk Managers

aren't

concerned about the liability associated with this practice? Perhaps

they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs

because

they're still getting paid. The point is, however, that the negative

fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It

would be

a good thing if EMS personnel took a more active role in protecting

their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is

discharges

home.

> Here in the metroplex there is a hospital, which will remain

nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them,

to

say a

> discharge CHAIR, to free up the bed. One example out of many. When

a

> paramedic in the " line " suggested that to the nursing staff, they

were

waved

> off and told to mind their business and wait. Management of the

facility

> was just as eager to dismiss the suggestion. Nurses will do what

they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a

show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control

person

and

> get irate because they were promised beds 30 minutes or an hour or

MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors

etc...and we

do send what

> patients we can to chair waiting...we've also had problems with

clearing

beds

> with patients waiting to return to the Nursing home...to the point

of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two

hats: ED

> doc and EMS director, this idea comes easy...) would be to have your

EMS

> direction doc sit down with the ED director and ED nurse manager and

see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

[Guest guest]

I believe it's important for everyone to attempt to get on the same page,

however the hospital administrator and BOD is responsible for providing the

hard logistical support. I wonder why the hospital's Risk Managers aren't

concerned about the liability associated with this practice? Perhaps they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs because

they're still getting paid. The point is, however, that the negative fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It would be

a good thing if EMS personnel took a more active role in protecting their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is discharges

home.

> Here in the metroplex there is a hospital, which will remain nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them, to

say a

> discharge CHAIR, to free up the bed. One example out of many. When a

> paramedic in the " line " suggested that to the nursing staff, they were

waved

> off and told to mind their business and wait. Management of the facility

> was just as eager to dismiss the suggestion. Nurses will do what they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control person

and

> get irate because they were promised beds 30 minutes or an hour or MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors etc...and we

do send what

> patients we can to chair waiting...we've also had problems with clearing

beds

> with patients waiting to return to the Nursing home...to the point of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two hats: ED

> doc and EMS director, this idea comes easy...) would be to have your EMS

> direction doc sit down with the ED director and ED nurse manager and see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

[Guest guest]

I believe it's important for everyone to attempt to get on the same page,

however the hospital administrator and BOD is responsible for providing the

hard logistical support. I wonder why the hospital's Risk Managers aren't

concerned about the liability associated with this practice? Perhaps they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs because

they're still getting paid. The point is, however, that the negative fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It would be

a good thing if EMS personnel took a more active role in protecting their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is discharges

home.

> Here in the metroplex there is a hospital, which will remain nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them, to

say a

> discharge CHAIR, to free up the bed. One example out of many. When a

> paramedic in the " line " suggested that to the nursing staff, they were

waved

> off and told to mind their business and wait. Management of the facility

> was just as eager to dismiss the suggestion. Nurses will do what they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control person

and

> get irate because they were promised beds 30 minutes or an hour or MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors etc...and we

do send what

> patients we can to chair waiting...we've also had problems with clearing

beds

> with patients waiting to return to the Nursing home...to the point of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two hats: ED

> doc and EMS director, this idea comes easy...) would be to have your EMS

> direction doc sit down with the ED director and ED nurse manager and see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

[Guest guest]

I believe it's important for everyone to attempt to get on the same page,

however the hospital administrator and BOD is responsible for providing the

hard logistical support. I wonder why the hospital's Risk Managers aren't

concerned about the liability associated with this practice? Perhaps they

just want to keep their jobs.

EMS personnel see this as another (frustrating) facet of their jobs because

they're still getting paid. The point is, however, that the negative fiscal

impact on the EMS system or company influences the net margins, thus

affecting monies available for raises, benefits, equipment, etc. It would be

a good thing if EMS personnel took a more active role in protecting their

economic futures.

Bob Kellow

Re: Extortion

>

>

> In a message dated 11-Nov-05 11:56:21 Central Standard Time,

> manemtp@... writes:

>

> True Enough Dr Krin, the bed management you CAN control is discharges

home.

> Here in the metroplex there is a hospital, which will remain nameless,

that

> ROUTINELY keeps ambulatory patients in their bed till all paperwork

> pertaining to their discharge is completed, instead of moving them, to

say a

> discharge CHAIR, to free up the bed. One example out of many. When a

> paramedic in the " line " suggested that to the nursing staff, they were

waved

> off and told to mind their business and wait. Management of the facility

> was just as eager to dismiss the suggestion. Nurses will do what they

want

> and how fast they want. That was made very clear.

>

> And I know this is only one story, in one facility, but lets have a show

of

> hands (figuratively) who's had a similar scenario?

>

> I've also seen the ED, like in your case, call their bed control person

and

> get irate because they were promised beds 30 minutes or an hour or MORE,

ago

> and still have patients in the ED. So what's the answer?

>

>

> well, since this is such a small facility, I have a bit of direct

> supervision involved...including bugging nursing supervisors etc...and we

do send what

> patients we can to chair waiting...we've also had problems with clearing

beds

> with patients waiting to return to the Nursing home...to the point of

being

> stuck with a patient in the ED for 4 hours until the Nursing Home's

driver

> came on duty...

>

> One thing that comes to mind (since I have in the past worn two hats: ED

> doc and EMS director, this idea comes easy...) would be to have your EMS

> direction doc sit down with the ED director and ED nurse manager and see

what can

> be hashed out...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>