Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 In a message dated 11-Nov-05 18:40:10 Central Standard Time, texaslp@... writes: Take the patient to another facility........ lessee....the next nearest facility is 45 minutes either north or south...both of which lose patients to this hospital on a regular basis.... or you can go east for an hour to get to two much larger and one charity facility... or west into Texas where the hospitals are still barely operating... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 In a message dated 11-Nov-05 19:01:03 Central Standard Time, texaslp@... writes: Awww Chuck, You always seem to spoil my best laid plans..... Tater sorry 'bout that, mate... it's the reason why Acadian 'won't let us go on diversion'....it's also the reason why the nursing homes frequently have to hold the patients at their facility for a while before I will accept them...they don't like it, but if the formally hypoglycemic patient is now conscious and alert thanks to the medic giving an appropriate dose of D50...and all of my beds are tied up with righteously ill people.... S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 In a message dated 11-Nov-05 19:01:03 Central Standard Time, texaslp@... writes: Awww Chuck, You always seem to spoil my best laid plans..... Tater sorry 'bout that, mate... it's the reason why Acadian 'won't let us go on diversion'....it's also the reason why the nursing homes frequently have to hold the patients at their facility for a while before I will accept them...they don't like it, but if the formally hypoglycemic patient is now conscious and alert thanks to the medic giving an appropriate dose of D50...and all of my beds are tied up with righteously ill people.... S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 You're probably right. 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 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 You're probably right. 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 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 You're probably right. 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 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 In a message dated 11-Nov-05 19:52:30 Central Standard Time, miller@... writes: I agree with you , However, having worked 30 years in large overcrowded ED's and been the Chairman of 5 of them for over 20 years, I can emphatically say that the problem is not the ED. Why are our beds full? And why are our halls full? It is always because the hospital will not admit the ED patients to the floor. We baby sit them for hours (or days), when they should be on the floor. For some unexplained reason, it is fine to keep patients in the ED halls, but unacceptable to keep them in the ICU halls. Why? Are our halls better than their halls? Hospitals are a business, and as any good business they need more customers. Why then don't they plan for increase business (and increased profits)? I agree with you also...it is within my professional memory that we used hallways and day rooms for over flow patients....but since the 'improvements' in privacy that the feds have foisted off on us over the last 20 odd years, I've seen fewer and fewer hospital admin types willing to put the extra beds there. At my current facility, it is more often limitations on nurses than on beds...with about 50 rated beds on Med Surg (two floors), they need 6 nurses to run at full capacity, at least two of which need to be RNs...7 beds in the ICU means that we need 4 nurses up there for full capacity, only one of which can be an LPN... our usual staffing is about 5 and two, respectively, with two more in the ED... Of course, I remember when a 34 bed post op ortho floor was run with two RNs, two LPNs and three aides...and *EVERY* patient got good PM care, including appropriate showers and back rubs... S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 Take the patient to another facility........ " , " wrote: 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 Take the patient to another facility........ " , " wrote: 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 Awww Chuck, You always seem to spoil my best laid plans..... Tater krin135@... wrote: In a message dated 11-Nov-05 18:40:10 Central Standard Time, texaslp@... writes: Take the patient to another facility........ lessee....the next nearest facility is 45 minutes either north or south...both of which lose patients to this hospital on a regular basis.... or you can go east for an hour to get to two much larger and one charity facility... or west into Texas where the hospitals are still barely operating... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 easy fix, huh? 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 easy fix, huh? 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 I agree with you , However, having worked 30 years in large overcrowded ED's and been the Chairman of 5 of them for over 20 years, I can emphatically say that the problem is not the ED. Why are our beds full? And why are our halls full? It is always because the hospital will not admit the ED patients to the floor. We baby sit them for hours (or days), when they should be on the floor. For some unexplained reason, it is fine to keep patients in the ED halls, but unacceptable to keep them in the ICU halls. Why? Are our halls better than their halls? Hospitals are a business, and as any good business they need more customers. Why then don't they plan for increase business (and increased profits)? A good analogy can be taken from Wal-Mart. They are also in business to make money and provide a service. What if on Saturday afternoon they became really busy to where the checkout lanes were overcrowded. Would Wal-Mart think this was a horrible situation? Would they lock the doors and tell customers to go on diversion to Target? Or would they open up more checkout lanes? Hospitals are no different. They have chosen to be inefficient and refuse to plan for success. No wonder many of them are having financial problems. Another analogy: Labor and Delivery. Why don't we keep pregnant patients that are in labor in our ED? Because Labor and Delivery units have traditionally accepted all patients in labor as soon as they hit the ED doors. Why shouldn't that practice of immediate admission be the same for heart patients or any other category you may wish to discuss. It is because hospitals are mired in tradition and years of inefficiency. They cannot or will not operate like a successful business. They will not change to meet demand. Instead, when we ask to admit a patient to ICU we get the usual runaround: the bed is not ready; its report time, call later; its lunch time, its change of shift, we don't have any free beds; we don't have enough nurses, we are saving our beds for post-surgical patients (I love this excuse - what about saving beds for post-ED patients?) I would never blame patients or those who send patients to the ED (EMS and nursing homes). That is what we are in business for. Best regards, Larry Larry > 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 I agree with you , However, having worked 30 years in large overcrowded ED's and been the Chairman of 5 of them for over 20 years, I can emphatically say that the problem is not the ED. Why are our beds full? And why are our halls full? It is always because the hospital will not admit the ED patients to the floor. We baby sit them for hours (or days), when they should be on the floor. For some unexplained reason, it is fine to keep patients in the ED halls, but unacceptable to keep them in the ICU halls. Why? Are our halls better than their halls? Hospitals are a business, and as any good business they need more customers. Why then don't they plan for increase business (and increased profits)? A good analogy can be taken from Wal-Mart. They are also in business to make money and provide a service. What if on Saturday afternoon they became really busy to where the checkout lanes were overcrowded. Would Wal-Mart think this was a horrible situation? Would they lock the doors and tell customers to go on diversion to Target? Or would they open up more checkout lanes? Hospitals are no different. They have chosen to be inefficient and refuse to plan for success. No wonder many of them are having financial problems. Another analogy: Labor and Delivery. Why don't we keep pregnant patients that are in labor in our ED? Because Labor and Delivery units have traditionally accepted all patients in labor as soon as they hit the ED doors. Why shouldn't that practice of immediate admission be the same for heart patients or any other category you may wish to discuss. It is because hospitals are mired in tradition and years of inefficiency. They cannot or will not operate like a successful business. They will not change to meet demand. Instead, when we ask to admit a patient to ICU we get the usual runaround: the bed is not ready; its report time, call later; its lunch time, its change of shift, we don't have any free beds; we don't have enough nurses, we are saving our beds for post-surgical patients (I love this excuse - what about saving beds for post-ED patients?) I would never blame patients or those who send patients to the ED (EMS and nursing homes). That is what we are in business for. Best regards, Larry Larry > 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 In your situation it seems appropriate! krin135@... wrote: In a message dated 11-Nov-05 19:01:03 Central Standard Time, texaslp@... writes: Awww Chuck, You always seem to spoil my best laid plans..... Tater sorry 'bout that, mate... it's the reason why Acadian 'won't let us go on diversion'....it's also the reason why the nursing homes frequently have to hold the patients at their facility for a while before I will accept them...they don't like it, but if the formally hypoglycemic patient is now conscious and alert thanks to the medic giving an appropriate dose of D50...and all of my beds are tied up with righteously ill people.... S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 Dr. , As you have probably heard at Diversion Task Force meetings in SA, the best analogy was the " sink " analogy: An ED is a sink...the drain (the hospital) is clogged and nothing can get out....and both the hot and cold water is on full-blast. We can't shut off the cold water (walk-in's, drive-ups, etc) so we try as hard as we can to shut the hot water (EMS) off...it doesn't fix the problem but hopefully slows it down. What a breath of fresh air to read your desciption below. I thought only public safety was the area where years of tradition are unimpeded by progress....how unique to hear it is in the hospital as well. I think EMS has other choices. Many locations have stopped diversions (including many in Texas) and many do not allow ER holding of EMS patients. We have a policy letter from CMS that makes this clear...and many agencies have taken steps to prevent the holding...anything from having spare stretchers in the ED, to putting patients on backboards or scoops on the floor, or exploring other areas of the hospital (recovery, surgery hold, etc) for beds and bringing those to the ED. I personally think that we (EMS) should be a little more aggressive. As long as EMS keeps taking it and allowing the ED to function WITHOUT failure...they won't fail and it won't change. We were fortunate in SA that at least one hospital system stopped (or greatly reduced) their diversions...this allowed the system to start returning to normo-stasis...patients going to their desired hospitals no matter what, and not getting shifted to others...and all systems diversion hours declined.... We need to share best practices on how to stop ER holding...and we need to stop both convenience diversions and then ED holds...we (EMS) can stop this...we have the power to keep the hot water on full-blast...just like the cold. Dudley Re: Extortion I agree with you , However, having worked 30 years in large overcrowded ED's and been the Chairman of 5 of them for over 20 years, I can emphatically say that the problem is not the ED. Why are our beds full? And why are our halls full? It is always because the hospital will not admit the ED patients to the floor. We baby sit them for hours (or days), when they should be on the floor. For some unexplained reason, it is fine to keep patients in the ED halls, but unacceptable to keep them in the ICU halls. Why? Are our halls better than their halls? Hospitals are a business, and as any good business they need more customers. Why then don't they plan for increase business (and increased profits)? A good analogy can be taken from Wal-Mart. They are also in business to make money and provide a service. What if on Saturday afternoon they became really busy to where the checkout lanes were overcrowded. Would Wal-Mart think this was a horrible situation? Would they lock the doors and tell customers to go on diversion to Target? Or would they open up more checkout lanes? Hospitals are no different. They have chosen to be inefficient and refuse to plan for success. No wonder many of them are having financial problems. Another analogy: Labor and Delivery. Why don't we keep pregnant patients that are in labor in our ED? Because Labor and Delivery units have traditionally accepted all patients in labor as soon as they hit the ED doors. Why shouldn't that practice of immediate admission be the same for heart patients or any other category you may wish to discuss. It is because hospitals are mired in tradition and years of inefficiency. They cannot or will not operate like a successful business. They will not change to meet demand. Instead, when we ask to admit a patient to ICU we get the usual runaround: the bed is not ready; its report time, call later; its lunch time, its change of shift, we don't have any free beds; we don't have enough nurses, we are saving our beds for post-surgical patients (I love this excuse - what about saving beds for post-ED patients?) I would never blame patients or those who send patients to the ED (EMS and nursing homes). That is what we are in business for. Best regards, Larry Larry > 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 Very well said Dr and Dudley! Lee Re: Extortion I agree with you , However, having worked 30 years in large overcrowded ED's and been the Chairman of 5 of them for over 20 years, I can emphatically say that the problem is not the ED. Why are our beds full? And why are our halls full? It is always because the hospital will not admit the ED patients to the floor. We baby sit them for hours (or days), when they should be on the floor. For some unexplained reason, it is fine to keep patients in the ED halls, but unacceptable to keep them in the ICU halls. Why? Are our halls better than their halls? Hospitals are a business, and as any good business they need more customers. Why then don't they plan for increase business (and increased profits)? A good analogy can be taken from Wal-Mart. They are also in business to make money and provide a service. What if on Saturday afternoon they became really busy to where the checkout lanes were overcrowded. Would Wal-Mart think this was a horrible situation? Would they lock the doors and tell customers to go on diversion to Target? Or would they open up more checkout lanes? Hospitals are no different. They have chosen to be inefficient and refuse to plan for success. No wonder many of them are having financial problems. Another analogy: Labor and Delivery. Why don't we keep pregnant patients that are in labor in our ED? Because Labor and Delivery units have traditionally accepted all patients in labor as soon as they hit the ED doors. Why shouldn't that practice of immediate admission be the same for heart patients or any other category you may wish to discuss. It is because hospitals are mired in tradition and years of inefficiency. They cannot or will not operate like a successful business. They will not change to meet demand. Instead, when we ask to admit a patient to ICU we get the usual runaround: the bed is not ready; its report time, call later; its lunch time, its change of shift, we don't have any free beds; we don't have enough nurses, we are saving our beds for post-surgical patients (I love this excuse - what about saving beds for post-ED patients?) I would never blame patients or those who send patients to the ED (EMS and nursing homes). That is what we are in business for. Best regards, Larry Larry > 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2005 Report Share Posted November 11, 2005 Very well said Dr and Dudley! Lee Re: Extortion I agree with you , However, having worked 30 years in large overcrowded ED's and been the Chairman of 5 of them for over 20 years, I can emphatically say that the problem is not the ED. Why are our beds full? And why are our halls full? It is always because the hospital will not admit the ED patients to the floor. We baby sit them for hours (or days), when they should be on the floor. For some unexplained reason, it is fine to keep patients in the ED halls, but unacceptable to keep them in the ICU halls. Why? Are our halls better than their halls? Hospitals are a business, and as any good business they need more customers. Why then don't they plan for increase business (and increased profits)? A good analogy can be taken from Wal-Mart. They are also in business to make money and provide a service. What if on Saturday afternoon they became really busy to where the checkout lanes were overcrowded. Would Wal-Mart think this was a horrible situation? Would they lock the doors and tell customers to go on diversion to Target? Or would they open up more checkout lanes? Hospitals are no different. They have chosen to be inefficient and refuse to plan for success. No wonder many of them are having financial problems. Another analogy: Labor and Delivery. Why don't we keep pregnant patients that are in labor in our ED? Because Labor and Delivery units have traditionally accepted all patients in labor as soon as they hit the ED doors. Why shouldn't that practice of immediate admission be the same for heart patients or any other category you may wish to discuss. It is because hospitals are mired in tradition and years of inefficiency. They cannot or will not operate like a successful business. They will not change to meet demand. Instead, when we ask to admit a patient to ICU we get the usual runaround: the bed is not ready; its report time, call later; its lunch time, its change of shift, we don't have any free beds; we don't have enough nurses, we are saving our beds for post-surgical patients (I love this excuse - what about saving beds for post-ED patients?) I would never blame patients or those who send patients to the ED (EMS and nursing homes). That is what we are in business for. Best regards, Larry Larry > 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2005 Report Share Posted November 12, 2005 What about paramedic-induced diversion? I know of one large urban system where the medics communicate via cell phones, to be off-radio, and " pick " a hospital to overcrowd that day. Then, as the hospital backs up, the medics get a longer and longer " break " while waiting for a bed. When that hospital goes on divert, the next hospital is " chosen " and the paramedics again get the only break of their shift while waiting in line for an ER bed... Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2005 Report Share Posted November 12, 2005 Good point, Mike. Such an occurrence would not be the first time that medics formed a " confederacy of dunces " within an EMS system. However rare this situation might be, said medics should be expunged from EMS. In too many cases EMS is being " eaten hollow " by its own practitioners. Bob Kellow Re: Extortion > What about paramedic-induced diversion? I know of one large urban > system where the medics communicate via cell phones, to be off-radio, > and " pick " a hospital to overcrowd that day. Then, as the hospital > backs up, the medics get a longer and longer " break " while waiting for > a bed. When that hospital goes on divert, the next hospital is > " chosen " and the paramedics again get the only break of their shift > while waiting in line for an ER bed... > > Mike > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2005 Report Share Posted November 12, 2005 Good point, Mike. Such an occurrence would not be the first time that medics formed a " confederacy of dunces " within an EMS system. However rare this situation might be, said medics should be expunged from EMS. In too many cases EMS is being " eaten hollow " by its own practitioners. Bob Kellow Re: Extortion > What about paramedic-induced diversion? I know of one large urban > system where the medics communicate via cell phones, to be off-radio, > and " pick " a hospital to overcrowd that day. Then, as the hospital > backs up, the medics get a longer and longer " break " while waiting for > a bed. When that hospital goes on divert, the next hospital is > " chosen " and the paramedics again get the only break of their shift > while waiting in line for an ER bed... > > Mike > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2005 Report Share Posted November 12, 2005 Good point, Mike. Such an occurrence would not be the first time that medics formed a " confederacy of dunces " within an EMS system. However rare this situation might be, said medics should be expunged from EMS. In too many cases EMS is being " eaten hollow " by its own practitioners. Bob Kellow Re: Extortion > What about paramedic-induced diversion? I know of one large urban > system where the medics communicate via cell phones, to be off-radio, > and " pick " a hospital to overcrowd that day. Then, as the hospital > backs up, the medics get a longer and longer " break " while waiting for > a bed. When that hospital goes on divert, the next hospital is > " chosen " and the paramedics again get the only break of their shift > while waiting in line for an ER bed... > > Mike > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2005 Report Share Posted November 12, 2005 Thanks Dudley, You certainly have made a huge difference for the better in San & Shertz. Keep up the good work. Larry > Dr. , > > As you have probably heard at Diversion Task Force meetings in SA, the > best analogy was the " sink " analogy: > > An ED is a sink...the drain (the hospital) is clogged and nothing can > get out....and both the hot and cold water is on full-blast. We can't > shut off the cold water (walk-in's, drive-ups, etc) so we try as hard > as we can to shut the hot water (EMS) off...it doesn't fix the problem > but hopefully slows it down. > > What a breath of fresh air to read your desciption below. I thought > only public safety was the area where years of tradition are unimpeded > by progress....how unique to hear it is in the hospital as well. > > I think EMS has other choices. Many locations have stopped diversions > (including many in Texas) and many do not allow ER holding of EMS > patients. We have a policy letter from CMS that makes this clear...and > many agencies have taken steps to prevent the holding...anything from > having spare stretchers in the ED, to putting patients on backboards or > scoops on the floor, or exploring other areas of the hospital > (recovery, surgery hold, etc) for beds and bringing those to the ED. > > I personally think that we (EMS) should be a little more aggressive. > As long as EMS keeps taking it and allowing the ED to function WITHOUT > failure...they won't fail and it won't change. We were fortunate in SA > that at least one hospital system stopped (or greatly reduced) their > diversions...this allowed the system to start returning to > normo-stasis...patients going to their desired hospitals no matter > what, and not getting shifted to others...and all systems diversion > hours declined.... > > We need to share best practices on how to stop ER holding...and we need > to stop both convenience diversions and then ED holds...we (EMS) can > stop this...we have the power to keep the hot water on > full-blast...just like the cold. > > Dudley > > > > Re: Extortion > > I agree with you , > > However, having worked 30 years in large overcrowded ED's and been the > Chairman of 5 of them for over 20 years, I can emphatically say that the > problem is not the ED. Why are our beds full? And why are our halls > full? > It is always because the hospital will not admit the ED patients to the > floor. We baby sit them for hours (or days), when they should be on the > floor. For some unexplained reason, it is fine to keep patients in the > ED > halls, but unacceptable to keep them in the ICU halls. Why? Are our > halls > better than their halls? Hospitals are a business, and as any good > business > they need more customers. Why then don't they plan for increase > business > (and increased profits)? > > A good analogy can be taken from Wal-Mart. They are also in business to > make money and provide a service. What if on Saturday afternoon they > became > really busy to where the checkout lanes were overcrowded. Would > Wal-Mart > think this was a horrible situation? Would they lock the doors and tell > customers to go on diversion to Target? Or would they open up more > checkout > lanes? Hospitals are no different. They have chosen to be inefficient > and > refuse to plan for success. No wonder many of them are having financial > problems. > > Another analogy: Labor and Delivery. Why don't we keep pregnant > patients > that are in labor in our ED? Because Labor and Delivery units have > traditionally accepted all patients in labor as soon as they hit the ED > doors. Why shouldn't that practice of immediate admission be the same > for > heart patients or any other category you may wish to discuss. It is > because > hospitals are mired in tradition and years of inefficiency. They > cannot or > will not operate like a successful business. They will not change to > meet > demand. Instead, when we ask to admit a patient to ICU we get the usual > runaround: the bed is not ready; its report time, call later; its lunch > time, its change of shift, we don't have any free beds; we don't have > enough > nurses, we are saving our beds for post-surgical patients (I love this > excuse - what about saving beds for post-ED patients?) > > I would never blame patients or those who send patients to the ED (EMS > and > nursing homes). That is what we are in business for. > > Best regards, > > Larry > > > Larry > >> 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 >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2005 Report Share Posted November 12, 2005 Wow, That is scary. Larry > What about paramedic-induced diversion? I know of one large urban > system where the medics communicate via cell phones, to be off-radio, > and " pick " a hospital to overcrowd that day. Then, as the hospital > backs up, the medics get a longer and longer " break " while waiting for > a bed. When that hospital goes on divert, the next hospital is > " chosen " and the paramedics again get the only break of their shift > while waiting in line for an ER bed... > > Mike > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2005 Report Share Posted November 12, 2005 Wow, That is scary. Larry > What about paramedic-induced diversion? I know of one large urban > system where the medics communicate via cell phones, to be off-radio, > and " pick " a hospital to overcrowd that day. Then, as the hospital > backs up, the medics get a longer and longer " break " while waiting for > a bed. When that hospital goes on divert, the next hospital is > " chosen " and the paramedics again get the only break of their shift > while waiting in line for an ER bed... > > Mike > > > > > Quote Link to comment Share on other sites More sharing options...
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