Ailing ERs threaten patients, leave communities vulnerable

[flashl]

On the night of her baby's seizure in February, Brandy Nannini discovered a harsh reality of today's overtaxed medical system. The ambulance crew that responded to her 911 call refused to take 23-month-old Bella to a nearby Washington, D.C., hospital where her doctor was waiting. The emergency room was so crowded it was closed to new patients. Despite Nannini's pleas, the ambulance was diverted to suburban Virginia.

Bella got to a hospital in time. But Nannini, who has insurance but goes to the ER often because of her child's seizures, was shocked that emergency rooms could simply close.

They can, and they do. In fact, they have little choice. Once a rare safety valve, "diversions" to other hospitals have become routine. And they are just one symptom of an emergency system that is sick.

Rising health care costs have forced hundreds of hospitals out of business, mostly in poorer areas, putting pressure on those that remain. They, too, are racing to trim costs, and there's little incentive to focus on ERs, which are not money-makers. So the sickest patients are endangered, and communities are left unprepared for disasters, whether a bus crash, a hurricane or a terror attack.

USA Today

It is with wonderment one can observe the amazing ability within the magic kingdom that allows, within bubble economies, trillions of dollars to be created from the thin air while remaining parts of the U.S. crumble.

[Heddi]

1. Hosptials sometimes have to divert

I worked in a town that had 2 hospitals, after that you had to go 3 hours West to Seattle or 4 hours east to Spokane to get an ICU bed.

My hospital had 11 ICU beds. THe other hospital had 10. If my hospital was out of ICU beds, we had to divert to the other hospital because we could not take ICU level patients at that point. If the other ICU was booked up as well, then patients were stabilized in the ER and flown generally to Seattle, occasionally to Spokane.

Same with medical beds===Pneumonia season is havock at small town hospitals. When your beds are full, they're full. You can't build bunk beds, or have people sleep on the floor. You have to divert.

Same with staffing. Last year we had a hellofa snow storm, and about 1/3 of our night shift staff were stuck with no way to get to work. The hospital was on bare bones for about 3 days, and 2 of the days we HAD to divert because not only were we short on beds, but we were SUPER short on staff. Even with day shift RN's staying and working 18 and 22 hours straight, there was no way to admit additional patients. It just wasn't safe.

I think the article makes some good points, but I really dislike it articles like this come out. OH MY GOD THEY"RE SHUTTING THE ER"s when the reality is that diversions are common, they happen, and they happen for a variety of reasons. I can tell you that none of the times we diverted were because of "rising health care costs". It was because too many damn people were sick at one time and we didn't have a bloody place to put them.

Once we had to divert all head traumas because we had no neurosurgeon available for our hospital, as he was snowed in about 6 hours away.

[flashl]

2. IN DC, hospitals are closed in underserved communities then residents hear about diverting.

[Heddi]

4. Well, then that's not truly "diverting"

If a hospital has closed, the patients that would have gone there aren't truly being "diverted". The phrase is being misused.

Diverting, in a hospital sense, means that an open, functional, and staffed hospital has to close it's doors to any new patients for a certain amount of time because of lack of staff, lack of beds, or lack of equipment. A hospital cannot take patients with head traumas if their CT and MRI machines aren't working.

Closing a hospital for good is a terrible thing, sometimes, of course depending on why the hospital was closed in the first place. Just because it's a place that people go doesn't mean it's a place that people SHOULD go--and that's for private and public entities. I work with RN's who have worked in inner-city public hospitals in LA, NYC, DC, Detroit--cities with enormous populations of under-serviced inviduals. Just because a hospital is run by the county doesn't mean that it, or its workers, are any good or actually doing a service to the community. I have heard horror stories again and again and again---unsafe practice, unsanitary practice, unethical practice. Hospitals that do not perform should not be allowed to continue to perform, especially if they are putting patient's lives and wellbeing in danger.

Now, that's not to say that I think that for-profit centers are any better---I do not think that, necessarily. I think that non-profit, for profit, private, and public hospitals are generally all excellent centers of health, but not all of them are. Of course county/state facilities often operate on lack of funds, lack of staff, lack of new durable equipment. Many times, however, their lack of funds come because of hospital-acquired injuries or infection, and those aren't reimbursed by medicade or medicare.

As an RN that works at the largest state hospital in the Pacific Northwest, who works at a level 1 trauma center serving the entire pacific northwest, who works at a hospital where 60% of the patients are homeless, uninsured, underinsured, underserved, immigrants, I see this from a unique perspective.

My hospital is a state-run facility. We operate on a shoestring budget compared to the non-profit (yet not state run) hospital I worked at previously. But we're a good facility. We have great staff that are highly trained. But it wasn't always that way, and there was a time in the past where my hospital's reputation was pretty shitty, and for good reason. They were threatened with closure and finally got their shit together and are now a world-class facility with a great reputuation.

But had this hospital NOT changed it's practice, it SHOULD have been shut down. A facility with no concern for patients has no business being in operation.

[Fire_Medic_Dave]

3. My folks live in Tennessee and TennCare has caused huge ER overcrowding.

Many very sick people moved here, when TennCare was established, for coverage. TennCare was horribly mismanaged took away all individual payments for ER visits so people quit going to their regular doctors and started using the ERs for routine care. Of course they often call an ambulance to go there by further straining the system. It would have been nice to see how it would have worked if the greedy politicians hadn't gotten in the way.

David