Originally Posted by golfing eagles
A lot of this has been posted before, but I guess it is time to write another novel in response.
It seems the main thrust of your post is the waiting time, no mention regarding quality of care, so let's focus on that. Also, it would be nice if DB, a retired hospital administrator and frequent poster on TOTV would weigh in as well
ER waiting times are determined by many factors:
The number of beds in the ER
Staffing
Speed at which ER staff works
Bed availability for admissions
Number of patients that show up
Also, keep in mind, it is not a "first come, first serve" endeavor. I'm truly sorry your daughter was quite ill, but that means different things to patients than it does to healthcare professionals, hence the triage process.
My wife was quite ill last year, probably within hours of leaving us, and was admitted for 2 weeks after coming in through the ER and then spent another month in rehab, so I have first hand experience with TVRH. I also have 30+ years of experience as a board certified internist, professor of medicine at State University of New York, Chairman of our Quality Assurance Committee, and Chief of Staff at our community hospital, so I do have some "vague" idea of what I'm talking about.
At the time my wife was brought to the ER, all the ER beds were occupied and there were about 10 patients in the waiting room. Despite that, it took less than 5 hours from the time she arrived until she was in a bed on the floor, so no complaints from me as to time. Many others have been satisfied with waiting times, many others completely dissatisfied. And then there are the ludicrous posts about 90 year olds waiting 22 hours in pain to be seen by a doctor---you decide if that is credible.
I thought the number of beds in the ER were adequate, and the NUMBER of physicians and extended providers could handle the workload if the were diligent. Unfortunately, ERs tend to get bogged down by the "walking wounded"----patients who would be better served for their minor complaints in an urgent care setting or their doctor's office, but we all know THAT doesn't happen. As I looked around at the 10 patients in the waiting room, 8 of them could obviously be handled elsewhere, so triage was probably appropriate.
So far, so good, but now for the bad news:
From what I observed, the PACE at which work was being done seemed to be pretty slow. There did not appear to be any great rush to get admissions to the floor or get the remainder treated and released. My impression was that myself and one of my ER friends could clear that place out pretty quickly. Apparently the ER is staffed by a sub-contracted group out of the Miami area, and many of their ER docs are locum tenens---temporary employees that travel and generally work 3 months at a given location. My opinion of this situation is pretty low---they have no vested interest in our community, they are essentially nameless, faceless individuals who will soon be moving on, don't have a strong desire to work hard, and in general are just punching a time clock (My apologies to those dedicated locum tenens physicians out there) As a result, the ER tends to back up. Believe me, a stable group of ER docs who live in the community and are treating their friends and neighbors makes a WORLD of difference.
But they are not the sole reason. Getting admissions out of the ER depends on bed availability on the floors, which is not a monolithic problem either. The attending physicians need to discharge patients as early in the day as possible and in a timely manner. The nurses need to do their discharge paperwork and review it with the patient. The discharge planners need to finalize their plan and explain it. And housekeeping needs to clean the room after the patient leaves. Some of these groups are more motivated than others as well.
Here's how we fixed the problem in NY:
First we asked all attending physicians and hospitalists to do as much discharge paperwork as possible the evening before. Then we had them write a simple order: "Plan for AM discharge". This triggered the evening and night shift nurses to do as much discharge work as possible as well, and the discharge planners to get their ducks in a row.
We also spoke with the nursing homes, rehab facilities, home care agencies and medical transport companies and asked them to help by staggering shifts in such a way that more planning could be done the day and evening before discharge. We were able to get the medical community on the same page and work together to get more beds available earlier so the ER could get their patients to the floor. Believe it or not, the main resistance came from housekeeping. In general these are less educated minimum wage employees, many of whom had the job as a requirement of continued public assistance, with less motivation to put out extra effort.
So, a few final thoughts:
The one thing the hospital cannot control is how many patients show up at a given time. No restaurant, no retailer can staff for peak volume all the time, so sometimes the wait will be longer than others.
I think the ER wait issues are completely fixable, although it could be difficult. If I were in charge I'd be looking at a different ER group. It is probably not possible to build our own ER group with a top notch director and physicians who live here, due to recruiting difficulties. However, I would have the QA committee sitting on the ER and monitoring both wait times and quality issues. Probably 30-40% of the staff in that ER needs to experience "alternative career opportunity enhancement" . I would then try to address the issues surrounding discharges.
Lastly, to the individual who drives 30-70 miles to go elsewhere, even if sick, be careful---your luck may eventually run out.
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