The State of ER Services

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  #31  
Old 03-03-2020, 11:43 AM
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blueash blueash is offline
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While it would be medically better if only patients with real "emergencies" went to the ER it would not necessarily save money for the health care system unless many ER's closed. The ER needs to have on site the equipment and medications needed for real emergencies. The facility must be constructed to allow patient and staff flow to optimize care. The base cost of all the requirements to be an ER are huge. This cost is then spread over the charges applied to the users of the ER. Fewer patients, higher per user cost. So the runny nose that really doesn't belong in the ER gets socked with a high bill which represents that person's contribution to the cost of having a facility equipped to handle emergencies.

Fewer patients in the ER and the ER can't survive economically. So like it or not, the ER's financial viability depends on having people in the beds, and the waiting room.

A couple random thoughts. The training to become a board certified ER specialist is college, 4 years of medical school, and then 4 years of residency/fellowship training. That is 7-8 years post college in a very intense program. And no PA or NP does anything even approximating that kind of training. So when I see that the PA is providing care I know that the ER is having staff available for the very low level of medical urgency that a PA or NP is qualified to handle. Saving money on staff costs.

As to the insistence that the ER is not required to care for you if you do not have an emergency that is both true and wrong. The ER cannot send you away until after they have determined that you do not have a condition requiring emergency care. So they must evaluate you first. As the evaluation usually is more complex than the management there is little reason for a general policy of declining care when the triage secretary may think it is not an emergency. And they are not really qualified to make that decision. A runny nose may be just a mild URI or allergy. Or it can be a fractured cribriform plate which if ignored will rapidly lead to bacterial meningitis.

Making that differentiation requires a good history and if appropriate a urine glucose dipstick. So even runny nose can be, extremely rarely, a true emergency. That's what the ER doctor spent all those years learning. Sometimes it is a zebra.
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  #32  
Old 03-03-2020, 02:14 PM
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Quote:
Originally Posted by blueash View Post
While it would be medically better if only patients with real "emergencies" went to the ER it would not necessarily save money for the health care system unless many ER's closed. The ER needs to have on site the equipment and medications needed for real emergencies. The facility must be constructed to allow patient and staff flow to optimize care. The base cost of all the requirements to be an ER are huge. This cost is then spread over the charges applied to the users of the ER. Fewer patients, higher per user cost. So the runny nose that really doesn't belong in the ER gets socked with a high bill which represents that person's contribution to the cost of having a facility equipped to handle emergencies.

Fewer patients in the ER and the ER can't survive economically. So like it or not, the ER's financial viability depends on having people in the beds, and the waiting room.

A couple random thoughts. The training to become a board certified ER specialist is college, 4 years of medical school, and then 4 years of residency/fellowship training. That is 7-8 years post college in a very intense program. And no PA or NP does anything even approximating that kind of training. So when I see that the PA is providing care I know that the ER is having staff available for the very low level of medical urgency that a PA or NP is qualified to handle. Saving money on staff costs.

As to the insistence that the ER is not required to care for you if you do not have an emergency that is both true and wrong. The ER cannot send you away until after they have determined that you do not have a condition requiring emergency care. So they must evaluate you first. As the evaluation usually is more complex than the management there is little reason for a general policy of declining care when the triage secretary may think it is not an emergency. And they are not really qualified to make that decision. A runny nose may be just a mild URI or allergy. Or it can be a fractured cribriform plate which if ignored will rapidly lead to bacterial meningitis.

Making that differentiation requires a good history and if appropriate a urine glucose dipstick. So even runny nose can be, extremely rarely, a true emergency. That's what the ER doctor spent all those years learning. Sometimes it is a zebra.
Thanks, couldn't have said it better

I suggest that the people who insist that an ER can turn you away read the COBRA of 1987
  #33  
Old 03-03-2020, 02:37 PM
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Originally Posted by schrdr View Post
I would like start a discussion on the state of ER services in TV. I know this issue has been beaten to death over and over.

However its a new day and with the 2 new ER centers that have opened, has there been any improvement?

Has anyone used either of these new ER centers?
Quote:
Originally Posted by rmd2
The Ocala ER that is just past the Walmart on 441 about a mile or two is excellent. The wait time is zero to 5 minutes. The staff is very good. I've been there three times and have never had a long wait and they have good medical care. WAY better than The Villages ER!
That's Ocala Health Summerfield ER

The Villages Florida

Quote:
Originally Posted by Ann Sim
I was having shortness of breath ..heaviness in my chest & went to OCALA ER on 466 A.. I was very satisfied with their prompt professional service..I was hooked up to many devices..took many blood tests..CT scans etc.When all was medically necessary done, I was transferred to West Marion hospital in OCALA
by SUMTER CO. ambulance, because OCALA ER is an OCALA free standing ER

So I learned..Only inconvenience was the fact they are not connected to the VILLAGES system, so therefore I had to have all my labs repeated..CT etc. And now I have to get all my medical records etc..from West Marion Hospital.
HOWEVER I AM SO EVERY GRATEFULL they were close by..
Same facility as Summerfield, Ocala Health ER now open in Trailwinds Village on 466A

The Villages Florida

Quote:
Originally Posted by PugMom
yes, unfortunately we needed to use the new Brownwood ER last weekend. for a new facility, i was impressed on the staff, equipment & performance of the Dr's. we had no wait time, were seen right away, and very pleased @ the overall operations. i'd go again, when need be
New University of Florida ER now Open on SR44 across from Brownwood

The Villages Florida

I would say that ER Services are up 200% in the Southern Areas.
  #34  
Old 03-03-2020, 02:59 PM
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Originally Posted by golfing eagles View Post
Thanks, couldn't have said it better

I suggest that the people who insist that an ER can turn you away read the COBRA of 1987
I did read it. As understand it, if the patient is stable, they can be transferred to another facilty. If they are not stable, the ER can stabilze them and then transfer them to another faciility. Post No. 16 describes how that process can work. It sounds more efficient to me, but not as profitable for the ER.
  #35  
Old 03-03-2020, 03:32 PM
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Originally Posted by retiredguy123 View Post
I did read it. As understand it, if the patient is stable, they can be transferred to another facilty. If they are not stable, the ER can stabilze them and then transfer them to another faciility. Post No. 16 describes how that process can work. It sounds more efficient to me, but not as profitable for the ER.
That is correct. But the ER has to evaluate the patient first and determine stability. Then there has to be an acceptable reason for the transfer, the most common being patient request and the availability of a specific service at the accepting facility that is not available at the originating ER. Lack of insurance in and of itself is not an acceptable reason. Then the paperwork at both ends has to be filled out correctly. There was a time, and I don't know if it has changed, that filling out the paperwork incorrectly was considered a COBRA violation. The fine for violating COBRA starts at $50,000 AT EACH END and goes up from there. As you can imagine, there is a great deal of care taken in any transfer.
  #36  
Old 03-03-2020, 05:08 PM
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Unfortunately, It could be like that all over. Need some good NYC care! LOL
  #37  
Old 03-03-2020, 05:59 PM
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Originally Posted by retiredguy123 View Post
Not true. The ER doesn't have to treat non-emergencies.
As of 2 weeks ago, Unless our ED was full we turn away no one. But then again only been doing this for 4O plus years. The chance of sending someone out of ED without evaluation, could be a toe tag. We always try to avoid toe tags, it’s a lot of paperwork.
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Last edited by asianthree; 03-03-2020 at 06:06 PM.
  #38  
Old 03-03-2020, 06:04 PM
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Originally Posted by asianthree View Post
As of 2 weeks ago, Unless our ED was full we turn away no one. But then again only been doing this for 4O plus years.
Beats my 37 years and dozens of transfers under COBRA regulations. But this is TOTV----people have OPINIONS on subjects they know nothing about.
  #39  
Old 03-03-2020, 07:18 PM
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So not true. The insurances, Medicare included pay very little for emergency services.
  #40  
Old 03-04-2020, 06:42 AM
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You are correct, beaten to death.
  #41  
Old 03-04-2020, 10:08 AM
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I slipped in our culdesac and broke my femur. The fire department showed up within a few minutes, a short time after the EMS ambulance showed up. I felt like a family member was taking care of me. They were extremely attentive and tried to get me comfortable without moving me too much. They’re all 10’s I’m my book.
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  #42  
Old 03-04-2020, 08:01 PM
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Default The new Brownwood ER

On Valentines Day a couple of weeks ago , I think Dr Robertson at Brownwood ER probably saved my wife's life . What she and I thought was the flu and 15 hours of throwing up and fever, finally we said we needed to go to the ER for anti nauseous medicine and IV's for re-hydration.

Well the web site showed only a 6 minute wait at Brownwood as opposed to the 45 minute wait at The Village Hospital ,so the choice was easy. The nurses quickly got the IV's going and the monitors hooked up , but the doctor ( a young sharp lady ) said she thought sometime else was going on here and did a cat scan.

This was not the flu but a burst appendix that probably happened 15 hours earlier and emergency surgery at Leesburg Memorial was scheduled because they had surgeons there at 9pm on a Friday night. The Surgeon said we must have a guardian angel because the point of no return had pasted .

She spent a week at the hospital fighting the poisons and infections with constant antibiotics IV's . Another week of home care with visiting nurses finally has her smiling again .

Thanks Dr Robertson
  #43  
Old 03-10-2020, 07:25 AM
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Default ER doctors

Does anyone know if Dr Robertson has a practice in TV or is she just working for the hospital ??
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