Talk of The Villages Florida - Big Black Eye for TV

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According to Scripps.....
Time for the ER

�Emergency departments are an essential part of our health care system,� says Shawn Evans, MD, an emergency medicine physician at Scripps Memorial Hospital La Jolla. �They are there to provide medical care at any time.�

The emergency department was designed to provide fast, life-or-limb-saving care. Many people, however, use the ER as a place to receive urgent care without realizing it. If you�re ever in doubt, it�s better to be safe and go to the closest ER. These are just a few of the conditions that are medical emergencies:

Persistent chest pain, especially if it radiates to your arm or jaw or is accompanied by sweating, vomiting or shortness of breath
Persistent shortness of breath or wheezing
Severe pain, particularly in the abdomen or starting halfway down the back
Loss of balance or fainting
Difficulty speaking, altered mental status or confusion
Weakness or paralysis
Severe heart palpitations
Sudden, severe headache
Sudden testicular pain and swelling
Newborn baby with a fever
Intestinal bleeding
Falls with injury or while taking blood thinning medications
Loss of vision
Head and eye injuries
Broken bones or dislocated joints
Deep cuts that require stitches � especially on the face
Head or eye injuries
Severe flu or cold symptoms
High fevers or fevers with rash OriginalPoster
Bleeding that won�t stop or a large open wound
Vaginal bleeding with pregnancy
Repeated vomiting
Serious burns
Seizures without a previous diagnosis of epilepsy

You may also be sent to the ER by your doctor if you have an underlying condition, such as hypertension or diabetes, which could complicate your diagnosis and require extra care."

Pretty much sums it up regardless of "opinions."

Quote:

Originally Posted by Vernster (Post 838462)

One of the reasons there are fewer physicians now is because of the reduction in reimbursement from insurance companies; particularly Medicaid and Medicare. Private insurance companies pay somewhat more but frequently also reduce their payments. This is a particular problem for primary care physicians who are paid much less than specialists. Most medical docs are over $200,000 in debt when they finish their education and have no money left to open a private practice like was done in the past. The result is multi medical practices owned and run by large corporations. Very few doctors today have the luxury of owning their own practice, hiring their office staff and charging their patients what they wish.

Yes, it is terrible to see all those primary care physicians lined up at the Goodwill store, the food pantries, and the soup kitchens. :ohdear:

Quote:

Originally Posted by jbdlfan (Post 838473)

Your post 78 was kind of eroded by this posting of yours. Glad you looked up what constitutes an emergency. Keep it up.

Quote:

Originally Posted by Bogie Shooter (Post 838465)

This is a proud statement of your village community............................

Snort!!!!!!:laugh:

Quote:

Originally Posted by jbdlfan (Post 838473)

According to Scripps.....
Time for the ER

�Emergency departments are an essential part of our health care system,� says Shawn Evans, MD, an emergency medicine physician at Scripps Memorial Hospital La Jolla. �They are there to provide medical care at any time.�

The emergency department was designed to provide fast, life-or-limb-saving care. Many people, however, use the ER as a place to receive urgent care without realizing it. If you�re ever in doubt, it�s better to be safe and go to the closest ER. These are just a few of the conditions that are medical emergencies:

Persistent chest pain, especially if it radiates to your arm or jaw or is accompanied by sweating, vomiting or shortness of breath
Persistent shortness of breath or wheezing
Severe pain, particularly in the abdomen or starting halfway down the back
Loss of balance or fainting
Difficulty speaking, altered mental status or confusion
Weakness or paralysis
Severe heart palpitations
Sudden, severe headache
Sudden testicular pain and swelling
Newborn baby with a fever
Intestinal bleeding
Falls with injury or while taking blood thinning medications
Loss of vision
Head and eye injuries
Broken bones or dislocated joints
Deep cuts that require stitches � especially on the face
Head or eye injuries
Severe flu or cold symptoms
High fevers or fevers with rash [CO LOR="Yellow"]OriginalPoster[/COLOR]
Bleeding that won�t stop or a large open wound
Vaginal bleeding with pregnancy
Repeated vomiting
Serious burns
Seizures without a previous diagnosis of epilepsy

You may also be sent to the ER by your doctor if you have an underlying condition, such as hypertension or diabetes, which could complicate your diagnosis and require extra care."

Pretty much sums it up regardless of "opinions."

Perhaps one of the nurses on TOTV can verify this. The baby had a 101 fever. When our kids were toddlers, I thought a fever of 103, 104 was indicative of ER intervention, but 101 ws to be treated at home.

I also thought the severe flu symptoms requiring ER had to do with dehydration. I could be wrong.

My specialty is certainly not pediatric or labor and delivery ....but as an RN any fever that can't be treated or stabilized at home with rotation of Children's Motrin and Children's Tylenol is certainly a need for a MD visit. Any fever of 103 is alarming. Children crash quick--especially asthmatic children. Nobody should ever smoke around children who have asthma. Not even in the car--or hold children in their arms if they are a smoker. I hate seeing children come in sick with parents who smell like a cigarette factory and they say "I only smoke outside". BIG DEAL if you are carrying your child on your shoulder.

There are many factors in triage-regardless if it is a fever or not. Most suffering children (emergent) are what we call lethargic or sickly. Sleepy-not crying as much, not as many wet diapers in a day, dry lips, flushed face/ears....Temp of 101 can certainly be pneumonia or teething. You have to look at the child and put the story together--if something isn't adding up--it is possible critical and that child would not wait 11 hours in any ER.

Dehydration sets in quick with elder population as well. Vomiting 12 times in 2 weeks is not dehydration. Vomiting 12 times in one day is alarming.

Quote:

Originally Posted by buggyone (Post 838476)

Yes, it is terrible to see all those primary care physicians lined up at the Goodwill store, the food pantries, and the soup kitchens. :ohdear:

You purposely miss the point in order to ridicule.

The insurance, Medicare and Medicaid paperwork, documenting to CYA in case of malpractice lawsuits, and now electronic medical records are making the drs. spend their time on everything but patient care. This is part of the problem at TVRH and every E.R.:

"Robert G. Hill Jr, MD, from St. Luke's University Health Network, Allentown, Pennsylvania and colleagues analyzed time use in their emergency department and found that physicians spent 43% of their time, on average, performing data entry, or roughly twice as much as that spent on direct patient care. Their study was published online September 23 in the American Journal of Emergency Medicine.

During a busy 10-hour shift, their calculations suggested that a physician might perform a finger-numbing 4000 mouse clicks entering data.

"Emergency department physicians spend significantly more time entering data into electronic medical records than on any other activity, including direct patient care," the investigators note. "Factors such as operating system speed, server/mainframe responsiveness, typing skills, user-friendliness of system, interruptions, extent of training, opportunity to delegate tasks, and various environmental attributes can influence data entry time. Efficient use of the EMR system will increase physician productivity and hospital revenue," they maintain.

Although EMRs are now the federally mandated standard for medical records, they are still controversial, with hefty up-front costs and uncertain benefits, according to the investigators......"

http://www.medscape.com/viewarticle/811841

Quote:

Originally Posted by TraceyMooreRN (Post 838410)

So what is acceptable time frame to wait in an ER? For those who use it as an Urgent Care facility (no matter their cause--insurance, no insurance). I believe the national average to be 8-10 hours?-Not sure on my numbers. Pile all the "snowbirds" into a community hospital for non-emergencies--you get a CLINIC. Really sick people waiting hours-due to others making a choice to come to an ER for non-emergencies. I wish all insurance companies would say--go to urgent care, if you go to an ER and deemed not emergency, you should have to pay out of pocket. IMO

I know for a fact--Leesburg has 11 hour waits as well. All ER wait times are hit and miss.

The less peak hours in most ERs are 3am-6am---just a scenario. You can always call ahead and check what the wait times are approximately.

I hope that in the future (maybe 10 years) but in the future--we will get approved for a larger hospital near Brownwood. TVRH does not have pediatrics-doesn't mean they can't treat pediatrics. They have to transfer the sickest children out to Leesburg or Ocala. They don't have neurosurgeon most of the time. They don't offer critical heart cases-(bypass surgery). TVRH is not a trauma center. If we could build what Leesburg has at Brownwood...offering a two door emergency room. One will be CLINIC patients other EMERGENCY patients (those who anticipate admission).

:ohdear: Also- please remember do not use up resources like EMS to provide you transportation unless you are having an emergency. Sad- that some people still think that is going to help? Or would even consider this... Most ERs have Triage in the back and in the front. In other words--calling EMS to transport you because you think you will see a doctor sooner--is a BIG MISTAKE and frowned upon wasting resources that could actually save a life. Taking up the closest ambulance to give you a "ride" for a faster triage infuriates medical care providers. It should also infuriate the other citizens in our community. Waste of a great resource for true emergencies. While one ambulance is taking your 4 day headache to the ER--someone in respiratory arrest now has an ambulance that takes 10 minutes longer because the closest one is out on a "Taxi Ride" :cus:

If you come to the ER and leave--regardless of the wait time--It was not an emergency. There were other alternatives that you choose not to take, but came to the ER. :bigbow:

My husband was still hospitalized last year over the Easter weekend. Guess what? The ER was virtually deserted every time I passed by. Come Monday...overflowing again. "Emergencies" take holidays, too?

Your thought of having non-emergency being taken care of through the urgent cares by insurance is right on. It would definitely cost less all around and free up ER's for the emergencies. (Also, the lady at the hospital when I called about this discussion, said that those on Medicaid and those with no insurance at all have to pay at the urgent care so they come to the ER.) It will also take urgent care facilities to take up longer hours. Maybe it should be a requirement that they be manned from 6 in the morning to midnight, at least in order to be licensed.

Something that many don't realize, either, is that when a nurse's shift is say 6-12, that does not mean that nurse gets to walk out the door at 12:00 or come scootin' in at 6:00 to get started. (I'm sure you can attest to that, Tracy.) So before anyone starts complaining to or about nurses not doing enough, think about that. They have to give a report to the oncoming nurse about each patient that she/he has been responsible for during the shift, then finish up all the paperwork before leaving. And, if they are attending to one of those patients at 12:00, they don't just quit right in the middle of what they are doing. They finish and then do all the other stuff they have to do just to get to leave. That goes for all areas of the hospital.

I, for one, am eternally grateful for all the devoted men and women who serve us in this or any other medical community. Thank you!

Quote:

Originally Posted by buggyone (Post 838477)

Your post 78 was kind of eroded by this posting of yours. Glad you looked up what constitutes an emergency. Keep it up.

Pretty much confirms prior post, that was the reason for the confirmation. Thank you for the blessing.

Quote:

Originally Posted by buggyone (Post 838476)

Yes, it is terrible to see all those primary care physicians lined up at the Goodwill store, the food pantries, and the soup kitchens. :ohdear:

I am curious at the hostility of this post toward doctors. Some doctors are very well paid. Some aren't. Either way, having observed the dedication and very hard work of many of them, I say 'Good for them'. They, and others who also work hard in any field, should profit from it.

Notice I don't necessarily say they should get rich, but as long as they do it honestly and earnestly, more power to them. I, for one, don't want to see my doctor lined up at Goodwill.

Quote:

Originally Posted by Parker (Post 838526)

I guess the sarcasm was not seen. What I meant was even though doctors have a lot of student debt, they recoup it through their salaries and tax write offs within a few years. Doctors earn good salaries and their is now a record high enrollment of medical students.

Seems to me if TV hospital wanted to do satellite locations of their own this could eliminate some of the overcrowding. Staffing late hours may be a problem but a regional center may be a solution for less serious conditions.

My experience with Leesburg hospital is as bad, if not worse, than TV!

Quote:

Originally Posted by salferg (Post 838917)

My experience with Leesburg hospital is as bad, if not worse, than TV!

How so? Can you give a report on your experience?

Quote:

Originally Posted by salferg (Post 838917)

My experience with Leesburg hospital is as bad, if not worse, than TV!

Emergency room?
Outpatient?
In Patient?
Doctor(s)?
Nurse(s)?
As asked above....how so?