[Parker]

Might part of the problem be staffing issues? Hospitals must ramp up staffing for high season, then ramp down when the snowbirds leave. Months like April, when there is a transition, might run into this problem head on.

[ilovetv]

It seems that if privately run urgent care centers are not willing to stay open until 10pm or midnight, TVRHospital ought to have its urgent care longer and open another one in the southern half of TV. With previous plans for a full hospital in Brownwood, for which C.O.N.was approved (I heard) and then plans were tabled, it seems so obvious that the hospital needs to build at least an urgent care or maybe a 24-hour freestanding full E.R. as other cities have around the country.

Even with a good supply of urgent cares open, a lot of seniors are so extremely sick and complicated that urgent care is not even the right place to be because of limitations on complexity of care they can handle. That is probably a big part of the clogged traffic in and out of TVRH E.R.

[Russ_Boston]

Originally Posted by rp001

Sorry Russ, have to disagree with you...The majority of the negative posts did complain about waiting times, but in addition some of us pointed out what we had seen there in regards to lack of care and suffering to the extreme. As I've said before, I personally witnessed a young man with an obviously dislocated shoulder, moaning in pain in a wheelchair for 8 hrs...I witnessed a diagnosed stroke patient, with spouse that worked there, leave for another hospital after sitting for 6 hrs unattended, and elderly in wheelchairs left unattended for hrs..In no way do I see this as any form of normal treatment in this country.

Your mentioning care in the ER. No, none, nada, zero stroke patients wait in the ER unattended. NONE. Repeat NONE. You may have been told by the patient that he/she was a positive stroke patient but I guarantee you that IF they were a positive blockage or bleed stroke patient they were cared for and monitored in the ER. If they had a blockage they would have been given some sort of thrombolitic (Tpa, Heparin drip, Fragmin etc.). That is the standard of care and we follow it very seriously for stroke. You can see from the JHACHO report that we do very well in stroke care.

You can say what you want on this forum and YOU may even believe it was real but I really don't think that happened. Most people on this forum don't have the inside knowledge to argue against you, but I do. I know exactly what the stroke protocol is. I'm certified in stroke care and procedures at TVRH. And IF it did happen then it is a real one-off and should be reported to TVRH management with full names, dates etc so the event can be recorded and investigated.

[Russ_Boston]

Originally Posted by ilovetv

It seems that if privately run urgent care centers are not willing to stay open until 10pm or midnight, TVRHospital ought to have its urgent care longer and open another one in the southern half of TV.

Are you going to pay for it? TVRH is not run by The Villages management. They are not going to open something that doesn't make money. It's simple math. Why should TRVH do it if other urgent cares know it's not profitable? TVRH should lose money? - just cuz?

[rp001]

Originally Posted by Russ_Boston

Your mentioning care in the ER. No, none, nada, zero stroke patients wait in the ER unattended. NONE. Repeat NONE. You may have been told by the patient that he/she was a positive stroke patient but I guarantee you that IF they were a positive blockage or bleed stroke patient they were cared for and monitored in the ER. If they had a blockage they would have been given some sort of thrombolitic (Tpa, Heparin drip, Fragmin etc.). That is the standard of care and we follow it very seriously for stroke. You can see from the JHACHO report that we do very well in stroke care.

You can say what you want on this forum and YOU may even believe it was real but I really don't think that happened. Most people on this forum don't have the inside knowledge to argue against you, but I do. I know exactly what the stroke protocol is. I'm certified in stroke care and procedures at TVRH. And IF it did happen then it is a real one-off and should be reported to TVRH management with full names, dates etc so the event can be recorded and investigated.

No I'm not medically qualified to diagnose a situation such as what I saw..The gentleman I was sitting with had a problem, went to his doctor, was sent to the er and he told me his doctor told him he had a stroke and needed admittance...He sat for hours...Maybe he was lying...Who knows but the other cases I MENTIONED DID NOT REQUIRE MEDICALLY TRAINED PROFESSIONALS TO DETERMINE HIS ARM WAS HANGING ASKEW AND IN TEARS AND MOANING.....FOR HOURS...PERHAPS DEFENSIVE POSTURING ISN'T THE RIGHT TACK, RATHER SEEKING A SOLUTION FOR THE GOOD OF ALL.

[Carla B]

For those who suggest going to the ER at Leesburg Hospital, I'll relate my experience last month on a Friday evening. I wanted to go to an urgent care center but they were all closed and I knew that the ER at TVRH would be overwhelmed.

I was taken in for testing very promptly and then sent back to the waiting room which was filled to capacity. After almost three hours waiting there, during which time not ONE patient was called back, I decided to go home.

My point is: if just one of the many urgent care centers had been open a little later, in my opinion this trip and drain on the ER resources would have been unnecessary. In any case, it looks like Leesburg ER is just as overwhelmed as TVRH.

On the other hand, I was admitted to TVRH last year twice through the ER. The care by the nursing staff when I got to a room was just great.

[curly top]

The horror stories of the inefficiencies of TV Hospital is repeated several times throughout the day. It is very scary that nothing is done about it. I wrote to them after my husband waited 6 hours, during which time we saw people bleeding not being attended to, a gentleman throwing up and noone cleaning it until I complained, etc.,
The "friendliest hometown" needs to take action about improving the situation at the hospital.

[gemorc]

Originally Posted by blueash

Shands in both Gainesville and Jacksonville have been given special legislative protection against having to pay malpractice awards over 200,000. So if they take out the wrong kidney or forget to give you oxygen while you are in surgery your ability to collect is severely limited whereas I believe no other hospital in Florida except Jackson Memorial in Miami has a similar limitation. The hospital itself is a teaching hospital. It is fairly well ranked and has some fields ranked in the top 50's nationally. Shands at the University of Florida in Gainesville, FL Rankings - US News Best Hospitals

Please read this month's Consumers Reports' section on teaching hospitals safety performance. On page 11, Shands Jacksonville recieved a score of 27 out of 100. The average score, for all hospitals, was 49. Safety of hospitals has little to do with ERs, but wouldn't you hope to achieve at least average?

[OnTrack]

Originally Posted by CFrance

I plan to look up all the urgent care facilities in the area and put their addresses, hours and telephone #s on the side of our fridge. If something happens, we'll know where we can go, or have to go.

Good idea.

Worst case, with them being on the fridge it will be a reminder to make a snack......to bring for the wait.


.

[Russ_Boston]

Originally Posted by rp001

No I'm not medically qualified to diagnosE a situation such as what I saw..The geltleman I was sitting with had a problem, went ot his doctor, was sent to the er and he told me his doctor told him he had a stroke and needed admittance...He sat for hours...Maybe he was lying...Who knows but the other cases I MENTIONED DID NOT REQUIRE MEDICALLY TRAINED PROFESSIONALS TO DETERMINE HIS ARM WAS HANGING ASKEW AND IN TEARS AND MOANING.....FOR HOURS...PERHAPS DEFENSIVE POSTURING ISN'T THE RIGHT TACK, RATHER SEEKING A SOLUTION FOR THE GOOD OF ALL.

I'm not defensive posturing at all. If these did happen then we have real issues. But I think:

1. not a real stroke that required any treatment, just evaluation. (and had a CT done within the 1st hour just to be sure that there was no blockage- I'm absolutely positive of that - I've yet to see a suspected stroke that did not have an hour one CT). He was waiting for a bed to open up on the second floor where we continue to monitor and test for any deterioration in condition. I do this EVERY day when I'm working on 2nd floor.
2. Just a dis-located shoulder - yes it hurts but nowhere near life threatening.
3. Hence more important injuries come first - just saying.


Triage is the name of the game in ER when we have 25 beds and 75 patients. Do the math. Your tone of inference is that both these cases should have been seen earlier and otherwise it is deplorable health care. Not the case IMHO. You say "seeking a solution". Solution to what exactly? Doing triage as it should be done?

Bottom line: If you go to TVRH ER (and many other local hospitals) with a non life threatening condition and expect to get out soon you're dreaming.

[BobnBev]

Russ, you make the most sense of anybody concerning the ER. Don't let the naysayers get you down. The majority of us appreciate what you do. Thanks.

[mickey100]

Originally Posted by Russ_Boston

I'm not defensive posturing at all. If these did happen then we have real issues. But I think:

1. not a real stroke that required any treatment, just evaluation. (and had a CT done within the 1st hour just to be sure that there was no blockage- I'm absolutely positive of that - I've yet to see a suspected stroke that did not have an hour one CT). He was waiting for a bed to open up on the second floor where we continue to monitor and test for any deterioration in condition. I do this EVERY day when I'm working on 2nd floor.
2. Just a dis-located shoulder - yes it hurts but nowhere near life threatening.
3. Hence more important injuries come first - just saying.


Triage is the name of the game in ER when we have 25 beds and 75 patients. Do the math. Your tone of inference is that both these cases should have been seen earlier and otherwise it is deplorable health care. Not the case IMHO. You say "seeking a solution". Solution to what exactly? Doing triage as it should be done?

Bottom line: If you go to TVRH ER (and many other local hospitals) with a non life threatening condition and expect to get out soon you're dreaming.

Agreed. Just common sense. The place isn't large enough or have enough staff to make waits any quicker, unless there are less patients, which isn't going to happen.

[JourneyOfLife]

Real numbers always help.


Here is the Medicare web site Hospital compare page. You can see all kinds of data being compared including Emergency Department wait times. You can compare hospitals against each other. Do some comparisons between TVRH and some hospitals you used "Back Home" to compare. Note: I could not compare hospitals in 2 different states on one page. So I opened two browser pages and switched back and forth between pages to compare.

Medicare Hospital Compare Quality of Care

Some general information on this topic at the CDC website.

FASTSTATS - Emergency Department Visits


National Hospital Ambulatory Medical Care Survey: 20 1 0 Emergency Department Summary

http://www.cdc.gov/nchs/data/ahcd/nh...web_tables.pdf




Gotta complaint with your hospital, let 'em know.

MEDICAL COMPLAINTS

[ilovetv]

The links provided by JourneyOfLife above are instructive.

In light of the coming changes brought by Affordable Care Act, to shift Medicare and other tax revenues to expand Medicaid to those who are currently uninsured so they (in theory) won't rely on the Emergency Dept. (most expensive setting) for non-emergency complaints, these two illustrations are telling of the behavior involved in gaining "free" or largely-subsidized first-dollar coverage:



And about the theory that providing publicly funded insurance (medicaid) to the uninsured will decrease ER usage by these recipients, because they'll now (in theory) have a primary-care doctor (never mind the existing shortage of those):



"Persons with Medicaid coverage were more likely to report at least one ED visit and multiple ED visits in a 12-month period than those with private coverage or the uninsured. This finding may reflect higher rates of disability and chronic conditions among persons with public insurance, including Medicaid, relative to the uninsured. However, uninsured persons under age 65 were more likely to have multiple ED visits in a 12-month period than those with private insurance. The data also show that persons without a usual source of medical care are not more likely to have an ED visit than those with a usual source of care, and that uninsured persons are not more likely than others to access the ED for nonurgent visits. Future work should focus on untangling the complex interactions among the sociodemographic, health status, and health care access factors that appear to be associated with visits to the ED.

From CDC - NCHS:
http://www.cdc.gov/nchs/data/databriefs/db38.pdf

[Mack184]

Originally Posted by Russ_Boston

I'm not defensive posturing at all. If these did happen then we have real issues. But I think:

1. not a real stroke that required any treatment, just evaluation. (and had a CT done within the 1st hour just to be sure that there was no blockage- I'm absolutely positive of that - I've yet to see a suspected stroke that did not have an hour one CT). He was waiting for a bed to open up on the second floor where we continue to monitor and test for any deterioration in condition. I do this EVERY day when I'm working on 2nd floor.
2. Just a dis-located shoulder - yes it hurts but nowhere near life threatening.
3. Hence more important injuries come first - just saying.


Triage is the name of the game in ER when we have 25 beds and 75 patients. Do the math. Your tone of inference is that both these cases should have been seen earlier and otherwise it is deplorable health care. Not the case IMHO. You say "seeking a solution". Solution to what exactly? Doing triage as it should be done?

Bottom line: If you go to TVRH ER (and many other local hospitals) with a non life threatening condition and expect to get out soon you're dreaming.

As Packard used to say.."Ask the man who owns one.." In this case..ask and or at least have the intelligence to LISTEN to the man who works there. The constant carping about TVRH and the "something MUST be done" whines come from people who don't have the foggiest notion how an ER works and what happens behind the doors. I'm sorry you have have to wait and I'm sorry you're going to miss your sacred tee-time or your table at Katie Belle's because you had to wait while people who REALLY need instant-stat treatment go before you.

Something MUST be done. I've told you before what MUST be done..It requires a VAST infusion of cash to build new beds and add a significant amount of staff. It's not going to happen without it. So go ahead and whine all you want, and stamp your feet and holler that "Something MUST be done" and continue to live in your ignorance of how hospitals and ERs work.

People like Russ bust their butts to take care of you. And..unless lots and lots and LOTS of money start getting donated to TVRH, you are NOT going to see any change because TVRH gets fully 88% of it's revenue stream from Medicare and their reimbursements to ALL hospitals are falling at unprecedented rates which leaves TVRH with a VERY thin operating margin.

As Russ & I have both said in the past TVRH has a limited amount of bed space to fill an ever-growing population. It's only going to get worse and not better.