One time, after we had been in a hallway for hours with our son, waiting for an ER room (not a regular hospital room), we inquired about how much longer they thought he would be in the hall. They said they were waiting for the room to be cleaned. My husband volunteered to do it, but they turned him down.
It does vary a lot - when my husband went in to the same ER a few weeks ago (on a Friday night about 10:30 pm), there was NO wait. He was taken straight for an X-ray and then to an ER room.
A friend is a nurse in another local ER. She said she was glad she didn’t work last weekend, because the ENTIRE computer system went down, for over 48 hours. The older nurses and doctors were comfortable with reverting to the “old” way of doing everything, but it was tough on the youngsters.
I have sympathy for the ER personnel having to deal with severely mentally ill people. Ugh. There really should be a separate entry point for mental health crises versus physical ones.
We were pleasantly surprised H was given a bed in under an hour. It was a strange room—actually a corridor that most of the nurses and staff walked in and out of but at least he had a bed and they started testing and imaging pretty quickly. We were happy to be out in about 6 hours. We were fortunate it wasn’t more crowded and there weren’t more urgent cases.
I’d like to say that I’ve had great success with ED in two different places. Both small towns.
Staff was great, and we have been very impressed by their caring and understanding. One ED found my mom a room right away and the other transported my husband to a hospital that could treat him.
Trying to say that not all experiences are bad.
Now the Saturday night ED experience in a major east coast city was completely different. It was triage and get the H out of here. Glad we were able to get mom to another ED in her home town for appropriate care.
In the big city defense, it was Saturday night and the person in the room next to us coded during shift change. I wish they had done more for my mom who was in great distress. We put off any care for her because of non diagnoses after a fall.
Sadly this was even an issue when I worked as an ER nurse over 20 years ago, but typically only over the winter months. Should have been addressed then - although I guess it was trying to be when there was the huge influx of urgent care centers to try to meet the needs of the non-emergent cases.
One of the issues is the ER cannot turn anyone away as they are bound by EMTALA, so many patients who have no other means of healthcare will go to the ER through no fault of their own. Another issue is PCP offices are so overbooked that patients who have certain issues now that need to addressed shouldn’t be stuck waiting weeks to be seen. This also leads to the urgent cares being back logged as well, but as long as they are stand alone and not affiliated with a hospital system, they can turn people away.
Also, after COVID, many ER’s lost their experienced staff and were forced to hire new grad nurses in the ER (which used to be extremely rare). Due to extreme short-staffing issues, these new grads probably did not receive the type nor length of orientation they typically would have, and were thrown into the deep end way too soon to sink or swim. Totally not fair for these new nurses and is why you’ll now see a high turnover rate of staff.
I wish I had ideas for a solution, but it’s been many years since I’ve worked in the ER. Again, this is not a new problem, just one that has grown exponentially over the years.
The healthcare system I use the most here in Brooklyn, NY has a great virtual urgent care appointment program with same-day scheduling. Of course the docs (I haven’t seen an NP or PA yet; that’s who staffs office-based urgent care like CityMD here) can an order bloodwork and/or imaging if necessary.
Every crisis is a crisis especially for the person admitted and anyone who accompanies them. But triage is an important step in the ER process. For them to put attention and compassion into “every” emergency has to be emotionally exhausting.
So, honest questions - do they accept patients who do not have a way to pay for services, and how do they perform a hands-on assessment - say for someone who has abdominal pain? My fear in that would be diagnostic testing being ordered that isn’t necessary, hiking costs up. However, since I’m unfamiliar with how this works, maybe they have that issue ironed out.
I totally agree. When I broke my arm just before the pandemic was detected here and I presented myself at a hospital ER, I was really hurting (no duh!). The triage nurse said, “You look like you’re in a lot of pain!” and came back with a giant Percocet. Ahhh! Whereas the urgent care office where I went first and who sent me to the hospital a couple of blocks away had a staffer who when she checked me out said, “And have a nice day!” I was NOT having a nice day!
The problem is not just those who have no other choice defaulting to the ER…the problem is the long wait time to get an appointment with a ‘regular’ doc. these days.
Case in point. DH…who never notices these things, says …hmmmm this mole/thingy cropped up very quickly do you think I should worry about it.
It doesn’t look like a bad thingy to me…but what do I know…so…tell him to get it looked at before we leave for a three week trip at the end of next week.
Emails PCP…gets canned response…‘please make an appointment’…three months out.
Calls an independent dermatologist he’s seen in the past…also scheduling three months out.
So…DH will try urgent care first thing Monday morning. UC now requires you to make an appointment (because apparently people plan to have a medical issue tomorrow at 2 so they will stay up until midnight when the next day’s appointments ‘drop’ so that they can grab one). The other option is to be there 30 minutes before the reception opens. And you will be seen that morning.
So UC for a mole…and if that doesn’t work…then maybe the ER…because waiting 3 months to see something that is ‘growing kinda quick’ is not how we roll.
Sounds like a great time for the physicians to advocate for the respiratory therapy department to get trained on intubation and ACLS like they are in many hospitals around the country. I’m sure the RTs are super short staffed and overworked like everyone but I’d bet they would offer some solutions for this situation! (Usually it’s pay better so we can retain staff but admin prefers pizza )
There are no RTs on the night shift at this particular hospital. There are no general surgeons, anesthesiologists or radiologists on night shift or on call either. Nor pediatricians or Ob/gyns. There is no peds ICU or in fact any pediatric beds at all. No L&D dept.
The hospital cannot keep enough nursing staff and relies heavily on traveling nurses (with alll the negatives associated with that). But hey, the hospital administrators gave themselves a 22% raise at the end of last year…
Yes, they see anyone. They assist them to apply for Medicaid if eligible, but sometimes refer to NYC Health and Hospitals network, a widely available network of NYC public hospitals and clinics.
Paying admin a huge raise when they won’t staff appropriately just shows that the understaffing is by design. Patient outcomes and burning out of staff be darned.
Respiratory therapists are great at intubating patients, but they should be performed under the direct supervision of a physician.
The trickiest part of intubating patients is deciding who needs to be intubated or not. That requires understanding of the underlying disease process and familiarity with alternative treatments. The best medical care provided is recognizing the patient who is in danger and treating the patient aggressively to avoid intubation. Many patients who are intubated are extremely difficult to wean off the ventilator, so intubation is not always a desirable outcome. It is also important to be able to identify the “difficult airway” patient where intubation should truly be considered a last resort and surgical backup should be at the bedside as well.
RTs and nurses are not allowed to independently order medications. These are necessary for ALCS protocols as well as pre-intubation treatment and post-intubation sedation. In those situations, you still need a physician present.
There are plenty of under resourced hospitals in this country. EDs that are short on staff, supplies, beds, hospitals that are too small to accommodate all who need care, etc.
This is not the fault of the people working in those EDs. They are doing the best they can with what they have (or don’t have).
Many under resourced hospitals do not have other specialists on staff 24/7. In some of these places, these specialists don’t exist at all (hospitals without L/D often don’t even have an OB Gyn in town).
Some are located a distance from a higher level of care medical center, and it does take time to transfer people…sometimes time is not on their side.
We are extremely fortunate to have good ERs in our area. When H had issues in the middle of the night, they got him in quickly, and he received great care.
Mental health ER situations are another story, especially for children and teens. Our state does not have adequate resources, facilities or staff to treat these crises. Our paper has done some really good reporting on the situation. Children sit in the ER for days and even weeks sometimes. It’s awful.
I was in an ER the day after Christmas and it was pure chaos. When I got called into triage, I mentioned that a woman had come by ambulance before me and still hadn’t been triaged. They thanked me for pointing out that oversight. There were very few chairs to choose from, but I was able to avoid sitting near any “respiratory” cases. Also, sitting near the outside door provided the best ventilation.
This is nothing new. I was an ER nurse for years and the system is flawed. The mental health system is even worse. It’s heartbreaking to try and work in it and do your best to help people.
I’m watching the Super Bowl at our friends’ house. Their daughter is an EMT in Philadelphia. I asked her what percentage of her calls are mental health related and she said at least half.
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