We need to investment in low tech solutions like nurses to staff beds, case managers to help navigate new placements, and social service staff to manage problems on the weekend. We also need actual housing.
100%. Beyond the ED there are those that are eventually admitted and sit (or raise hell) in hospital rooms waiting for placement for months sometimes. Meanwhile, nurses are run ragged caring for the acutely or critically ill, while still trying to manage essentially babysitting mentally ill or dementia patients that facilities don’t have room for or won’t accept. Of course contributing to long ED boarding times and lack of beds for others who need care. Around and round we go.
As the CMO at a large healthcare system, my entire morning would be spent trying to “move” ED patients.
The vast majority needed beds in the hospital as inpatients. The most frustrating were the psych holds. As mentioned, the disparity between the total extant county psych beds and needs was a chasm.
IMHO there are two major reasons for all ED’s being overwhelmed and under capacity.
1. Urgent patient access to their outpatient doctors is difficult to impossible.
2. The primaries, when confronted with someone asking to disrupt their schedule, themselves, tell the nurse “send him/her to the ED/ER”
I have listened to recordings on PCPs’ answering machines stating “ go to emergency room if you need to be seen urgently” (words of substance)
I have nothing but admiration for ED docs. It’s the toughest job anywhere in medicine. Remember the adage about anesthesiology?
95% boredom and 5% chaos: emergency room medicine is 20% boredom and 80% chaos.
I am a PCP and to use a sports analogy, primary care doctors have become punters, not quarterbacks.
Ben Hourani, MD MBA.
Board Certification, Internal Medicine Geriatrics-retired
We had a “secure holding” area of several beds on a locked portion of the ED, and it was definitely helpful for many. Tragic for others who used the ED as their PCP and homeless - many “non psych” folks would end up there for lack of anywhere else to go. There has to be a better way but I was unable to find one during my career in healthcare.
Was there anything different about his new facility that will make him less likely to set his room on fire there? Different smoking policy? More willing to look the other way about vapes in the room? I wonder if there is anything making it less likely we'll have another 70 hours in the ED for this man in another year?
Great story that reflects a longstanding and frustrating situation for both patients and staff. After many years as a nurse, it still seems crazy that hospitals, theoretically 24-hour facilities, shut down many services after 5 pm and all weekend. This includes numerous clinical and support services that cannot be foisted onto the backs of overburdened bedside nurses, a decent selection of food for anyone not working 9 am - 5 pm, and many other things. Holding this patient in an ER is expensive. It's a penny wise and pound foolish choice.
The Report on Improving Mental Health Outcomes might be of interest. https://psychrights.org/ReportOnImprovingMentalHealthOutcomes.pdf
100%. Beyond the ED there are those that are eventually admitted and sit (or raise hell) in hospital rooms waiting for placement for months sometimes. Meanwhile, nurses are run ragged caring for the acutely or critically ill, while still trying to manage essentially babysitting mentally ill or dementia patients that facilities don’t have room for or won’t accept. Of course contributing to long ED boarding times and lack of beds for others who need care. Around and round we go.
As the CMO at a large healthcare system, my entire morning would be spent trying to “move” ED patients.
The vast majority needed beds in the hospital as inpatients. The most frustrating were the psych holds. As mentioned, the disparity between the total extant county psych beds and needs was a chasm.
IMHO there are two major reasons for all ED’s being overwhelmed and under capacity.
1. Urgent patient access to their outpatient doctors is difficult to impossible.
2. The primaries, when confronted with someone asking to disrupt their schedule, themselves, tell the nurse “send him/her to the ED/ER”
I have listened to recordings on PCPs’ answering machines stating “ go to emergency room if you need to be seen urgently” (words of substance)
I have nothing but admiration for ED docs. It’s the toughest job anywhere in medicine. Remember the adage about anesthesiology?
95% boredom and 5% chaos: emergency room medicine is 20% boredom and 80% chaos.
I am a PCP and to use a sports analogy, primary care doctors have become punters, not quarterbacks.
Ben Hourani, MD MBA.
Board Certification, Internal Medicine Geriatrics-retired
We had a “secure holding” area of several beds on a locked portion of the ED, and it was definitely helpful for many. Tragic for others who used the ED as their PCP and homeless - many “non psych” folks would end up there for lack of anywhere else to go. There has to be a better way but I was unable to find one during my career in healthcare.
Was there anything different about his new facility that will make him less likely to set his room on fire there? Different smoking policy? More willing to look the other way about vapes in the room? I wonder if there is anything making it less likely we'll have another 70 hours in the ED for this man in another year?
Great story that reflects a longstanding and frustrating situation for both patients and staff. After many years as a nurse, it still seems crazy that hospitals, theoretically 24-hour facilities, shut down many services after 5 pm and all weekend. This includes numerous clinical and support services that cannot be foisted onto the backs of overburdened bedside nurses, a decent selection of food for anyone not working 9 am - 5 pm, and many other things. Holding this patient in an ER is expensive. It's a penny wise and pound foolish choice.