Hallway to heaven
Tuesday, October 28 2008
In an article that verges on alarmist, the AP discovers that patients are being left in hallways after ER visits. [My first read of that article was a little off, so I've revised the rest of the post accordingly.]
The problem is that patients are filling up ERs and not being admitted to the hospital proper. That means ER docs are overworked and ER patients suffer longer waits and less attention. Some patients die. The article highlights the emerging practice at some hospitals of admitting patients and then putting them in hallways in regular wards, if rooms aren’t available. The theory – and the evidence – suggest it’s better to get them out of the way than leave them in the ER.
As far as crowded ERs go: been there, done that, got the plastic bracelet. When you show up at an ER with a 103.5*+ fever and a history of Crohn’s disease, you’re going to get IV fluids, antibiotics, maybe some sort of analgesic, and probably a CT scan. Once the needle’s in and the meds are flowing, you’re no longer an emergency – all the docs can do is watch and wait and decide whether to admit. Usually they don’t.
And for about two or three years of my life, this happened to me every few months – I would get my fever, go to the ER, spend the night, and come home the next morning. Under the circumstances, I never felt like I had any priority for a room. If I could have gone anywhere else – if I could have stuck myself and pumped the meds at home – I would have. But my fevers tended to spike late at night, usually around midnight, often on weekends. At that hour, there’s no where else to go but the ER.
Just because I’m sick enough to go to the ER, doesn’t mean I need to be admitted. For about the first half-dozen times this happened, I never got admitted. I usually spent the night in the ER and was sent home with scrips for antibiotics. This was fine – a hospital admission adds another $150 (per day) minimum to my out-of-pocket expenses.
So while I’m okay with the abstract principle behind this article, I don’t want “crowded ER” to be a factor in determining whether I’m admitted. If I had my way, there would be somewhere else I could go late at night to get IV drugs antibiotics, without bothering the ER staff. Barring that, I’m happy to sit in a chair in or near the ER, out of the way, soaking up my meds and watching the world go by. All of which is more or less a long-winded introduction to the story I want to tell.
Once, after I drove myself to the ER on a Friday night, the nurses sat me in a recliner facing the ambulance entrance. It was like living out a Discovery Channel special. At one point, the police brought in a guy in handcuffs – he had been injured in a fight. “This guy’s deaf,” the cops told the nurse, “we need an interpreter.” So the nurses treated him while some underling went to find the ASL interpreter. When the interpreter showed up, the docs started asking the patient questions, and the interpreter did his thing. In response, the patient just shrugged his shoulders angrily, so the doctor asked the interpreter, “what’s wrong?” “You have to uncuff him,” said the interpreter, “so he can use his hands to sign.” The cops looked at the interpreter, and then at one another, as if wondering whether this guy was some kind of master criminal who had figured out how to escape handcuffs and was about to unleash a criminal rampage on the ER department. Finally one of the cops shrugged, got out his key, and let the guy loose from the handcuffs. I can report that the culprit did not escape nor further resist, and was well-treated by the ER staff. After a while, the cops took him back to deaf-people’s prison.
So just think: if I had been upstairs in a hallway, I would have missed all the fun.
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