Emergency Rooms
In June many of us witnessed (after the fact and via hospital surveilance camera footage) Esmin Green, a 49-year-old mother of six, tumble off her chair onto the floor of the Kings County psychiatric E.R. waiting room in New York City. Members of the hospital staff saw her lying there but did nothing for about an hour. When Green was finally brought into the E.R., she was dead. An autopsy revealed that she died from a pulmonary embolism, which occurs when a blood clot forms in the leg, breaks off, and travels to one or both lungs. This can also occur and kill long-haul airplane passengers who sit in one spot for hours: The blood sits stagnant in their legs for so long that it clots. Green had been on her own plane ride of sorts. She'd waited for a psychiatric-unit bed to open up for more than 24 hours, roughly the same flight time as a trip from New York to Tanzania.
The surveillance video of Green collapsing and lying untended, as hospital staff at Kings County fail to respond to her collapse, is inexcusable by any stretch of the imagination, causing Nancy Grace, for one, to focus on the negligence. But what's largely missing from this story is the likely cause of Green's pulmonary embolism. The answer lies in a far more systematic and widespread danger in hospital care: E.R. waits. Why was Green sitting and waiting while blood pooled in her legs? Despite increasing evidence that crowded E.R.s can be hazardous to your health, hospitals have incentives to keep their E.R. patients waiting. As a result, there has been an explosion in E.R. wait times over the past few years, even for those who are the sickest.
A major cause for E.R. crowding is the hospital practice of boarding inpatients in emergency departments. This happens when patients who come to the E.R. need to be admitted overnight. If there are no inpatient beds in the hospital (or no extra inpatient nurses on duty that day) then the patient stays in the E.R. long past the completion of the initial emergency work. This is what happened to Green, and it has become widespread and common. The problem is that boarding shifts E.R. resources away from the new patients in the waiting room. While E.R. patients wait for inpatient beds, new patients wait longer to see a doctor. As more new patients come, the waits grow. And an E.R. filled with boarding patients and a full waiting room is an unhappy E.R.:
The atmosphere is at once static and chaotic. If you or a loved one has waited for hours in an E.R., you know what we mean. The environment can be unsafe and even deadly.
This practice of "bed-hiding" is also becoming a common practice.
Emergency Room Germs
And then of course we know that Emergency Rooms, like doctor's offices only multiplied, are virtual peetrie dishes of every type of germ imaginable. So even though a trip to the E.R. is sometimes unavoidble, avoiding one if it is not imperative, is vital to your health.
In June many of us witnessed (after the fact and via hospital surveilance camera footage) Esmin Green, a 49-year-old mother of six, tumble off her chair onto the floor of the Kings County psychiatric E.R. waiting room in New York City. Members of the hospital staff saw her lying there but did nothing for about an hour. When Green was finally brought into the E.R., she was dead. An autopsy revealed that she died from a pulmonary embolism, which occurs when a blood clot forms in the leg, breaks off, and travels to one or both lungs. This can also occur and kill long-haul airplane passengers who sit in one spot for hours: The blood sits stagnant in their legs for so long that it clots. Green had been on her own plane ride of sorts. She'd waited for a psychiatric-unit bed to open up for more than 24 hours, roughly the same flight time as a trip from New York to Tanzania.
The surveillance video of Green collapsing and lying untended, as hospital staff at Kings County fail to respond to her collapse, is inexcusable by any stretch of the imagination, causing Nancy Grace, for one, to focus on the negligence. But what's largely missing from this story is the likely cause of Green's pulmonary embolism. The answer lies in a far more systematic and widespread danger in hospital care: E.R. waits. Why was Green sitting and waiting while blood pooled in her legs? Despite increasing evidence that crowded E.R.s can be hazardous to your health, hospitals have incentives to keep their E.R. patients waiting. As a result, there has been an explosion in E.R. wait times over the past few years, even for those who are the sickest.
A major cause for E.R. crowding is the hospital practice of boarding inpatients in emergency departments. This happens when patients who come to the E.R. need to be admitted overnight. If there are no inpatient beds in the hospital (or no extra inpatient nurses on duty that day) then the patient stays in the E.R. long past the completion of the initial emergency work. This is what happened to Green, and it has become widespread and common. The problem is that boarding shifts E.R. resources away from the new patients in the waiting room. While E.R. patients wait for inpatient beds, new patients wait longer to see a doctor. As more new patients come, the waits grow. And an E.R. filled with boarding patients and a full waiting room is an unhappy E.R.:
The atmosphere is at once static and chaotic. If you or a loved one has waited for hours in an E.R., you know what we mean. The environment can be unsafe and even deadly.
This practice of "bed-hiding" is also becoming a common practice.
Emergency Room Germs
And then of course we know that Emergency Rooms, like doctor's offices only multiplied, are virtual peetrie dishes of every type of germ imaginable. So even though a trip to the E.R. is sometimes unavoidble, avoiding one if it is not imperative, is vital to your health.
- If at all possible go to your family doctor or an urgent care, unless it is a true emergency.
- If it is a true emergency call an ambulance; ambulance patients are attended first.
- If at all possible, do not take well children or infants to the E.R.
- Take hand-sanitizers with you and use them throughout your stay.
- Try not to eat in the E.R.
- If you are not the patient and have a long E.R. stay, take regular fresh air breaks outside.
- If you or someone you love is left sitting or lying in the E.R. for hours, complain!
A recent study found that critically ill patients who spend more than six hours in the E.R. are 4 percent more likely to die.
Part 3 Continued Tomorrow
Source: Zachary F. Meisel and Jesse M/Posted on Slate.com
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