As my thirteen year old daughter would put it, “it bites” being stuck working on Christmas Eve in the Emergency Department. Considering how busy we normally are on a typical work day, the fact that I am able to sit here with the nurses at the computer typing this entry I find thoroughly amazing. Since 2:00 pm today, my staff and I have been keeping a tally of what pathology has shown up so far.
Years ago I was working with New York City as an EMT out of Queens General Hospital. I remember being in shock after picking up an otherwise non-ill appearing man who gave a complaint that I currently cannot recall. We took him in a city ambulance to the local hospital. The part that shocked me was that he never entered the hospital. He thanked us and proceeded to go across the street to do his shopping. He never was sick and never intended to enter the ED doors. We served as free transportation for him.
Emergency services selects for a unique “customer” base. This customer base is comprised of the truly ill and the desperate, those who have no where else to turn for care, as well as those with poor coping skills and a naiveté regarding emergency care realities and, on occasion, those with secondary gain interests. What is being measured is the perception of quality in care and not quality of care. The survey industry has duped the hospital administrators who are trying to promote their “businesses”. Kind, considerate, thoughtful care, with a focus on the patient is absolutely paramount. Inappropriate prescribing of antibiotics and addictive narcotics, exposure to potentially harmful unnecessary studies, especially in developing children, as well as further straining an already economically burdened health care system are just some of the products of blinding following these surveys. The survey industry has duped hospital administration into believing that the same system used to evaluate customer service at my auto dealership translates to all niches of hospital care. Obviously, it doesn’t. Blind focusing on these surveys without true reflection on their source and meaning will lead to many patients becoming victims.
I found the following on a general search for a project I’m working on. Interesting points. The google search simply led to a download with no listed author. If you know who wrote this, please let me know!
Emergency Department Overcrowding: Right diagnosis, wrong etiology, no treatment
There’s been a lot of hoopla about the phenomenon of emergency department overcrowding in recent years. This has been an issue worthy of Time magazine, CNN, and Nightline. Do we know the solutions? Are we on message? Or have we done ourselves harm?
Beginning January, 2011, a Medical Director is required for all ambulance services in the Commonwealth of Pennsylvania. Additionally, the ability to contact Medical Command is required of all ambulance services as well. This seems as if we are heading in the right direction regarding oversight. Up until now, AEDs were optional for BLS ambulance services. The mandate that they are onboard has prompted the need for having a Medical Director. Hopefully, this will generate some quality control. Hopefully, this will not be a localized step forward in one individual state.
It seems as if the overall system for Emergency Medical Care is in need of reinvention. A centrally controlled scene command, an assurance of minimal skill and proficiency for EMTs and first responders, and an ability of hospitals to have a built in cushion to absorb patients, are all core components of an effective disaster preparedness system. This reinvention must be realized on a state or regional level. Failure to address these issues could prove disastrous in the future if such circumstances ever reoccurred
Jordan Barnett, MD, is an Emergency Medicine Physician in the Philadelphia Suburban Region. He has previously worked as a volunteer firefighter, was a member of New York City EMS, and provides Medical Command for several ALS Ambulance Services. Dr Barnett provides EMS consultation services. Additionally, he is actively involved with EMS education.