Canada’s Hospitals, NOT Canada’s ERs, missing mark on waiting times, new statistics reveal – The Globe and Mail

The Globe and Mail missed the mark. Hospitals, NOT Emergency Departments (EDs), leave patients in overcrowded EDs for nearly 30 hours before moving them to an inpatient bed. EDs do not make admitted patients spend too long in the ED. Hospitals do. Hospitals could empty EDs of admitted patients at any time, if they wanted to.

Canada’s ERs missing mark on waiting times, new statistics reveal – The Globe and Mail.

Hospitals choose to leave 15 extra patients admitted in the ED; they could spread them out over all the inpatient wards. Few hospitals enter the political battle of angering unions by placing extra patients on inpatient hallways, despite the nearly 400 articles published showing that mortality and morbidity increase for every hour admitted patients get warehoused in EDs.

Full Capacity Protocols empty EDs, have been used in Canada, and leave no excuse for exposing patients to the proven risks of long waits in the ED.

When will government change incentives so that hospitals start emptying EDs?

5 Ways to Reduce Healthcare Spending on Emergency Departments

ED visits are growing.

ED costs are growing.

If the ED was a bakery, we could send customers away at the front door when the pastries were gone. Some still suggest this dangerous practice. Here are 5 better ideas that will work.

5 Ways to Save $$ on EDs

1. Increase access to imaging and labs. A patient can’t wait weeks to find out whether the lump in her breast is a cancer or headache is a tumour. Patients come to the ED even though they’d often rather go anywhere else.

2. Provide clinics for ‘in-between’ patients (CTAS 3). On a scale of 1 to 5, CTAS 3 patients aren’t dying but have more than a sunburn. These patients needs tones of care and investigations. A few are acutely ill, but most suffer from chronic issues. Either give them direct access to clinics, or let emergency physicians send patients directly to specialty clinics (same day appointments).

3. Get admitted patients out of the ED. Admitted patients get horrible care in the ED and cost the most, by a very wide margin. ED care costs more than ward care. Get admitted patients were they can get the care they need: up to the wards!

4. Don’t transfer dying patients to the ED who never wanted to come to the hospital in the first place (signed advanced directive).

5. Close EDs. In Canada, we close rural EDs and refuse to expand the size or number of EDs to keep pace with population. It’s a terrible option for customer service, but it does save money. 🙁

What do you think? Click Leave a Reply or # Replies below.

Emegency Departments That Lag

Time to treatment equals quality for much of emergency medicine. It’s also the easiest way to decide whether an ED is any good. Missed diagnoses, errors of judgment, and clinical mistakes can be hard to spot by comparison.

Emergency Departments That Lag

1. Long Line up at triage –

The most at-risk patients stand in the line-up for triage. Every day, patients walk in with a deadly process inside of them. Until they have been seen, they are unsafe. A line up to be seen is indefensible.

2. Long triage process –

Triage should be sorting; not a primary nursing assessment. Patients need a diagnosis and treatment. In most cases, this means getting patients and physicians together as fast as possible. A long triage process does not add value for patients.

3. Long Line up at registration and long registration process –

Registration – getting a chart made – does not add value for patients; it only delays care. It must be short!

4. Packed waiting room –

There is no reason for patients to EVER wait in the waiting room. Please argue in the comment section below if you disagree.

5. Patients must repeat their story over and over and over.

Providers should quickly check what others have recorded, verify the facts and ask additional questions. Starting over with every provider drives patients nuts.

6. No discharge excellence

Patients should leave the ED with copies of lab and radiology reports, written discharge instructions (if necessary), and clear instructions for follow-up and return visits to the ED.

7. Dismissive attitude

Patients should be welcomed to the ED for ANY complaint. No complaint is trivial for a patient. We – healthcare providers, media, government, all of society – seem to think healthcare would be just fine if it weren’t for all the patients. Besides being unwelcoming non-verbally, there’s a big difference between “Why are you hear today?” and “How can I help you?”

Rules in case you get sick:

Don’t go to your family doc unless you’ve tried something yourself first.

Don’t go to your specialist unless you go to your family doc first.

Don’t go to the ED unless you’ve gone anywhere else first.

Don’t go to the ED unless you are nearly dying.

If you are dying, you shouldn’t go to the ED because we can’t do anything for you…

Excuses

But all our beds are full of admitted patients!

Definitely the most popular excuse, admitted patients definitely make it almost impossible to provide emergency care some of the time. But, even with admitted patients blocking beds, patients should still be brought into the ED and seen on exam tables. If they can wait on chairs in the waiting room, they can wait on chairs inside after they’ve been assessed.

Thankfully, Ontario has started to hold hospitals accountable for getting admitted patients out of the ED, and up to the wards.

Who owns morale?

Management owns operations; staff owns morale. Sure, you can crush morale in even the most engaged staff, but blaming management for staff attitudes will mire an ED in under-performance. Staff control their own morale, and it must be part of performance management.

How does your ED stack up? As a patient, have you researched your local EDs to see which ones to avoid?