The final word on South Shore ER

Today the Massachusetts Department of Public Health came down with its decision on South Shore hospital, just south of Boston. I have written about the situation previously and followed up here.

The Department of Public Health report, released yesterday, ends review of a dozen complaints about the pace of care in South Shore’s emergency room since last year. It found that emergency room staff at the Weymouth hospital wrongly delayed treatment for two patients with appendicitis earlier this year because they did not monitor the women’s pain closely enough, and cited the hospital for one relatively minor violation, dispensing drugs without a written prescription.

As I have written before, waiting endless hours at the emergency room is not the fault of the hospital, but rather is a reflection of a larger problem. Patients who bristle at the long ER waits have to understand that the ER is not a place for primary care, nor for convenient care. It needs to be reinforced to patients that the ER is for “emergent” care – not for medication refills and the like.

It is distressing that the media chooses to highlight the sensational aspects of the case and when the hospital is cleared of wrongdoing, provides sarcastic headlines (“South Shore Hospital gets wrist slap . . .”). It would be more helpful to highlight the larger crisis and help educate the public in proper use of emergency care. But I guess that doesn’t sell papers.

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  • Carsten

    In the ED where I worked, time from patient arrival to physician evaluation ranged from 2-6 hours. I have also seen cases like the one South Shore got its “wrists slapped” for.. The problem is, as you state, too many patients are using the ED for primary or “convenience” care, rather than seeing their PMD. In California, one hospital ED instituted a program where patients presenting with non-emergent primary care complaints are given the option of a clinic appointment in 1-3 days, rather than an ED visit with an unknown (but definately long) wait. Many patients take the primary care clinic appointment, and it reduced the ED’s rate of inappropriate visits from 30% to 6%. [Kelly, K. (1994). “Referring patients from triage out of the Emergency Department to Primary Care settings: One successful Emergency Department experience.” J Emerg Nursing 20(6): 458-63.] In Kentucky, those on the Medicaid rolls are assigned a PCP who acts as a gatekeeper. Patients must call their PCP (who must be available 24/7)prior to using the ED for authorization. Otherwise, Medicaid will not reimburse the patient, and they will be stuck with a (large) ED bill. This, as you can imagine, also had a significant impact. Prior to the implementation of this program, only 59% of ED visits were considered appropriate, but afterwards, that figure shot up to 92%. [Franco, S., Mitchell, CK and Buzon, RM (1997). “Primary Care Physician Access and Gatekeeping: A Key to reducing Emergency Department use.” Clin Pediatr (Phila) 36(2): 63-8.]
    I strongly feel that these type of reforms need to be instituted nationwide to control the problem of ED overcrowding, long wait times, and substandard care that results.

  • Anonymous

    We had a good one at our ER on tues. morning (talk about abuse) 2 sisters age 14 and 15 come in at about 10:45 am being driven by a 16 yr. old male friend..15 yr. old says she thinks sister is having an asthma attacke, 14 yr. old trying hard to look the part…Faking SOB, then telling me throat is sore, dizzy, etc…Where is Mom??? ER Clerk calls home and mom answers in a panic..She is advised her children are at the ER and she needs to come to give information and sign for treatment…Mom says “BS, don’t do anything with those 2 brats, I’m on my way!”

    Seems mom received a call at work at approx 10:00am informing her that daughters were not in school…Before leaving work to begin searching for missing children she calls daughter’s friend that they ride to school with (the 16 yr old boy) whose parents are not home, he answers phone and swears he knows nothing about the girls whereabouts…Well, you can figure out the rest of the story…..Mom arrives, not in a good mood….Daughter says “but mom, I really do have a sore throat”, sister says…”Tell mom how many cigarrettes you have smoked this morning and she will know why your throat is sore!”

    I throw up my hands and walk out of room…The depressing part is that school just started here on Monday and already they are working us!

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