Probably, said the on-duty ER physician:
The Saint John hospital emergency room was crowded and over capacity the day Lillian Mullin, 78, was sent home with the bowel problems that killed her 24 hours later, a doctor told a coroner’s inquest on Thursday.Dr. Tushar Pishe was on duty at the ER when Mullin arrived with abdominal pain and severe diarrhea in February 2005. He told the jury that “it was a zoo” in the emergency room, and in a situation the hospital calls Code Orange, which means no beds are available and patients are placed in the hallway.
Pishe was asked if Code Orange can affect his decision to admit or discharge a patient. He said he tries not to let it happen, but he said it can be a factor.
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{ 3 comments }
I don’t see where he said “probably.”
From the article: “Pishe was asked if Code Orange can affect his decision to admit or discharge a patient. He said he tries not to let it happen, but he said it can be a factor.”
He was answering a general question, and he never mentioned whether the circumstances affected this particular patient’s disposition.
The patient’s daughter, on the other hand, “told reporters she thinks Code Orange may have contributed to the decision to discharge her mother.”
Having said that, I would admit that it seems like it probably did. If we had unlimited beds, we would admit almost everyone, I suspect.
Ishemic bowel is a very hard diagonsis to make.
Apparantly the patient had “kidney failure, irregular heartbeat, chronic bowel disease” and other ailments. I’d be curious to see which were acute and which were chronic. If she had acute decompensation, she either gets admitted (maybe to hallway slot) or trasnfered to another hospital.
If they were all chronic, I’m not so convinced anyone could have made the diagonsis.
But yes, ERs and hospitals are overcrowded. Only way to fix that is to build more (takes a long time), discharge people earlier (requires more staff and asuming mroe risk), or not admitting patients with very poor prognoses (goes against society’s view of what a hospital does).
The hospital did very much intend to influence clinical decision making. Having an official status of alerting clinicians to the lack of beds, or condoning the unofficial use of such terminology, indicates that the hospital wanted clinicians to alter their threshold for admission.
If the doc were an independent agent then perhaps he could reccomend admission without considering the hospital’s plight. But he is under the screws of the hospital administration to work within the system. Some days this patient might have been admitted if beds were free and he had a mild gnawing in his gut; other days he knows that he must street anyone not flagrantly in trouble.
Many medical errors, if there was one here, are the result of a complex system, with the physician as the point man and fall guy, while the system that was providing inadequate support hides in the background. Administrative decisions that undercut good practice are never punished.
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