Comments on: Did a "Code Orange" affect this patient being discharged from the ER? http://www.kevinmd.com/blog/2006/12/did-code-orange-affect-this-patient.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Gasman http://www.kevinmd.com/blog/2006/12/did-code-orange-affect-this-patient.html/comment-page-1#comment-69300 Gasman Mon, 04 Dec 2006 13:58:00 +0000 http://clients.emmense.com/kevinmd/2006/12/did-a-code-orange-affect-this-patient-being-discharged-from-the-er.html#comment-69300 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. <br/>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.<br/>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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/did-code-orange-affect-this-patient.html/comment-page-1#comment-69259 Anonymous Sat, 02 Dec 2006 19:50:00 +0000 http://clients.emmense.com/kevinmd/2006/12/did-a-code-orange-affect-this-patient-being-discharged-from-the-er.html#comment-69259 Ishemic bowel is a very hard diagonsis to make.<br/><br/>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.<br/><br/>If they were all chronic, I'm not so convinced anyone could have made the diagonsis.<br/><br/>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). 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).

]]> By: scalpel http://www.kevinmd.com/blog/2006/12/did-code-orange-affect-this-patient.html/comment-page-1#comment-69257 scalpel Sat, 02 Dec 2006 18:53:00 +0000 http://clients.emmense.com/kevinmd/2006/12/did-a-code-orange-affect-this-patient-being-discharged-from-the-er.html#comment-69257 I don't see where he said "probably." <br/><br/>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."<br/><br/>He was answering a general question, and he never mentioned whether the circumstances affected this particular patient's disposition.<br/><br/>The patient's daughter, on the other hand, "told reporters she thinks Code Orange may have contributed to the decision to discharge her mother."<br/><br/>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. 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.

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