Comments on: Nathan Lanier: Solving the emergency room crisis http://www.kevinmd.com/blog/2008/07/nathan-lanier-solving-emergency-room.html Tue, 14 Feb 2012 23:00:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/07/nathan-lanier-solving-emergency-room.html#comment-86650 Anonymous Mon, 14 Jul 2008 06:28:00 +0000 http://clients.emmense.com/kevinmd/2008/07/nathan-lanier-solving-the-emergency-room-crisis.html#comment-86650 This poster directly above this makes alot of sense. When my mom was almost 80 she had Gallbladder surgery. Not the lap but large open surgery. Apparently ins. companies and medicare will allow for a certain number of days covered, and then you must be discharged. Other medical issues mean nothing, age means nothing, complications from said surgery means nothing.<br/><br/>The Doctor told us mother HAD to be discharged but he also told us she really needed to stay hospitalized, so he say to take her home and then bring her right back through the ER and have them call him and he will readmit her through emergency. This was the most crazy, time consuming waste of ER time and effort I ever seen. Not to mention her being very sick uprooted, made to get dressed, hauled to the car, home and then back and through all the mess at the ER. This poster directly above this makes alot of sense. When my mom was almost 80 she had Gallbladder surgery. Not the lap but large open surgery. Apparently ins. companies and medicare will allow for a certain number of days covered, and then you must be discharged. Other medical issues mean nothing, age means nothing, complications from said surgery means nothing.

The Doctor told us mother HAD to be discharged but he also told us she really needed to stay hospitalized, so he say to take her home and then bring her right back through the ER and have them call him and he will readmit her through emergency. This was the most crazy, time consuming waste of ER time and effort I ever seen. Not to mention her being very sick uprooted, made to get dressed, hauled to the car, home and then back and through all the mess at the ER.

]]> By: Dr. Matthew Mintzhttp://www.kevinmd.com/blog/2008/07/nathan-lanier-solving-emergency-room.html#comment-86648 Dr. Matthew Mintz Mon, 14 Jul 2008 00:40:00 +0000 http://clients.emmense.com/kevinmd/2008/07/nathan-lanier-solving-the-emergency-room-crisis.html#comment-86648 ER's are overcrowded because people lacking insurance use emergency rooms for primary care, access for primary care for those with insurance is terrible, and because, even for the insured, non-emergent health care is usually only available Monday through Friday, 9-5. Some of these problems are being addressed through Minute Clinics in retail pharmacies and Urgent Care centers allowing after hours care. However, these are not widely available and likely can not provide the services that most of us need. The only way to fix the ER problem is to fix the health care system. Penalizing sick people for a faulty system makes no sense. ER’s are overcrowded because people lacking insurance use emergency rooms for primary care, access for primary care for those with insurance is terrible, and because, even for the insured, non-emergent health care is usually only available Monday through Friday, 9-5. Some of these problems are being addressed through Minute Clinics in retail pharmacies and Urgent Care centers allowing after hours care. However, these are not widely available and likely can not provide the services that most of us need. The only way to fix the ER problem is to fix the health care system. Penalizing sick people for a faulty system makes no sense.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/07/nathan-lanier-solving-emergency-room.html#comment-86642 Anonymous Sun, 13 Jul 2008 21:27:00 +0000 http://clients.emmense.com/kevinmd/2008/07/nathan-lanier-solving-the-emergency-room-crisis.html#comment-86642 Legitimate reasons but there are many more:<br/><br/>1.)EMTALA<br/><br/>2.)de facto clinic for illegal immigrants<br/><br/>3.)Nursing shortage<br/><br/>4.)Problem with hospital boarding of admitted patients in the ER. This is probably the most significant issue, and is itself multifactorial.<br/><br/>5.)liability fears: longer more extensive work ups in the ED and more cases "sent to the ER" by PCP's, nursing hotlines, etc<br/><br/>6.)CYA crapola. example: medical clearance for every drunk going to jail or psych ward.<br/><br/>7.)Mental health service crisis with patients waiting days to go to psych wards.<br/><br/>8.)older and sicker population that requires time and resources.<br/><br/>9.)futile medicine the public keeps demanding.<br/><br/>10.) Lack of good primary care follow up.<br/><br/>11.) Actually ER's are victims of their own success. Why wait a week for your ultrasound or CT your doctor ordered when it is available 24/7 in the ER.<br/><br/>12.)Time consuming JCAHO requirements.<br/><br/>13.)The importance placed on patient satisfaction scores for job retention. You gotta be nice to that person who abuses the ER 10times a month for the same complaint.<br/><br/>14.)alcohol and other substance abuse<br/><br/>15.)No copays for medicaid service<br/><br/>16.)people who don't speak English so time is wasted in interpretation.<br/><br/>17.)Closure of ER's and Trauma centers. There are far fewer of each than 10-15 years ago.<br/><br/>18.)Fewer specialists that are on the call panel. Patients wait a long time to be transferred for speciatly services at other hospitals.<br/><br/>19.)Malpractice crisis and liability issues drives number 18<br/><br/>20.)Dwindling remimbursement drives number 18<br/><br/>21.)Uninsured have no other option<br/><br/>22.)The worried well: "I read on the internet that it could be a symptoms of........."<br/><br/><br/><br/>There is more, but my head hurts and why I am transitioning out of it. Legitimate reasons but there are many more:

1.)EMTALA

2.)de facto clinic for illegal immigrants

3.)Nursing shortage

4.)Problem with hospital boarding of admitted patients in the ER. This is probably the most significant issue, and is itself multifactorial.

5.)liability fears: longer more extensive work ups in the ED and more cases “sent to the ER” by PCP’s, nursing hotlines, etc

6.)CYA crapola. example: medical clearance for every drunk going to jail or psych ward.

7.)Mental health service crisis with patients waiting days to go to psych wards.

8.)older and sicker population that requires time and resources.

9.)futile medicine the public keeps demanding.

10.) Lack of good primary care follow up.

11.) Actually ER’s are victims of their own success. Why wait a week for your ultrasound or CT your doctor ordered when it is available 24/7 in the ER.

12.)Time consuming JCAHO requirements.

13.)The importance placed on patient satisfaction scores for job retention. You gotta be nice to that person who abuses the ER 10times a month for the same complaint.

14.)alcohol and other substance abuse

15.)No copays for medicaid service

16.)people who don’t speak English so time is wasted in interpretation.

17.)Closure of ER’s and Trauma centers. There are far fewer of each than 10-15 years ago.

18.)Fewer specialists that are on the call panel. Patients wait a long time to be transferred for speciatly services at other hospitals.

19.)Malpractice crisis and liability issues drives number 18

20.)Dwindling remimbursement drives number 18

21.)Uninsured have no other option

22.)The worried well: “I read on the internet that it could be a symptoms of………”

There is more, but my head hurts and why I am transitioning out of it.

]]> By: Complicationshttp://www.kevinmd.com/blog/2008/07/nathan-lanier-solving-emergency-room.html#comment-86639 Complications Sun, 13 Jul 2008 14:51:00 +0000 http://clients.emmense.com/kevinmd/2008/07/nathan-lanier-solving-the-emergency-room-crisis.html#comment-86639 <i>"four times for the same thing and is sent home with the same medication and the same diagnosis"</i><br/><br/>Edith Rodriguez.<br/>-------------------<br/>She might like to be comped her life. “four times for the same thing and is sent home with the same medication and the same diagnosis”

Edith Rodriguez.
——————-
She might like to be comped her life.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/07/nathan-lanier-solving-emergency-room.html#comment-86638 Anonymous Sun, 13 Jul 2008 14:06:00 +0000 http://clients.emmense.com/kevinmd/2008/07/nathan-lanier-solving-the-emergency-room-crisis.html#comment-86638 Must Revoke EMTALA Must Revoke EMTALA

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