Comments on: Should ERs prohibit going on diversion?

By: Anonymous

Anonymous — Sun, 28 Dec 2008 00:58:00 +0000

The hospital where I toil seemed to be “on divert” each morning. The doctors were blamed – of course – and were scolded to round (and discharge patients) at dawn.
One surgeon noticed that there were lots of empty beds, even as the divert announcements were made. He determined the real reason for the diverts: the JCAHO nurse-to-patient requirements were not met on the 7 to 3 shift, but were met when the requirements became more lenient at 3PM.
Manalive

By: Anonymous

Anonymous — Sat, 27 Dec 2008 19:58:00 +0000

Hopefully not too often–but from what I see in QA work, it wouldn’t hurt a thing for the younger generation of docs to be reminded that the object of the hospital is to care for the sick and that priority occasionally need to override the other interests of the institution, disrupt routines, and even break rules.

It is not uncommon in psychiatry at least for patients to be lying in the ER for days waiting on a bed, while patients on the floor are ready for discharge but discharge today would put the social worker off her routine or the attending doesn’t want to abrade anyones ego by discharging before “treatment team” meets next Tuesday to agree.

By: Rogue Medic

Rogue Medic — Sat, 27 Dec 2008 08:58:00 +0000

Since the problem just seems to get worse, this will probably just be a temporizing measure. One of the local hospitals has doubled the size of the ED. Since the expansion, the ED does not seem to go on divert any less frequently.

Part of the problem is the lack of inpatient beds. Part of the problem is using the ED as the primary care provider. Part of the problem is the fear of discharging a patient, who might be sick, and the legal system that produces that atmosphere. And so forth.

These are all different problems, that will not be fixed with a simple solution.