The Changing Face of E. R. Medicine

Posted by nurse on August 28, 2011 under Critical Care, Nursing Careers, patient health | Be the First to Comment

The popular Hollywood television show “E.R.” is what springs to mind when people discuss ER medicine. But the reality of most hospitals, including the one you go to, is very different. A broken leg, burn, or bleeding wound is no longer a ticket to enter a hospital for immediate medical attention. Today’s Emergency Room medicine is lost in a mishmash of buzzwords that disguise both the changes in conventional medicine planning and public healthcare facilities, but confuse the pathway of modern medicine in varying stages across the healthcare divide.

And healthcare is divided. Those who can afford to pay premiums and get coverage have a safety net in case of emergency. They are assumed to approach their healthcare provider offices first and use general emergency care for high-risk medical traumas such as critical infections, contagious disease outbreaks, flesh wounds caused by violence or gunshots. Unfortunately the incidence of household accidents, car accidents, and physical injury is so common now that this category is overflowing. But joining these persons waiting for Emergency Room care are those with dermatological ailments, chest colds, staph infections, influenza, and chicken pox (just to name a few).

Those who cannot afford coverage, cannot find HMO companies to accept their application, or who somehow are left between active coverage from regular insurance policies get caught in a trap. Any service they need now falls under the banner of “Emergency Room” care. In case of an illness their immediacy of physical illness advances their jockeying for treatment while their ability to pay (or meet the demand to get to a hospital or healthcare facility) is diminished. By doing so, the lack of coverage creates a slippery slope for at-risk medical populations. The inability of the hospital to treat anything bit the worst condition encourages patients to let their problems get worse to ‘earn them first priority when they do show up at the hospital.

The system in fact encourages people to get worse first, to qualify for quicker attention in the Emergency Room, rather than wait for days to see a doctor for preventative diagnoses and pharmaceutical treatment. Picture the average television drama where the patient rushed in on the gurney instead waits in the general ‘Urgent Care” lobby, filling out form and navigating a series of red tape and service desks to get to the word “Go”. In some cases twelve hours can pass from initial recording of vital signs to actual physician consultation.

What can hospitals do? Only long-term solutions are available. The improvement in health literacy would limit the damage done by ignorance of healthcare norms, personal hygiene, or contagious disease prevention lacking many regional and ethnic populations. Persons who may have never seen a doctor before or never been tested for general health problems appear in emergency rooms with little knowledge of their own personal history. This complicates the problem for doctors, who must chart an compete health profile for each such person. This takes a much longer time to deliver an adequate consultation

These individuals now number in the millions in each metropolitan area. In the at-risk population and the suburbs, individuals refuse to attend health clinics, pop-up health clinics, get blood taken or tested, or participate in basic healthcare unless they suffer a medical emergency such as a car accident or lose consciousness. But threats to general population health, such as hepatitis, staph infections, HIV, and chlamydia exist everyday, until long term symptoms present themselves and patients stumble to the “Emergency Room”, expecting a quick fix.

The population of these individuals lackadaisically showing up in the hundreds every hour to Emergency Rooms now outnumbers actual emergency room patients as qualified by the scenario seen on television. This is because the national healthcare services do not penalize individuals for refusing to seek medical attention (until they are dropping dead), or answer to a doctor for any medical condition. In a nation teeming with drug addicts, smoking addicts, alcohol addicts and cancer victims,

Imagine a person rushed to the hospital by EMT’s due to a 911 call and ushered into the hospital on a gurney. Then picture those same EMT’s wheeling that patient around all day from floor to floor, hall to hallway, department to department, because anything short of actual death, bleeding or gunshots merely earns the patient a place in a long line. The suggested instructions to call 911, found on the back of medication bottles or given by advice columns, assume a healthcare provider is available on less than an 18 hour wait.

Seventy years ago, only persons living in wilderness areas or on remote ranches or farms needed to address extreme situations of health consultations and inadequate care due to inability to gain access to adequate medical staff and health services. Home healthcare nursing used to be an exotic professional sideline for nurses whose clientele were independently wealthy or otherwise unable to get transported to a proper medical facility. Now many patients prefer this type of care because they find hospitals and clinics overcrowded, their questions shut out, and the quality of care too significantly diminished.

But today an entire layer of ill or ailing persons exists in a gray area. These individuals cannot afford insurance, have pre-existing conditions, and delay or avoid medical consultations, examinations or qualified advice until an “emergency” arises. Emergency Room care used to be specifically for accidents, cardiac events, respiratory emergencies, or skin and wound trauma that was likely only remedied by surgery and/or a hospital admittance scenario. The framework of “Urgent Care” patients now includes physical conditions years old and ailments impossible to treat in a surgical setting or benefit from a trauma team treatment window or 24- hour care plan.

But nurses and physicians know that these emergency situations arise out of lack of addressing current health problems as well as accidents, and an emergency room visit is far more likely to be the result of a long standing medical problem, physical ailment, or ongoing disease, rather than something having occurred in the last few days. The lack of healthcare literacy amongst the general population, as well as the mental and psychological fears associated with hospitals visits, also keep patients from coming promptly to the hospital when they should.

When they do come to the hospital, they get an ugly surprise. Persons with sniffles and headaches now stand in line side by side with persons with split skin, fever, chills, infection and contagious diseases. People wearing surgical masks now dot the emergency rooms, because they know the likelihood for casual contact with chairs, instruments, and bathroom surfaces occupied by ery sick people waiting 8 hours or more can commence another medical problem. But closure of healthcare facilities and the number of persons dropped from insurance due to occupational severance makes these “emergency room” care situations worsen.

Horror stories abound from people whose condition grows worse because they have to stand in line behind thirty people with minor symptoms and wait for them to thread their way through the initial stages of emergency room care screening. The bar for actual Emergency Room care has risen so high, due the population pressuring it upward, that for every person admitted to an actual treatment room, over five hundred are turned away. The creates a snowball effect, because each one of those patients may worsen and become tomorrow’s emergency.

The lofty aims of nursing and physician education can leave a gap between the reality of everyday medical practices and the abstruse discussion of methods in practice. The nature of the healthcare animal as a service is that the treatment will be performed long before the payment scenario is ironed out. To limit their exposure, hospitals now dump all their incoming medical patients in one group and have them sit in “cattle call” waiting rooms. This puts pressure on nursing staff and creates a negative atmosphere for patients.

The ability of most people to simply afford the treatment they need creates layers of new problems that burden systems already bulging at the seams. The inelasticity of hospital billing, the hourly surge of hundreds of new patients per dozen beds, and the concrete limitations of admittance patterns was not designed to accommodate the portion of uninsured individuals that now flood emergency rooms. The problem is that hospitals have changed their inpatient routines to classify emergency room situations for consultation and examination.

Nurses in large part must shoulder the burden of the pressure of increased application of individuals to Emergency Room care. Nurses must act when they see a worsening condition in a candidate for a Emergency Room consultation. Physicians must take into account arresting a medical condition with the proper application of resources when the patient does arrive, and gage risk of re-infection and recovery in their everyday environment. History will show if the standard techniques applied today in Emergency Room will benefit the public at a large, or create an underclass of extended ailment patients untreated at large.