The issue of off load delay is becoming ever more relevant as emergency departments (ED) are filling up and having longer wait times. This isn’t always an issue when there are free paramedic crews in the area but it often results in coverage lapses. The question becomes, should paramedics be leaving their less urgent patients in triage with walk-in patients so that they can get to other people in need? A balance needs to be found between leaving the CTAS 4 and 5 patients in the waiting room and leaving 911 callers at home to wait.
According to the Basic Life Support (BLS) Patient Care Standards, Section 1 M, if the ED won’t be able to accept responsibility for the patient in a reasonable time, the paramedics may “remain on standby for return
Answer: In this particular case, I would address my concerns of left behind documentation with the physician of care of this patient. Typically in an ER setting, when this occurs the physician immediately contacts the patient himself, or he is unable to he then gives the charge nurse on duty instructions to taking care of this matter.
Although the hospital was following the directive in order to maintain legal immunity for its hospital staff, the rights of the family were violated along with the medical fundamental principle to “first, do no harm”. First of all, despite the wishes of Marlise Munoz, she continued to receive the help of machines and hospital staff at John Peter Smith Hospital even after being declared dead. Marlise was found on her kitchen floor after more than an hour without oxygen on November 26, 2013. Arriving at the hospital, the staff placed Marlise on life support in accordance with section 166.049 of the Texas Advance Directives Act. The directive states, “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”
I found your post interesting, having worked in an emergency department during my paramedic years. In my career as a nurse working in a clinic on occasion we must send a patient to the emergency department. I always call to speak with the charge nurse to provide report prior to just sending the patient, often I am on hold for greater than 15 minutes. This often results in the patient arriving at the ER before I can give report. Adding to this the charge nurse on more than one occasion is calling me on another line to ask why the patient it there! However, from past experience I do know how busy the ER can be at any given time.
...o get a do not resuscitate order. That is an order that the families may sign so the hospital does not have to give effort to bring a person back to life anymore once they have stopped breathing.
Nobody is perfect. We all make mistakes. Some of the best lessons in life are learned from making a mistake. But in the healthcare world making mistakes means losing lives. This has started to happen so frequently there has been a term coined – Failure to Rescue or FTR. Failure to rescue is a situation in which a patient was starting to deteriorate and it wasn’t noticed or it wasn’t properly addressed and the patient dies. The idea is that doctors or nurses could’ve had the opportunity to save the life of the patient but because of a variety of reasons, didn’t. This paper discusses the concept of FTR, describes ways to prevent it from happening; especially in relation to strokes or cerebrovascular accidents, and discusses the nursing implications involved in all of these factors.
Realistically, they very well could be going to someone who has had a persistent cough for 3 weeks and decided tonight was the night that they should be checked out in the emergency room. Unfortunately, the abuse and misuse of the emergency medical system (EMS) is one that exists but can have terrible outcomes and consequences if not changed soon. This problem is not just an issue for the patients waiting on care, but it also affects the hospitals and the emergency workers alike.
Calls to outpatient areas such as radiology, rehab, and the hospital lobby are also on the rise, with family members, visitors, and employees being added, besides the inpatients, to the list of eligible Code Rescue calls for the ICU nurse to respond to. With Code Rescues involving a Stroke Alert, the ICU nurse must accompany the patient to the CT Scan area for a STAT CT of the brain, which takes the nurse away from their assigned patients for an even longer period of time based on the status of that patient. When a nurses take their break, another nurse is required to monitor those patients as well as take care of their own patient assignment. The attention given to the other patients is not considered to be extensive, basically “keeping an eye” on them until their nurse returns. This patient assignment could be at a safety risk if their nurse is also the one assigned to respond to Code Rescues at any time during the
Wake County EMS responds to almost 90,000 requests for service annually and serves almost 1 million people, which places the WCEMS system in the top fifty EMS systems in the country based on call volume and size of population served. ("Wake county department," 2012) In response to ever-increasing call volume, a decrease in primary care, and the universal changes in healthcare, which have resulted in more people using EMS and the local emergency room for primary care and non-life threatening events, the EMS Department elected to change their service structure. The department would move away from the traditional EMS mantra of “you call we haul” and having a system being designed around reactive responses to healthcare issues in the community to an evidenced based incident prevention structure. No longer, would it be considered prudent or correct to just continue to add transport resources to address the increasing call volume and continue to place the actual burden of care on the local hospitals, it would become the burden of the EMS system to provide alternatives to properly address the actual healthcare needs of those who called 911. Wake County EMS had already utilized evidenced based ...
... revealed that longer waiting times has negatively impacted the lives of not only patients, but also healthcare providers . Some QI strategies implemented such as simulation tools, fast -track and reorganization of the ED by several hospitals has shown some improvement in workflow thus decreasing overcrowding and the length of time spent in the ED. As healthcare leaders, the focus should reside on ongoing advocacy for new policies or guidelines to resolve the waiting time issues and addressing limitations of previous interventions. Addressing the ED issues, Leaders should abide by the IOM report considering overcrowding as a mostly external or a system-wide issue. Implementing preventive measures described earlier will help not only to decrease WT in the ED, but also to avoid future incidents similar to the one recently experienced in St Barnabas Hospital.
“Summary Report for: 29-2041.00 - Emergency Medical Technicians and Paramedic.” O*Net. 2008. Web. 18 Feb. 2010.
Emergency care has always been an important part of history all over the world. It has been said that medical assistance has been around and prevalent since as far back as 1500 B.C. Around the 1700’s is when EMS systems first began to experience large advancements, and ever since then, the field continues to grow and improve every year.
In addition, those potentially nearing the end of their life may be asked a DNR, or “Do Not Resuscitate,” Order. This states that in a life-threatening emergency where one is facing possible death, no actions shall be done try and “resuscitate” the individual in an attempt to restore life to the person. However, if a DNR Order is not filled out, actions including CPR, or cardiopulmonary resuscitation, mechanical ventilation, h...
The facility should have written statement to refer to in case of emergency to help and protect the health care workers that are onsite. So that it would minimize the confusion. We all know that in the case of cardiac arrest time is very critical. The nurse wasted the patient greatest opportunity of survival by standing there and refusing care. It’s the policy of this facility to not make care for cardiac arrest patient difficult. I understand at 87 years of age the end result is most likely not going to be a promising, but I would help to know that there are some people who are willing to help. I hope the nurse learned her lesson and stand clear of confusion for future patient that reside the
Naturally you'd hope and expect the hospital to have enough resources to facilitate the return to health, or to prolong their lives,
Commonly throughout most countries of the world, citizens of the society at large establish the system for Emergency Medical Services. In the case that the public is not willing or capable of summoning such a service, the country often finds other emergency services, businesses, or the government and authorities who act to employ a system. In other parts of the world, the emergency medical service additionally takes on the role of transporting patients from one medical facility to an alternative one. This occurs with some frequency because once a patient is analyzed and provided care at the immediate hospital; it may be more appropriate for a variety of reasons the patient needs to move to another facility. As one can see, the relat...