Elderly patients can deteriorate in the ER. This team works to get them out | Hacker News Reader

Elderly patients can deteriorate in the ER. This team works to get them out

cbc.ca

13 pointscanucker201616 comments

> With the frenetic surroundings of an ER — lights and noise that disrupt sleep, no windows, meals and medication given sporadically or skipped — a patient can grow delirious in just a couple of hours.

I feel like I should point out this is hardly unique to elderly people. I haven't experienced it myself, but I've seen enough anecdotes to leave me convinced that ERs are practically designed to turn anyone and everyone into a dazed mess.

ERs are designed to quickly triage patients. To prioritise the real urgencies from those that can wait a bit, to those that aren't urgent at all. Within great financial constraints.

What this team seems to be doing is essentially refining the triage procedures to take ER-environment emergent problems into account, which sounds great to me. I'm sure that could be expanded to include populations other than the elderly over time, but they are obviously especially vulnerable.

I've encountered many people with complaints of ER waiting times, or being seen for 2 minutes only to be sent back to the waiting room for another hour. And I always tell them the same thing: be very happy that you get to wait in the ER, it's a good sign. If you come in and don't have to wait, you are likely in very deep shit, and the staff there will do everything they can to keep you alive.

While I'm on my soap box: some people actively abuse the ER to gain access to care more quickly, this should be actively fought and avoided. But a lot of people end up in an ER because they fear that something is bad and urgent when it's not (e.g. precordial catch + anxiety vs heart attack). Those aren't emergencies, but can be hard to distinguish from them, and so ER staff will be very happy help you.

Why are ERs in a constant state of triage, like first responders after a natural disaster, when they have also been bankruptingly high-priced and located all throughout the hearts of stable cities with well-developed infrastructure for decades?

Edit: The definition of triage is similar to rationing:

"In medicine, triage (/ˈtriːɑːʒ/, /triˈɑːʒ/; French: [tʁiaʒ]) is a process by which care providers such as medical professionals and those with first aid knowledge determine the order of priority for providing treatment to injured individuals[1] and/or inform the rationing of limited supplies so that they go to those who can most benefit from it.[2] Triage is usually relied upon when there are more injured individuals than available care providers (known as a mass casualty incident), or when there are more injured individuals than supplies to treat them." (Wikipedia)

The question is, "why are we triaging in cases where the demand is relatively stable and funds seem to be available?"

I feel like it's in the name: just like disaster responders operate in disaster, emergency rooms operate with patients in conditions of more or less emergency. Draw from a population large enough and you'll have a rolling supply of people encountering emergencies of varying degrees of urgency—plus people who worry that they're in an emergent condition but aren't trained to distinguish something critical from something worrying-but-not-urgent.

Because emergencies by their very name and nature are emergent phenomena and must be triaged?

I don’t fully understand your question actually. Do heart attacks stop at a certain level of funding?

Cities have emergencies all the time.

Emergencies than can only be predicted statistically and a population that has got poorer and more unhealthy over time and escalating costs due to the private equity take over of healthcare and pharmacy benefits.

What would you do to improve things?

That's kind of their job. Triage patients, take care of urgent and immediate problems, send stable patients elsewhere.

It's expensive because you've got to have a certain amount of medical professionals onsite to deal with unschedulable immediate problems, and more on-call in case the workload is higher than expected.

And there's a legal obligation to stabilize patients without consideration of ability to pay, so you've got to bill at a multiple of the cost and hope some will subsidize those that can't/won't pay.

this is a bit like asking why do fire fighters need a hose in my opinion.

Think about it. You’re in the ER and 3 people walk in at the same time, one is having a severe allergic reaction to food (anaphylactic) and they can barely breath, another has an ear infection, and another needs stitches from cutting themselves.

ER nurses and doctors are _already_ treating some of the existing patients in the hospital. You have the capacity to immediately re-allocate resources to 1 or 2 “emergencies” but not 3. So…you triage. So that you can help the person who needs help most urgently first.

Not sure if i misunderstood your question but it really didn’t make sense to me. It’s literally the function of an ER. To determine who gets care first based on medical need, within the constraints (number of staff, beds, etc)

Of course on a slow day, there may be 0 wait time, and triage is not necessary. That’s a good thing…but probably very rare.

But legitimately, ER's are possibly the worst place you ever want to go unless you are truly suffering a critical emergency. It takes hours to be seen and helped, if you are "waiting". The bigger the city, the worse this gets.

I really do appreciate the idea of walk-in urgent cares. These are critical to filling the gap between true emergency and moderate urgency. I wish there was a better way to let emergency rooms be able to triage and redirect patients to the urgent care facility (hopefully just next door) and that the urgent care had the ability to treat people within a reasonable time period.

And the people seeking care who are un/under insured, that's also a critical problem for the health care system. Again, I think an urgent care can help with this, where revenue came from donations, grants, taxes, subsidies, etc.

I wonder why hospitals don't open urgent care wings attached to the same triage area as the one that sends people to the ICUs.

Kaiser has this (at least did when I lived in San Diego). There's an urgent care in the same hospital as the ER.

Wish granted. Many if not most hospitals in W central Fla have urgent care facilities right next door, and beyond. The local big hospital has about half a dozen freestanding urgent care operations scattered about the county.

I almost feel like there is a different use of the word ER in Canada. Patients usually don't stay in ER/ED for long periods, they're released, sent to surgery, sent to ICU, or to Med-Surg. There just aren't that many beds, and you don't want ED to fill up unless the others are already full too (happened with COVID).

I have an elderly parent who has required multiple trips to the ER in the last year. The issue here (Seattle) is that the beds in the other departments are full, so there is no where else for them to go. The ER usually determine within a few hours she needs to be admitted, and then it takes a day for them to actually find the capacity.

I think the confusion might arise from the definition of "long". People who are stable can spend many hours waiting in an ER. This is a long time. Patients with urgent but not life threatening issues will be seen quickly and discharged quickly, e.g. getting sutures for a nasty cut.

But patients with urgent and life threatening problems, like trauma after a car crash, will receive emergency treatment to stabilize them and then they will be forwarded to another department as soon as possible. How soon depends on hospital capacity, time (day, night, weekend,..), etc.

Sounds like a typical work environment.

An unaddressed grey area is situations where elderly patients experiencing this delerium retain legal control of their affairs. I've seen various elderly people go in-and-out of hospitals and descend into cognitiive decline, and yet institutions still hold them responsible for managing assets and liabilities; as well as life-changing decisions that affect both them but also their care takers. The grey area gives individuals and their families the flexibility to make the best choices, but the opposite also occurs. I've seen people with dimentia and alzhimers lose fortunes because society allowed them to remain in control instead of transferring power of attorney to anyone who could have helped.

Reply on news.ycombinator.com