[traumanurses] Re: diversion policy

["Leiding, Lisa" <Lisa.Leiding@stvin.org>]

I hear you - welcome to the regional trauma center syndrome in rural America. We take patients and can not divert as the only game in town. We do not have to accept outlying hospital patients - however thank-you - we get more than plenty right off the street and in our immediate catchment area to do us in on a daily basis.

We have a 20 bed ED and we see 64,000+ patients a year. TRIAGE, TRIAGE and re-TRIAGE is how we are having to function. I think that it is beyond ridiculous that the federal government thinks that "we will just use the trauma system" when we have millions more injured or wounded due to bio-terrorism. I sit in the middle of two national laboratories. We are already bursting at the seams - and as we all know - most of the bio exposures will just walk up to the front door. But that is just a whole other issue. Just because we have a terrorism event doesn't mean that Mr X will postpone his heart attack, or Mrs. J will forget about the kidney stone that she is passing or that Mr Y will not come in looking for his weekly fix.

Some brilliant individual here thought that the ED should send the patients to the floors (who are "busy" and can't take report, or are "full" and let the patients wait in the halls up there for their bed - rather than a hall in the ED after they have been admitted, certainly is a much quieter environment, more HIPAA compliant. Doesn't address the JCAHO / Fire code issues - but.. ....

Lisa McLaughlin
Santa Fe, NM

-----Original Message-----
From: mike [mailto:mmackinnon@qwest.net]
Sent: Wednesday, April 30, 2003 1:11 AM
To: traumanurses@mailman.listserve.com
Subject: [traumanurses] Re: diversion policy

This idea of 'patient request' superceding diversion status is
counter-intuitive. How is it that a patient can request a facility that is
currently on diversion, indicating that it can no longer safely accept
patients?? Not only is this dangerous for us as staff but more importantly,
it could be deadly for patients. The average 'joe' has no idea what
diversion means (if they even know it exists) and when I explain to them
that they wont be seen for 'hours' even though they came in by ambo, they
simply are mortified. Then I explain what diversion is and although
paramedics usually explain it pretty clearly, they all the sudden 'had no
idea'.

On a legal note, lets assume a patient makes the decision (it is not an
informed one) they want to goto my hospital when on diversion. So at work
there are now 20 people in the waiting room at various levels of triage (all
getting angry and worse) staff is well beyond it's limit, every hallway bed
is taken. Another 20 people are in rooms but still not seen yet because one
of the (about to get off shift) night docs stopped seeing new patients over
an hour ago and the other is slow as molasses going uphill in winter. To
make matters worse, the whole hospital is full and we no longer will be
getting beds so we are now holding 5 ICU (supposedly ONE on ONE) patients,
another 5 tele and some medical. As usual, the ER staff is somehow expected
to do ALL the floor orders and BS and continue to rotate the remaining rooms
with ER patients.

So (that was long winded), in rolls betty, she has 'chosen' to come to us
because " My family doctor told me to come here when I called him because he
would meet me here" (oh, sure he will at 3 AM). Betty complains of some mild
abd pain that 'sortof' goes to her back (which she has chronic back pain
anyway). We ask the paramedics if she can walk, they nod, we send her out to
triage to wait like everyone else. 2 hours later she is complaining very
loudly and to avoid a complaint our charge RN moves yet another patient to
the hall (causing multiple OSHA, JACHO, FIRE and HIPPA violations) and puts
betty in a room. Since there is now only one ER doc on and there are
actually 'critical' patients in the ER, she waits another 2 hours to be
seen.

In the meantime, since the staff is well and far overworked, they haven't
really had time to do much for this patient, she blows a previously unknown
triple A at the right renal and basically bleeds out right there in the room
and she dies only to be found after her demise. Her son, who hasen't talked
to her in well over a year, now sues the hospital and successfully
prosecutes both the Hospital, the ER doc and the triage as well as the
charge and assigned RN for this patient. All 3 RN's lose their jobs, the
hospital has a nasty lawsuit and the Doc's ER group dosn't renew his
contract (besides the legal hassel he has already had). All this because a
patient can 'choose' to come to an already overburdened ER and somehow this
is the fault of the staff who have no choice in the matter.

So what has ever justified allowing a patient to choose vs diversion?

-Mike MacKinnon

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