What to Do with All These False Emergency Patients?

During her twenty-minute rest break at 3 A.M., Sue Abrams, M.D., rolled her eyes when Ken Raskins, a hospital administrator, asked her how she was doing. "It's real nice of you Ken, to drop by the emergency room to get a feel for what life is like in the trenches," said Sue. "You know it. The emergency room doctors and nurses know it. And the rest of the ER medical and support staff know it. We've got the same enormous problem in our ER that is sweeping the country. The ER has lost most of its original purpose, and the change is choking the staff." "I think I know what you're getting at," said Ken. "But please give me an update on the problem so I can take it up with the senior administrators." "Stated simply," said Sue, "I estimate that only about one-third of the patients who come to the ER are facing a real emergency. They are using the ER for such reasons as avoiding having to visit a doctor during the day, or simply to get treatment for a minor illness or injury." "I'm listening, and I'll take a few written notes," responded Ken. "Can you give me a few specifics?" "Okay," said Sue with a sigh of exasperation. "I'll give you a handful of examples before I have to get back to the next hypochondriac in the ER.

• A mother brought in her two children with ordinary colds. She told me she thought her children were dying from the swine flu.

• An older man said he wanted to be treated for a stroke because he felt a twitching over his left eye.

• A pregnant teenager came in with her boyfriend. She said she had a six-pack of beer that evening and she wanted to know whether her binge drinking had harmed the fetus.

• A young guy came in with a swollen hand. He said he got so mad that he hit the door in his apartment; he wanted to know what he should do for his hand." Ken said sympathetically, "I understand that from a medical standpoint these types of visits to the ER seem unwarranted. Yet a lot of people do not understand what constitutes a true medical emergency." Sue retorted, "Yet we still have a critical problem. We are clogging our ER beyond limits. It's gotten to the point where it is difficult to find nurses, nurse's aides, and physician assistants who will work in our ER." Ken finished the conversation by saying, "You are right Sue. We've got to do something with all these false emergency patients. I'll get this problem on the hospital administrator's agenda. Most likely, we'll ask you and other ER staff to provide some input. That's providing you have enough energy left to attend a meeting."

Discussion Questions

1. What is the problem facing the ER staff in terms of the discrepancy between the ideal and actual conditions?

2. How might the hospital staff go about resolving the problem or problems described by Sue Abrams? 3. For what reasons should the ER staff and the hospital administrators care if some of the visitors to the emergency room are really not experiencing an emergency?