A Budding Emergencist
Tuesday, July 18, 2006
  Some background...
Fortunately, since I'm being very careful to moderate all of my posts and my entire website for any indication of where I am working, being entirely HIPAA compliant about any patient details, and especially not the name or location of the hospital where I work, I can pretty much say whatever I want.

So, forthcoming vague details; I work in a fairly large urban center in the United States. Not on of your major teaching hospitals, call it a minor teaching hospital. But boy, we're trying. We're building like crazy--new designations galore--stroke center, cancer center, children's hospital, heart center, and we're building a giant new addition that will complete in about Feb 2007 and fill up in about a week.

The funny thing is, the ER is tiny. It's fairy new, too--finished about ten years ago. The paramedic in charge of prehospital services quit when he saw the plans for the current ER. "You mean the ambulances gotta back up in the middle of a busy street to get into the ambulance bay, which has room for two ambulances! I'm outta here!" So the new ER is full in about a week. Now we've got patients stacked 4 deep around a single nursing station where about 35 people all have to do their work. It's a nightmare. No way I'm gonna apply to be a resident here, unless...

The new building also has plans for a new peds ER. The current peds ER, a side department off of the postage stamp, will reopen as the acute side of the current postage stamp. (Note: the ER of this facility will heretofore be known as "the postage stamp".) I'm hoping they'll move the adjacent cardiac cath lab, as well. The new medicare reimbursement schedule will improve Evaluation and Management (E&M) reimbursement by 30% for maderately complex office and hospital visits (to the detriment of "hospital procedures," like colonoscopy, ambulatory surgery), so I hope the hospital will take note and act now. (Medicare reimbursement is revamped every 10 years.) However, the change will be phased in over four years.

More background, and personal background, later.
 
Comments:
Hi Doc;

Here's my own rule about emergency room capacity: BUILD IT AND THEY WILL COME.

My own urban mega-system anchor teaching hospital suffers from execrable design and we see over 90,000 yearly visits in a space I'd estimate could safely handle a third of that. To alleviate the problem we have been undergoing a major expansion.

Our acute care area has tripled in size in recent years and is still often over capacity. Part of it is due to constant revision of the criteria that will land someone in the room, but it also proves the rule: BUILD IT AND THEY WILL COME.

In a week or two we will open up our new moderate acuity wing and a very nice mental health wing. I predict that the doubling of the moderate acuity capacity will result in a higher average census and we'll still be stacking them two deep in every hallway. No matter how big we make the place it won't be big enough.
 
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Emergency medicine, from the beginning of a new doctor's career.

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Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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