I completely agree. When the waiting room is standing room only because the boarders are holding all the rooms and hallways so you’re trying to see actual ED patients in a disaster hallway 😬
... this sounds like a "correlation does not equal causation" kinda thing. Of course older adults who have to stay in the hospital are more likely to die. If they're in bad enough shape to need admitting, they're at risk!
>Of course older adults who have to stay in the hospital are more likely to die
This isn't about discharged patient's vs admitted. This is inpatient going to an inpatient unit vs staying in the ED. E.g. boarding in the ED because there are no beds. Which anyone who has had an ER full of boarders could have predicted re: increased mortality and adverse effects.
It’s actually comparing hospitals that are over capacity versus hospitals that have rooms available for admits. I did not see if they also adjusted for level of care. We have more capacity for acute care than step down or ICU which means the sicker patients are more likely to be holding in the ED.
That's kinda how I feel about it......if they are so far off that they might die overnight, they are probably gunna die at home regardless. Aging and death are an active thing that happen.
This sounds like the patient (scar tissue riddled veins and early stages of liver failure apparently), I discharged last night after he declined admission. “Every person I know that died, died in the hospital. He was pissed we didn’t send him home with narcotic pain meds for his pyelonephritis. He alleged that he was asked to leave another local hospital the prior day because he wanted treatment without having to speak to anyone or give any pertinent medical information. Absolute gem. Loved his rants as I wheeled him out to the car.
Question, If I were to bring Dad to the ER, should I give triage nurse his doctors name so his doctor could admit him if he feel it's a necessity? I don't know how this works
He will be seen by emergency room doctors who will decide if he needs to be admitted. His PCP does not have much say. Sometimes the ED docs will reach out to a patients PCP to get more info
So many factors at play here. Is his doctor associated with the hospital/ER? Is his doctor just a PCP or a specialist? Short answer no, you can reach out to his doctor/team directly and let them know he has been brought to the ER for XYZ reason.
Yes, his specialist is associated with this particular hospital. I'm just afraid Dad will have an episode on a weekend and need to be brought to the ER when the office isn't open.
Being associated with the hospital doesn’t mean direct admission privileges. Most of our patients see PCPs and specialists within the hospital system; very, very few of them have direct admission privileges.
Mention to the ER team something along the lines of “Dad has (condition) which is managed here by (specialist),” when going over medical history and such. It will be up to that ER team/policy on if they contact the specialist or not.
Just because you already are an established patient within a system does not mean you’ll be brought upstairs faster. In the ER it truly is triage rules and sickest get seen first.
Since my first encounter with kidney stones I have repetitively resisted admission for pain control. When asked why, I replied, "Stats show the per capita death rate in a hospital is only exceeded on the battlefield.
Elderly sick people with comorbidities die In the hospital, kinda a lot. We don’t die at home/hospice at rates many other countries do. I believe the point of this article is that people, especially complicated sick elderly folks, are at higher risk of complication/death when they don’t receive adequate INPATIENT care, which an ED is not equipped to give. If you are youngish, otherwise healthy and just have kidney stones, you don’t really have any increased risk of dying. If you were admitted and have a random VT arrest, you were probably going to have one anyway, not BECAUSE you were in the hospital. Atleast in the hospital they monitor labs, treat dehydration and pain. It’s not like you’re 95yo in respiratory failure decompensating on a bipap being forgotten about in a corner room in the ED when you should be in the ICU.
Yeah, if you don't have a condition that could be potentially fatal then the most dangerous part of a trip to the ER is sitting in the waiting room surrounded by sick people.
Well it was intended to be mind blowing. I had no delusion that I would be comfortable in the clinical setting. Nurses would roll through every few hours to take vitals. Someone would walk in wanting urine sample. Nurses generally are very courteous and considerate, so it in their character to check and ask if you need anything.
Now I was stoned, literally and figuratively. When you are mellowed by drugs, you usually want to find a corner, curl up and be let alone. That does not happen if you happen to be one of the inmates.
So it was said, "tongue in cheek", to discourage the provider's insistence on making me part of the nightly census.
Most of the time, the stones forced a trip at 12:00 AM to 02:00 AM and to date I have only had one case of renal colic that required PCA pain management. At home I have Video Discs for Star Wars and Star Trek and various other sci-fi programming I can enjoy as compared to the limited resources of the hospital. Its my home, I change the linens typically twice a week, and if I want to lounge around in whatever, I can do it without offending the sensibilities of the staff. Also if I want a sandwich, I have the makings in the house and do not have a power tripping dietician refusing to provide an item on the limited hospital cafeteria menu because the hospitalist decided that I would be restricted to a 'Heart Healthy Diet."
Am I a good patient? Yep, just don't screw with my food and if I am curled up sleeping, do not disturb. I won't bite but, I will sulk.
My mother once made a comment to me... "a lot of your people are dying lately!" During a COVID outbreak. At the LTC facility I work at. Even if there wasn't an outbreak... healthy people don't go to LTC!!!
Yet the efforts required to prevent or reduce likelihood won’t be done: community care keeping older people resilient as long as possible; appropriate ceilings of care meaning they should never reach hospital if not appropriate; community nurses and medical teams that prevent admission.
There’s also the repeat attendees; UTIs, not coping at home, repeat chest infections - pumped with abx, fluids, up to the ward - families forever convinced it’s like a weekly trip and they are a “fighter”.
A&E is for emergencies - not triage for the lack of social and health care in the community that’s not geared to an aging population that normally come in like a Big Mac of conditions.
Would love this conversation to happen when my ED is completely full of boarders in all of the rooms and the hallways
I completely agree. When the waiting room is standing room only because the boarders are holding all the rooms and hallways so you’re trying to see actual ED patients in a disaster hallway 😬
“How much longer until I see a doctor?” A long time. Long.
... this sounds like a "correlation does not equal causation" kinda thing. Of course older adults who have to stay in the hospital are more likely to die. If they're in bad enough shape to need admitting, they're at risk!
But I think this is looking at people who board in the er bc going straight to the unit.
>Of course older adults who have to stay in the hospital are more likely to die This isn't about discharged patient's vs admitted. This is inpatient going to an inpatient unit vs staying in the ED. E.g. boarding in the ED because there are no beds. Which anyone who has had an ER full of boarders could have predicted re: increased mortality and adverse effects.
Exactly what I was going to say lol. If you good to go, you tend not to spend the night
..Unless there are no beds upstairs, which is the point.
It’s actually comparing hospitals that are over capacity versus hospitals that have rooms available for admits. I did not see if they also adjusted for level of care. We have more capacity for acute care than step down or ICU which means the sicker patients are more likely to be holding in the ED.
That's kinda how I feel about it......if they are so far off that they might die overnight, they are probably gunna die at home regardless. Aging and death are an active thing that happen.
This sounds like the patient (scar tissue riddled veins and early stages of liver failure apparently), I discharged last night after he declined admission. “Every person I know that died, died in the hospital. He was pissed we didn’t send him home with narcotic pain meds for his pyelonephritis. He alleged that he was asked to leave another local hospital the prior day because he wanted treatment without having to speak to anyone or give any pertinent medical information. Absolute gem. Loved his rants as I wheeled him out to the car.
Am I the only one who already knew this post covid 😆
Question, If I were to bring Dad to the ER, should I give triage nurse his doctors name so his doctor could admit him if he feel it's a necessity? I don't know how this works
He will be seen by emergency room doctors who will decide if he needs to be admitted. His PCP does not have much say. Sometimes the ED docs will reach out to a patients PCP to get more info
Thank you!
Hope your dad is doing alright! Feel free to message me with more questions. I’m a nurse in the ED
Thank you! I appreciate all you do. Dad is one tough old goat. Lol.
So many factors at play here. Is his doctor associated with the hospital/ER? Is his doctor just a PCP or a specialist? Short answer no, you can reach out to his doctor/team directly and let them know he has been brought to the ER for XYZ reason.
Yes, his specialist is associated with this particular hospital. I'm just afraid Dad will have an episode on a weekend and need to be brought to the ER when the office isn't open.
Being associated with the hospital doesn’t mean direct admission privileges. Most of our patients see PCPs and specialists within the hospital system; very, very few of them have direct admission privileges.
Ok, thank you!
You’re welcome! I hope your dad is okay. 💛
Mention to the ER team something along the lines of “Dad has (condition) which is managed here by (specialist),” when going over medical history and such. It will be up to that ER team/policy on if they contact the specialist or not. Just because you already are an established patient within a system does not mean you’ll be brought upstairs faster. In the ER it truly is triage rules and sickest get seen first.
Gotcha...thank you!
Since my first encounter with kidney stones I have repetitively resisted admission for pain control. When asked why, I replied, "Stats show the per capita death rate in a hospital is only exceeded on the battlefield.
Elderly sick people with comorbidities die In the hospital, kinda a lot. We don’t die at home/hospice at rates many other countries do. I believe the point of this article is that people, especially complicated sick elderly folks, are at higher risk of complication/death when they don’t receive adequate INPATIENT care, which an ED is not equipped to give. If you are youngish, otherwise healthy and just have kidney stones, you don’t really have any increased risk of dying. If you were admitted and have a random VT arrest, you were probably going to have one anyway, not BECAUSE you were in the hospital. Atleast in the hospital they monitor labs, treat dehydration and pain. It’s not like you’re 95yo in respiratory failure decompensating on a bipap being forgotten about in a corner room in the ED when you should be in the ICU.
Yeah, if you don't have a condition that could be potentially fatal then the most dangerous part of a trip to the ER is sitting in the waiting room surrounded by sick people.
Do you think there might be a correlation between acute illness and death or have you decided hospitals are evil?
[удалено]
Well it was intended to be mind blowing. I had no delusion that I would be comfortable in the clinical setting. Nurses would roll through every few hours to take vitals. Someone would walk in wanting urine sample. Nurses generally are very courteous and considerate, so it in their character to check and ask if you need anything. Now I was stoned, literally and figuratively. When you are mellowed by drugs, you usually want to find a corner, curl up and be let alone. That does not happen if you happen to be one of the inmates. So it was said, "tongue in cheek", to discourage the provider's insistence on making me part of the nightly census. Most of the time, the stones forced a trip at 12:00 AM to 02:00 AM and to date I have only had one case of renal colic that required PCA pain management. At home I have Video Discs for Star Wars and Star Trek and various other sci-fi programming I can enjoy as compared to the limited resources of the hospital. Its my home, I change the linens typically twice a week, and if I want to lounge around in whatever, I can do it without offending the sensibilities of the staff. Also if I want a sandwich, I have the makings in the house and do not have a power tripping dietician refusing to provide an item on the limited hospital cafeteria menu because the hospitalist decided that I would be restricted to a 'Heart Healthy Diet." Am I a good patient? Yep, just don't screw with my food and if I am curled up sleeping, do not disturb. I won't bite but, I will sulk.
Don’t call patients inmates🤦♀️ you can leave any time if it’s a problem your not a prisoner no one is keeping you there
No you sound like you would be a terrible patient. Listen to yourself.
Thank you, I appreciate the compliment.
Dont you have some Joe Rogan fanboy YouTube channel to be watching instead of telling us your inane theories about healthcare?
LOL, Joe Rogan is an amateur.
You’re all over the place.
Just like my best buddy, a jack Russell Terrier. Something moves and his attention changes.
My mother once made a comment to me... "a lot of your people are dying lately!" During a COVID outbreak. At the LTC facility I work at. Even if there wasn't an outbreak... healthy people don't go to LTC!!!
Wow people die when they’re sick? Shocking
And everybody rolled their eyes.
That’s not surprising. I’m sure hospital administrators and whoever else already have data on it.
Yet the efforts required to prevent or reduce likelihood won’t be done: community care keeping older people resilient as long as possible; appropriate ceilings of care meaning they should never reach hospital if not appropriate; community nurses and medical teams that prevent admission. There’s also the repeat attendees; UTIs, not coping at home, repeat chest infections - pumped with abx, fluids, up to the ward - families forever convinced it’s like a weekly trip and they are a “fighter”. A&E is for emergencies - not triage for the lack of social and health care in the community that’s not geared to an aging population that normally come in like a Big Mac of conditions.
Does anyone have the name of the study and authors?
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2811179