A while back I wrote a series of posts criticizing the Institute of Medicine’s proposals to remedy ER crowding, and their incredible statement that hospitals can fix the problem, and eliminate diversion and patient boarding just by being more efficient. I thought I made it clear that I was only criticizing the IOM, but then Grunt Doc weighed in with this:
Second, what's so magic about the ED? Only the ED and OB have rubber walls and are infinitely flexible, to try our best to care for every patient ho needs our help. Except, see, our walls really aren't made of magic rubber, we can't just snap our fingers and make more rooms, beds, monitors or nurses appear. Every patient who should be admitted to the hospital but isn't is a) not getting the specialized nursing care available on the ward where they belong and b) is taking up a bed in the ED we need to see then next 1-12 patients. The linked commenters in the first paragraph give a 'suck-it-up ED' subtext that rankles.
That wasn’t what was intended, so I clarified here. Grunt Doc graciously relented (in my comments). But the finger pointing by some of the ED types in his comments suggested an “us against them” attitude. My clarification post made these points:
Wait a minute---nobody’s blaming the ER here. This isn’t “us against them.” The emergency department is part of the hospital. Their problems are the hospital’s problems, and vice versa. If the ER is overtaxed the entire hospital feels the strain due to extensive overlap and sharing of resources. Concerning whether patients who needed boarding should be boarded in the ER or on the wards I said: There’s nothing written in stone in my mind that such boarding has to take place in the ER unless the patient needs cardiac monitoring.
Well, I figured I’d made that pretty clear until commenter Ryan (evidently an ED provider) weighed in with this straw man: My question to you is why are my halls better then your halls? And then: I ask again why floor nurses are different from the ED nurses.
Look, it’s not a matter of my nurses vs. your nurses, or my hallways vs. yours. I never said it was! Why do ED types seem to want to frame it in adversarial terms? Hospitalists are “on board” with this issue. We’re on the same side. Really. One of the thought leaders at the Southern regional hospitalist meeting in New Orleans a week or two ago said that the Society of Hospital Medicine is committed to helping improve ER throughput. (I wasn’t there but I browsed the syllabus one of my colleagues brought back. Sorry I missed you DB. We’ll hook up one of these days).