ACEP Chief Rails Against ED Diversions, Scheduling

"She went to a hospital in Pittsburgh with very bad pneumonia, and after she got into a bed she got sicker and needed to go on a respirator in the ICU. I called in to see how she was doing and they told me she was transferred from a floor bed to the emergency room instead of the ICU.

"The reason that happened is because they had a 'call-off' of a nurse in the ICU, (a nurse who did not show up for work.) Every one of the nurses in the ICU already had two patients, and no one nurse can take care of three patients. They had an unwritten rule," said Schneider.

Schneider spoke with the ED nurse, identifying herself as the patient's niece, but also as an ED physician from another hospital.

She said, "He told me, 'Oh, you'll understand. I already have three ICU patients, and I have three patients already admitted to the hospital, and I'm also taking care of four emergency patients. I'll do the best I can by your aunt.' "

Schneider's aunt survived that incident and lived another year. But the ACEP president says she was outraged. "This isn't seen as wrong. No nurse should take care of more than two patients, but it's okay for the emergency department nurse to take care of 10 patients? You can imagine if one of those patients needed a lot of care, the other nine wouldn't be able to get very much," she said.

That, she says, is the problem that this JAMA paper is talking about. It may not just be life and death care, but care to address patient pain. "If you had a patient whose blood pressure was falling, and another needed pain medication, which would you address?" she asked.

The cycle is a vicious one.

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