Several patients' cases were cited in a report by the Connecticut Department of Public Health as it placed Farmington-based John Dempsey Hospital on probation for two years. It is the third time the health department has disciplined Dempsey, part of the University of Connecticut Health Center, in the past three years. As part of a consent agreement, the hospital agreed to bring in a consultant to recommend improvements for areas including nursing services and staffing levels, infection control, pharmacy, the operating room, emergency department, psychiatric services, and patient assessments.
The death of an 89-year-old woman on the roof of University of Pittsburgh Medical Center Montefiore is prompting several investigations, and the hospital could face fines, a change in its accreditation status, and a lawsuit from the woman's family. Pittsburgh police, the state Health Department, and the hospital itself will examine how the woman, who suffered from dementia and heart problems, was able to wander unnoticed from her 12th-floor room and go to the roof. Her body was found there by a maintenance worker. Within 45 days, UPMC is expected to issue a report and action plan to The Joint Commission.
The phrase "hallway medicine" doesn't exactly invoke images of a quality care environment. Not to me, at least. Nevertheless, some providers are beginning to view the notion of shifting emergency department patients to inpatient hallways as preferable to the alternative.
A study at Stony Brook (NY) University Medical Center found that no harm was caused by transferring ED patients to upper-floor hallways when they were ready for admission. Presented at a recent American College of Emergency Physicians meeting in Chicago, the study concluded that the strategy is a way to make the entire hospital responsible for emergency patient care and thus relieve overcrowding in the ED.
I confess I have mixed feeling on this one. The Associated Press quoted the study's lead author, Peter Viccellio, MD, as saying the findings mark "yet another battle cry for hospitals to get off their duffs and stop stacking people knee-deep in the emergency department." Well... yes... crowded emergency departments are a significant problem, to say the least. Boarding patients in the ED because there are no inpatient beds to be had is not an acceptable alternative; in fact, a 2007 ACEP survey of emergency physicians found that 13% of them had experienced patients dying because they were boarded in the ED even after they were admitted to the hospital. Viccellio, Stony Brook's ED clinical director, told the AP that on busy days, the ED would "grind to a halt" before his hospital began using hallways. And when it comes to finding solutions, healthcare certainly needs all the innovative thinking it can get.
But sticking patients in hallways as a matter of policy? Plenty of ED caregivers would probably tell me that they safely provide hallway care all the time and that I should get over it. But what about the privacy implications of hallway medicine? Or the safety issues? Or fire codes? Or the basic question of who cares for these patients?
Ultimately, I just have trouble accepting the premise that ED boarding and hallway medicine are the only alternatives. Our HealthLeadersmagazine cover story this past January looked at the steps some hospitals are taking to fix the problems in their emergency departments. In Mississippi, for instance, a 580-staffed-bed hospital developed a "rapid-admit" unit to quickly move patients out of the ED for preadmission procedures like IV insertion. Flagging ED tests as high-priority helped ease lab bottlenecks that exacerbated overcrowding. Other organizations addressed their triage processes to increase efficiency and weed out lower-level primary care cases to get people in and out more quickly and free up space. In short, there are hospitals out there that have found solutions that don't involve ED boarding or inpatient hallways.
That said, I realize that plenty of major ED overcrowding issues can't be solved just by tweaking some triage processes. If half of the ED's beds are filled with holds for the ICU or other areas of the hospital, how is that the ED's fault? And if patients are already receiving care in an ED hallway, are they any less safe in a hallway two floors up?
I'd like to hear from you on this—how is your hospital addressing the issue of ED overcrowding? Do you see hallway medicine as a viable alternative? Beyond the choice between boarding in the ED and inpatient hallway care, what is the best third option? Send me an e-mail—I'd love to hear your thoughts.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media QualityLeaders, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.
An official Los Angeles County assessment has acknowledged for the first time that a woman who died after writhing in pain for nearly an hour on the waiting room floor of Martin Luther King Jr.-Harbor Medical Center could have been saved if she had been properly treated. The woman was captured on security videotape as a janitor mopped around her and a triage nurse dismissed her complaints. Her death helped to precipitate the closure of the hospital's emergency room and inpatient care after federal regulators determined that staffers had failed to deliver a minimum standard of care.
Recent studies suggest that badly behaved doctors contribute to medical mistakes, preventable complications, and even death. A survey of healthcare workers at 102 nonprofit hospitals from 2004 to 2007 found that 67% of respondents said they thought there was a link between disruptive behavior and medical mistakes, and 18% said they knew of a mistake that occurred because of an obnoxious doctor. Another survey by the Institute for Safe Medication Practices found that 40% of hospital staff members reported having been so intimidated by a doctor that they did not share their concerns about orders for medication that appeared to be incorrect. As a result, 7% said they contributed to a medication error.
How well a person on Medicare understands the program's benefits affects their access to healthcare, according to a study. The report found that a third of the surveyed Medicare beneficiaries considered themselves as being unfamiliar or very unfamiliar with their program's benefits. "Well designed educational interventions or policies simplifying Medicare benefit programs could have a significant effect on beneficiaries' abilities to get needed care," principal author Robert O. Morgan, a professor of Management, Policy and Community Health at the University of Texas School of Public Health, said in a news release.