Re: Your socialized health care horror story of the day
- From: John J <JSJoyce@xxxxxxxxx>
- Date: Sun, 21 Oct 2007 22:17:48 -0000
On Oct 21, 5:14 pm, SETI2...@xxxxxxxxxxx wrote:
Hospital had to send man to Montreal for surgery. Ambulance got 'lost'
on the way after no doctors found here
Laura Drake
The Ottawa Citizen
Friday, October 19, 2007
When Dany Bureau's stomach started to hurt last week, he figured it
was just because of something he ate.
So the 21-year-old Gatineau student went to bed, thinking he'd feel
better by the morning. But when he woke up the next day, the pain was
still there, and it was getting worse.
He headed to Gatineau Memorial Hospital, thinking that doctors would
soon figure out what was ailing him and take care of it.
He never imagined the ordeal that would follow: The young man was
turned away from five hospitals, got lost in an ambulance and, 28
hours after he was diagnosed, he had a burst appendix removed -- in
Montreal.
Because Wakefield's Gatineau Memorial Hospital does not have surgical
capacity, the doctor who diagnosed him with appendicitis last Friday
started looking around for one that did. Usually, patients from
Wakefield are sent to Hull or Gatineau, but on that night, there were
no available beds at either.
As his doctor hunted around for an available surgeon, Dany's "tummy
ache" of the night before was turning into a searing pain in his
abdomen.
Meanwhile, his father, Robert, was waiting at home to find out which
hospital his son would get into. He says he kept getting calls
updating him as one after another of the closest hospitals couldn't
help, or weren't yet responding. None in Hull, Gatineau, Buckingham,
Ottawa, or Maniwaki could help.
"I thought, oh my God, where are we going to end up, the States?"
After several hours of searching for a surgeon to no avail, one was
eventually confirmed in Montreal.
As Dany waited for an ambulance to take him there, with the pain in
his side growing unbearable, he was confused about why he had to go so
far for what he thought was a simple surgery.
"If someone had something a lot more serious than me, what would they
do? Or if the Montreal hospital had no personnel, what would I have
done? Where would I have gone?"
As Dany was being loaded into the ambulance around 8:37 p.m. Friday,
Robert Bureau hopped in his car and started on the two-hour journey to
Montreal. "I anticipated that they would pass us on the way to the
hospital, but we never saw the ambulance," he said.
When he got to the hospital, there was no sign of his son -- who
didn't show up for another hour and a half because paramedics took a
wrong turn on the highway.
"I could hear them asking directions to people outside because they
didn't know where they were," Dany said.
Once the paramedics had found their way, they then mistakenly unloaded
their patient at the Montreal Children's Hospital before they finally
delivered him to the Montreal General Hospital 15 minutes after
midnight.
Marc Paquette, the director of operations for the Outaouais Paramedics
Co-operative, said yesterday that the paramedics did mistakenly take
Dany to the children's hospital. However, he said the driver was not
lost, but simply missed the Décarie exit for the hospital and turned
around when he realized his mistake. Mr. Paquette added that this was
an "isolated case," and that his drivers make trips to Montreal
regularly.
Mr. Bureau figures the trip took the paramedics about two hours more
than it should have. As a result, he said, the surgeon who was
awaiting Dany's arrival became involved with another trauma case. Then
other trauma cases came along -- so his son was put in a bed to wait.
It wasn't until 9:50 on Saturday night, after hours of pain and
worrying, that Dany was finally wheeled into an operating room.
"When they opened him up, it was busted. There was pus all over the
place. There was dead tissue. So they cleaned it all up and they
removed the appendix," Mr. Bureau said.
What's worse, he added, is that Dany developed peritonitis, an
inflammation that, if untreated, can be life-threatening, as it stops
the normal movement of the intestines.
It was his father's biggest worry. "That's all we hear in the news
nowadays: Somebody gets appendicitis, they get sent home by a hospital
and then they get peritonitis and die."
Because of the peritonitis, Mr. Bureau said, Dany had to stay in
hospital in Montreal until Wednesday so his recovery could be
monitored.
Citing privacy concerns, Alex Fretier, a spokesman for the Montreal
General Hospital, said he could not discuss the case. He was also
unable to provide information on normal waiting times for emergency
appendectomies.
Mr. Bureau said the entire experience has left him aghast at the state
of the health care system in his region.
"As a parent, I cannot believe that there is no emergency services or
surgery for our area or the Ottawa area to deal with something as
simple as an appendix," he said.
However, those familiar with Quebec's health system say that a lack of
available beds isn't that uncommon.
"When you make rounds around the province of Quebec, you will see that
every hospital, once in a while, won't have beds available and it
happened to us last weekend," said Sylvain Dubé, spokesman for the
Gatineau health and social services centre.
Although the general practice is to send Outaouais patients to
Montreal if there is no room at regional hospitals, the Ottawa
Hospital has an agreement to take them "if there is a threat to life
or limb," said spokeswoman Allison Neill, who added that their
emergency rooms have also been extremely busy lately.
However, Marthe Robitaille, a spokeswoman for Outaouais à l'urgence, a
group concerned with the quality of health care in the region, said
Outaouais patients are forced to go to Ottawa far too often because of
a lack of resources in the region -- something she feels should never
have to happen.
Ms. Robitaille said that what happened to Dany is a potential
consequence of the region's two biggest health-care problems:
underfunding and a lack of organization.
Bernard Chagnon, a spokesman for the Outaouais health and social
services agency, said the agency is working with the regional health
centres to better co-ordinate situations where patients need to be
transferred. Though the practice has always occurred, it has
traditionally been done in an informal way. Mr. Chagnon could not say
when a more formal process would be put in place.
Surgical Ordeal
- Thursday Oct. 11, 11 p.m. -- Dany Bureau starts to feel pains in his
stomach. He goes to sleep thinking he just has a stomach ache.
- Friday Oct. 12, 3 p.m. -- Since the pain has not gone away, Mr.
Bureau and his mother go to the Wakefield hospital to have him checked
out.
- At Wakefield's Gatineau Memorial hospital, a doctor determines that
there is a problem with Mr. Bureau's appendix. Calls are made to
hospitals in Hull, Gatineau, Maniwaki, Buckingham and Ottawa to find a
surgeon. A surgeon cannot be found.
- 8:25 p.m. -- Robert Bureau, Dany's father, receives a call informing
him that a surgeon is available at the Montreal General Hospital.
- 8:30 p.m. -- Mr. Bureau leaves his home in Aylmer for Montreal.
- 8:37 p.m. -- The ambulance leaves Wakefield hospital with Mr.
Bureau.
- 10:45 p.m. -- Robert Bureau arrives at the Montreal General
Hospital.
- Saturday, Oct. 13, 12:15 a.m. -- The ambulance with Dany Bureau
arrives at the Montreal General Hospital after missing the Décarie
exit and then mistakenly unloading him at the Montreal Children's
Hospital. The surgeon who had been awaiting Dany Bureau's arrival has
since become occupied with another trauma case.
- 9:50 p.m. -- Dany Bureau is taken in for surgery
- Oct. 14, 12:10 a.m. -- The surgeon who operated on Dany Bureau tells
his father that his appendix had burst and that he had developed
peritonitis. As a result, he is hospitalized for several days so his
recovery can be monitored.
Laura Drake
© The Ottawa Citizen 2007
http://www.canada.com/components/print.aspx?id=bd7f6fd5-f4d1-4573-b29...
Speaking of copy/paste:
http://www.boston.com/business/healthcare/articles/2007/10/21/daily_battle_for_beds_strands_mgh_patients?mode=PF
Daily battle for beds strands MGH patients
Tough calls, and a long wait in ER
By Liz Kowalczyk, Globe Staff | October 21, 2007
Lisa Manley shifted uncomfortably on her narrow gurney in Bay 28 of
the Massachusetts General Hospital emergency room, watching nurses and
doctors rush past the open curtain of her cramped cubicle.
It was 11 on an August morning, and she was back where her battle
against cancer had begun a year earlier. The previous night, she had
spent 2 1/2 pain-filled hours in the waiting room, throwing up into a
plastic supermarket bag. Then, at 1 a.m., a nurse had led her into one
of the ER's 49 bays, where Manley changed into a johnnie and at last
received morphine and nausea medicine.
So far, she'd spent 12 1/2 hours in the emergency room, with no idea
when she would get a room upstairs - an uncomfortable limbo faced by
ER patients in hospitals across the country. Though a physician had
decided to admit her for treatment, there were more patients than
available beds.
What Manley couldn't see from her gurney was the sometimes wrenching
behind-the-scenes decision-making that occurs at Mass. General about
how to distribute one of the most valuable resources in medicine:
hospital beds.
While Manley and 21 other emergency room patients waited for beds, a
team of triage nurses pored over computer screens and reports that
offered a worrisome picture. The hospital's medical and surgical
floors were at 96 percent capacity. The few open beds were off-limits
because they were in specialized units, or because patients in those
rooms were contagious or especially susceptible to infection.
The nurses' phones and pagers buzzed with requests - internists
seeking space for longtime Mass. General patients, surgeons wanting
patients transferred from other hospitals, and physicians pushing for
beds for family members. All day, the triage nurses shouldered
dilemmas with no easy answers.
For several days, Mass. General allowed a reporter and photographer
access to the hospital's triage operations, an attempt to shed light
on one of the vexing problems of US healthcare - why so many patients
are trapped in the emergency room for hours, so close to a hospital
bed, yet unable to get one - and how the hospital, with some success,
is tackling the problem.
Patients at Mass. General spend an average of about eight hours in the
ER before getting a hospital bed, but some, like Manley, wait far
longer.
She felt the nurses and surgeons provided very good care, but the
delays were stressful, she would say later. "I got so anxious," she
said. "You see someone right away but then you wait and wait."
The wait begins
Manley was supposed to be enjoying Basel, Switzerland, not staring at
the worn, gray linoleum floor in the emergency room.
In June 2006, Novartis, the giant pharmaceutical company, offered her
a job heading global recruiting. She accepted and underwent a routine
physical for new employees. The couple's Newburyport house was packed
and a flight booked for Aug. 30. But four days before they were to
leave, a doctor diagnosed advanced colon cancer and the family's plans
suddenly were on hold.
Mass. General surgeon Dr. David Rattner removed the tumor, and this
August she underwent follow-up surgery.
A week later, she walked 2 1/2 miles along the ocean, feeling almost
like her old self. Out of nowhere, labor-like pains shot through her
abdomen. She wanted to go to nearby Anna Jacques Hospital, which she
knew was small and fast. But Rattner urged her to leave immediately
for Mass. General, so his team could care for her.
X-rays taken in the ER showed a possible intestinal blockage, probably
a complication from her earlier operations and radiation therapy, and
then her wait for a bed began.
When her sister and a friend left at 3:30 a.m., she slept restlessly
for two hours on the hard mattress. Nurses hurried in and out of her
bay to grab supplies from a tall metal shelf; Manley helped herself to
a pair of socks during the night. To use the bathroom, she dragged her
IV pole in her johnnie past strangers.
"I'd like to get a bed because I think it's a better healing
environment," she said.
Several studies published last month in the Annals of Emergency
Medicine showed that the more crowded the emergency department, the
more likely pneumonia patients are to wait to receive antibiotics and
the more likely patients in pain are to face delays in getting pain
medicine.
Manley got the medication she needed, and initially doctors and nurses
were around often, taking blood and attaching EKG leads to monitor her
heart. But as night turned into morning, she saw less of staff, as
they moved onto a new wave of more urgent patients. Nurses forgot
about her EKG monitors, and when the sticky pads began to irritate her
skin, she asked someone to remove them.
She thought about letting her 3-year-old son visit. But she didn't
want him witnessing the open suffering in the ER. Maybe once she had a
room.
Each time a nurse turned into Bay 28, Manley's hopes for a room
upstairs rose - and fell. The nurses came for other reasons. "No one
said anything about when I'd get a bed," she said.
Tense juggling acts
Earlier that morning, soon after arriving at work, Kathleen Gottbrecht
sighed as she looked at the tiny squares on her computer screen, each
representing an emergency department patient. It's "a sea of red," she
said.
Yellow squares indicate a patient has been assigned a bed upstairs.
But at 7:40 a.m., she counted 22 red squares, meaning those patients,
including Manley, were waiting for beds.
"The ED is full and there's no place to put them," said Jennifer
McIntyre from the other end of an oval table in the nursing
administration office on the 14th floor, where the triage nurses were
meeting to prepare for another day of speeding access to beds and
matching patients with the right units. Expansion of the triage team
two years ago helped reduce average ER stays for patients admitted to
the hospital to 8.4 hours this September, from 11.6 hours the same
month last year.
In addition to waiting ER patients, eight patients in other hospitals
had requested transfers to Mass. General. Nine patients in the
hospital had been unexpectedly wait-listed for surgery, meaning they
were filling valuable beds. And in the coming hours, dozens of
patients would come out of the operating rooms needing beds.
Economic pressures in the 1990s forced some hospitals to close and
others to cut beds. Mass. General, like other hospitals, worked to
reduce the number of days patients stayed in the hospital. And the
advent of minimally invasive surgery meant many patients could go home
the day of their operation. But at the same time, new treatments
requiring inpatient stays have been developed, and are being heavily
marketed, and the number of elderly has increased. Overall, the number
of overnight patients at Mass. General has grown 8 percent in the past
five years.
Beds are mined like gold.
Gottbrecht and her colleagues struggle to balance the sometimes-
competing needs of sister hospitals, ER patients, surgery patients,
surgeons, and staff. The priority is to get unstable patients, or
those who have waited 24 hours or more in the ER, into beds. But often
the decisions aren't clear-cut.
On the morning of Aug. 23, Gottbrecht finished her meeting in the
nursing administration office and pulled on a hip-length white coat
with her name embroidered in blue cursive letters. She rode the
elevator to the first floor and walked a long corridor lined with
empty gurneys and wheelchairs for the daily 8 a.m. meeting with ER
doctors and nurses.
"I hear the bed situation is kind of grim upstairs," said nurse
Raymond Bisio. He urged Gottbrecht to give a lung cancer patient who
was in pain and needed a blood transfusion the first available bed.
Because Manley was stable, her name didn't come up.
"We don't promise anything" to patients, said Maryfran Hughes, nurse
manager of the ER. "Because we would say you're getting the next bed
and then someone [more urgent] comes in."
Gottbrecht told the ER staff that she hoped to have better news at
noon, as units began discharging patients scheduled to go home, but
privately she worried. On her next stop, at the admitting office, she
discussed her concerns with Benjamin Orcutt, the patient access
manager, who sent an urgent text page to 100 nurse managers, unit
coordinators, and physician leaders across the hospital.
"Overall Capacity Alert," he typed. "24 patients in ED awaiting
placement. 96% adult med/surg. Please expedite and advise admitting of
all discharges."
Now, it was Gottbrecht's turn to wait.
Difficult decisions
Some days, Gottbrecht and her colleagues have to put ER patients on
the back-burner. On the morning of Sept. 26, Gottbrecht studied
transfer request forms left in her inbox and knew she faced a dilemma.
A woman who had received a lung transplant at Mass. General became ill
over the weekend. The Mass. General ER was full and closed to
ambulances, so her local hospital rushed her to Brigham and Women's
Hospital. She had been waiting three days to get into Mass. General,
where doctors were familiar with her history. Complicating matters,
she needed her own room.
"It's our duty to get her in here," said Gottbrecht, sitting at a desk
in the admitting department. "But she's being cared for."
Orcutt told her another very ill man on her list was a patient of a
particular surgeon. "Let's make sure he gets in - five minutes ago,"
Orcutt said.
The surgeon specializes in gastrointestinal cancer, a targeted growth
area for the hospital, but one without its own unit, Orcutt explained.
So admitting staff pay special attention to these patients.
Then there was a woman at an out-of-state hospital whose son-in-law
was a doctor at Newton-Wellesley Hospital, a Mass. General partner.
The community hospital wanted Mass. General nurses to check with the
son-in-law about the type of unit she would be assigned, but
Gottbrecht felt the decision should be based solely on the clinical
evidence.
"Oh no, we won't be checking with him," Gottbrecht told fellow nurse
Margaret Ramage. "We're the triage nurses at MGH!"
Part of Gottbrecht's job is to help staff on the floors understand
when the situation is urgent, and to use negotiation or otherwise help
free up beds faster. She has short blond hair, and laughs and chats
easily, but she sometimes has to hold a firm line. "The answer right
now is no," she responded when Ramage asked about a transfer request.
She started punching numbers on the phone.
She called the head nurse in the trauma unit, which had four open beds
reserved for trauma patients, explained the hospital was desperate,
and asked her to take a transfer. Searching on the computer, she saw
that an open bed on Ellison 12 was not clean. She called a janitorial
team and asked them to head up there immediately.
Finally, near the end of the day, Blake 6, the transplant unit,
unexpectedly discharged a patient who required a single room.
Gottbrecht immediately snapped it up for the lung transplant patient
waiting at the Brigham. "Today was a good day," she said.
A month earlier, the day Manley waited, most of the transfer requests
were from patients without a Mass. General connection or a life-or-
death issue. They did not get in, including a woman on "comfort
measures only" at a community hospital. "There is no real point in
bringing her here," Gottbrecht said quietly.
The packed ER was her focus that day. Aside from the triage nurses,
Mass. General has taken other steps to ease the ER backlog. The
hospital opened an observation unit to monitor ER patients who are not
expected to need hospital care longer than 24 hours. Gottbrecht,
Orcutt, and others helped develop the computer system, called CBeds,
that tracks beds in the huge hospital, so the triage nurses and
admitting staff can see vacancies quickly - and so ER staff know as
soon as patients' beds are ready.
These changes, the denial of transfers that day, and the urgent page
from Orcutt, eventually freed a bed for Manley.
The wait ends
At 11:26 a.m., on a computer at the nurses station outside Manley's
cubicle in the ER, the small red square labeled Bay 28 suddenly turned
yellow.
Soon her husband, Morgan Stebbins, bounded into the room. "You got a
bed!" he said.
Perhaps as a cosmic reward for her wait, Manley hit the jackpot of
rooms - a single on the mahogany-appointed floor known as Phillips
House that overlooks the Charles River. But the wheels can turn slowly
at a large hospital. By the time Manley's room was cleaned and ER
staff had time to discharge her, it was 3:02 p.m. Then an orderly
wheeled her stretcher into the elevator. A lime green plastic bag
stuffed with her clothes rested at her feet.
Manley just wanted to close her eyes.
"I was exhausted, physically and emotionally," she said later.
A long road lay ahead for Manley - she would be in and out of Mass.
General over the next three weeks and finally undergo surgery for a
blood clot in her intestine, which is what caused her pain and nausea.
After meeting her new nurse, she fell asleep in the quiet room - 17
hours after she arrived in the ER.
Liz Kowalczyk can be reached at kowalczyk@xxxxxxxxxx
.
- References:
- Your socialized health care horror story of the day
- From: SETI2001
- Your socialized health care horror story of the day
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