Thursday, May 7, 2015

Another trip to the the ER with plenty of time for thoughtful reflection

Another day in the Emergency Room with Danny. Ho hum. What are you gonna do?

Three days ago, Danny threw up what appeared to be blood, so off he went to the Emergency Room at our local world-famous medical facility. When you need expert medical advice and specialized care, it is a fabulous institution. And it is an “institution” in the best and worst sense that the word is commonly understood. But the ER on a Monday afternoon can be a horror show.

Danny arrived at the ER with a staff person from the group home. I got there a couple of hours later and the place was jam-packed. There were sick people everywhere and ambulances pulled up every ten minutes or so with patients who had priority over the people who arrived there on their own. We waited and waited, but there was very little progress for people waiting to be seen by a doctor. The only thing that was happening was that a lot of people were called in to have their blood drawn and then were disgorged back again into the waiting room.

After I had been there for an hour or so, a man sitting in the crowd keeled over. He was having a terrible time breathing and he threw up on the floor. By this time the waiting room had become a small community of groaners, complainers, and the worried well. When the man hit the floor we were admonished by another ill and miserable person to pray for the man on the floor. I prayed that he would be removed as quickly as possible and given some help with his breathing. The ER team swooped in with a stretcher to take him into the inner sanctum.  

As the hours went by, someone saw the man who keeled over walk by in the hallway. As someone announced to the group that the man was OK, we heaved a collective sigh of relief.

At one point, about six people decided they would rather die at home than in the ER; they rose as one and left. Our small community had shrunk but we were now, on average, sicker and more pathetic than before. Danny suddenly had a desperate need to have his brief changed, so we were allowed to come into the inner chambers to occupy the smallest space possible to get him taken care of. An older woman who had waited about 9 hours was finally wheeled in to see a doctor. She waved to the crowd. We waved back and wished her well. At about 10 pm Danny officially entered into the care of the ER where he would remain until 7 the next morning when a hospital room was finally available for him to be admitted. 

There is much to be said about his hospitalization, but for now, it is enough to say that Danny will be OK and will soon go back to his group home.

A Crowded ER - Not Just a Local Problem

Sitting around in the hospital room, I discovered that the problem of overcrowded emergency rooms was not confined to my own sprawling medical facility. In an editorial in the New York Times for 5/6/15, Ezekiel J. Emanuel wrote on the subject, “How to Solve the E.R. Problem”.

He explains that one of the selling points of health care reform (Obamacare) was that by expanding insurance coverage, the unnecessary use of emergency rooms would decrease as preventive care became more available. It turns out that increasing insurance coverage alone was not sufficient to reduce the overuse of emergency rooms. In fact, the opposite has been true: major surveys have shown substantial increases in ER use, probably because newly insured people no longer have a co-pay for ER use.

Emanuel finds hope, however, in a Seattle partnership:  “…Group Health Cooperative of Puget Sound, a nonprofit that provides health care and insurance, and SEIU Healthcare NW Health Benefits Trust, which delivers health benefits to thousands of home health care workers, have reduced emergency room use among a subset of the trust’s membership by 27 percent over four years.”

The partnership's approach is this: “First, it offers a $100 cash incentive if workers complete four steps. The steps evolve each year but have included signing up for MyGroupHealth, an online platform where workers can email doctors, order prescriptions, and access health information and self-help resources; completing a 'health risk assessment,' a tool commonly used in corporate wellness programs; and completing preventive primary care and dental appointments.” Then it raised the co-pay for an ER visit to $200, a strong disincentive to use the ER if you have an alternative.

If you read the article, look at the comments, also. They provide an interesting critique of Emanuel's editorial.

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