Comments on: Banning Bypass: Good Policy or Tempting Fate?

By: MysteryMedic

MysteryMedic — Fri, 18 Dec 2009 02:43:22 +0000

To be clear though, bypass (or divert in my area), is a favor, NOT a requirement. You are only asking the 911 system to ask patient to go to another hospital. Not taking a patient requesting to go to a hospital that the ambulance would normally take a patient to because it’s on bypass is illegal. You cannot say to a patient a hospital is closed. You can bar entrance to the entire ER including walk-ins under rare circumstances but that has to be justified, usually because of an unsafe environment, and then our dispatch would alert us prior to a call if we didn’t know already. You can explain to the patient the hospital is asking them to go to another hospital because of low resources and may not be in their best interest but if they still want to go, then they have that right. As long as people can still walk in then you still have to accept that ambulance. I have had doctors on the command phone with the patient trying to talk them out as well and a few times it works because I know it’s in the best interest for the patient to take them somewhere else, but there were a few that refused and I told the patient they may be on my uncomfortable stretcher for a long time or may being going to a very packed waiting room. The really sick, the MI’s, strokes, severe burns, and trauma activations don’t really matter especially with a decreased LOC. They don’t care and it’s easy to convince a family if they need a specialty center and I have several of each type around. The hard patient is the 80 Y/O F who has been going to the same hospital for 20 years and is in minor/moderate distress with indeterminate chest pain. No one is convincing her and sometimes you have to pick your battles, even if you roll you eyes and ignore me I don’t want to be there anymore then you do but I tried. So please try to find me a stretcher so I can get back out to work. There may be a real emergency I need to get to.

By: Randy

Randy — Wed, 16 Dec 2009 20:06:05 +0000

Simple economics holds true in healthcare and anything else.

You can’t on one hand expect more of a product (healthcare/inpatient/ED beds) while at the same time insist on paying less for it. Like throckmorton says, fix the economics and the rest will fall into place.

By: throckmorton

throckmorton — Wed, 16 Dec 2009 13:29:06 +0000

One of the economic realities of hospital medicine is that for most hospitals to remain solvent, they need about an 87% occupancy rate. As reimbursement falls, they need to maintain an even higher rate. As a result, the number of beds available in the hospital is not sufficient to accomidate a rapid flux. The number of beds that a hospital can fill is regulated by law. Also because of econimics, we have hosital staffing based on that occupancy rate, and that staffing is stretched to the gills, so there just isnt enough staff. So what do we do when we are all filled?

Out our center, we occaisionally have to go on trauma divert. This is usually simple to figure out because we have every OR and ICU bed in use. These diverts do not last long, but do occur.

As we lose more and more hospitals and as hospitals constrict their number of beds we will see more and more of this. Step one fix the economics.

By: Katherine

Katherine — Wed, 16 Dec 2009 00:53:37 +0000

Exactly. Last time I went to the hospital late at night I just needed some stronger pain killers for a bad ear infection, and where can you get those except at the hospital at 1am?

By: RSDS

RSDS — Tue, 15 Dec 2009 22:29:51 +0000

In my large rural county, there is one, and only one, small, hospital. Therefore, going on bypass is something that just can not happen in the first place. A divert of over 100 miles, just is not practicle.

By: Marilyn

Marilyn — Tue, 15 Dec 2009 19:54:21 +0000

24/7 Urgicenter/Walk-in Clinic across the street from the Hospital ED would seem a better solution

I think a 24-hour Urgent/Immediate Care facility in close proximity to the hospital is a very good idea.

I’ve had to make to runs to the ER (yes, that’s what MY hospital calls their department ) this past year. Not because of a life-threatening emergency, but because of an urgent need when our Urgent Care was closed (they close at 6:00 PM on Sundays!)

Couldn’t wait the 14 hours for Immediate Care to open…one was a laceration that might have destroyed a pianist’s ability to play (possible tendon damage), the other a deep-puncture cat bite. We were apologizing all over the place to the lovely emergency personnel; they graciously said that even though it seemed insignificant emergency attention very likely prevented serious infection in the cat bite.

I vote for better Urgent Care accessibility.

By: Doc99

Doc99 — Tue, 15 Dec 2009 19:06:02 +0000

24/7 Urgicenter/Walk-in Clinic across the street from the Hospital ED would seem a better solution.
I look forward to the statistics after a year.

By: Dafydd

Dafydd — Tue, 15 Dec 2009 18:06:04 +0000

In the OR, we at times will put the our hospital on surgical “divert”. (I assume that doesn’t stop non-surgical ambulance runs.) When we do it is because we have no more staff, either all of the surgeons are working or we have all call crews working. If a “door-crasher” comes in in those situations, they are going to die. So, no this is not a good idea.

By: Ryan

Ryan — Tue, 15 Dec 2009 17:36:48 +0000

As a hospitalist working in MA, I’m familiar with these rules, and my role to play in assisting the ED when pt volume become overwhelming.

The main idea behind preventing EDs from going on bypass is that these busy times aren’t isolated to one hospital. If you’re ED is flooded with patients, so is the ED in all of the other hospitals.

So, if you go on bypass, your patients (who have local doctors and lots of records in your hospital) get diverted to hospital X across town. Then, hospital X goes on bypass, and since you’ve come off bypass, their patients are sent to you.

Now both hospitals have had time on bypass and come off, have the same number of patients, but have the wrong patients. This fractures care and doesn’t really accomplish anything in the long run.

We all need to come up with systems that allow us to deal safely with patients at peak times, not just average times.