Patient Advocacy | Health Commentary

Leaving the Emergency Room

Mon, 14 Jul 2008 18:40:37 -0400

It's great to be discharged, but be sure to follow instructions!

Have you ever been a patient in an emergency department? If your visit to the ED didn’t require an admission, that’s good news. After being told by the ED doctor that you could go home and armed you with discharge instructions, you most likely want to high tail it out of there as fast as you can.

Wait! Not so fast. It’s really vital that you do not leave the ED until you are absolutely clear about the discharge instructions. Understanding and following discharge instructions is critical for your well-being. The bad news is that complications can arise if you do not understand your diagnosis and discharge instructions.

According to the American College of Emergency Physicians (ACEP), it was reported in a recent study that 78% of patients do not fully understand discharge instructions they receive in the emergency department, and sadly the majority of patients do not understand what the doctors told them.

Emergency departments are chaotic and can be frightening and overwhelming. In the very fast paced and frenzied ED environment understanding information can be difficult. The communication process can be impeded in a setting that often seems confusing and unruly.

As a registered nurse who has been on both sides of the ED, as an administrative head nurse and as a family member, here are some simple tips:

1. Always speak up and ask questions. If you do not understand anything that is being told to you by your doctor or nurse, let them know! By speaking up and asking questions, you’ll know what to expect when you leave the ED. Don’t ever feel intimidated to ask questions.
2. When the discharge instructions are handed to you, make sure you review your instructions with your doctor or nurse. Go over each and every step. Repeat back the information.
3. If you need to write down information that will help you decipher what the doctor or nurse tells you, than do so.
4. If you are given prescriptions for medications, make sure you understand what you will be taking. Be clear about how to take your prescription, when to take it, the dosage, and any side effects. Also ask if it will interfere with any other medications that you may be taking.
5. If possible, it’s always a good idea to have a family member or trusted friend with you since they may be able to comprehend and understand instructions more clearly. As a patient, you may still be feeling overwhelmed by the whole ED process. Having someone with you can help ease the overpowering environment.
6. Be patient. Even though you are eager to go home and you want to be discharged as quickly as possible, please be aware that you are in an ED and your doctor or nurse may suddenly need to see an incoming, critically ill patient.
7. Despite the crazed atmosphere of the ED, the professional staff of doctors and nurses are concerned for your well-being and they are there to provide the best quality care for you.
8. If you do not feel your needs are met, you can always ask to speak to the nurse manager or during evenings, nights, weekends and holidays (depending on the hospital) you can ask to speak to an administrative head nurse or nursing supervisor.
9. Staffing issues and overcrowding are always concerns in an ED, but your care is very important. Remember to always take charge of your health and speak up and ask questions.
10. It’s important for you to speak up, and not only about your health, but the nation’s health. Emergency departments across the nation are in dire straits and they need you to speak up for them so you’ll be able to continue to receive the care you deserve. ACEP makes it easy for you to make your voice heard. Take action now!

If you find yourself in need of emergency treatment and you head to the nearest ER, remember these tips and don’t for to take “action now.”

(Barbara Ficarra is a registered nurse, executive producer & host of a Health in 30® a live radio show, founder of Healthin30.com and award-winning journalist. Barbara can be reached at B.Ficarra@Healthin30.com.)

Nurses and Doctors Together for the Good of the Patients

Tue, 03 Jun 2008 18:51:12 -0400

It's a very good thing...

What were the biggest challenges you faced as a patient in the hospital? If you could change anything about your hospital experience what would it be? Were there enough nurses and doctors on staff to care for you especially at night and on weekends? Was there a team effort between nurses and doctors?

Did you know that medical mistakes do happen in hospitals?

Medical mistakes unfortunately do happen in hospitals and shockingly, 238,337 patients died from potentially preventable medical errors during 2004 through 2006, according to HealthGrades' fifth annual Patient Safety in American Hospitals Study.

Hospitals have an increase in the number of errors on nights and weekends, and hospitals are fully aware of the existing problems. Are hospitals putting the lives of patients at risk if they knowingly are aware that these problems exist and they do not attempt to correct these conditions? Fortunately, hospitals have gotten the message that action is needed to keep patients safe and (alive).

In a recent article in The Wall Street Journal titled “Hospitals Move To Reduce Risk Of Night Shift” by Laura Landro, the focus is on hiring “nocturnists” to help relieve this crisis of substandard care on weekends and nights. However I find this a bit disconcerting since this article paints a picture of hospitals that function typically with doctors and the solution to this crisis is additional nocturnists. What about the nurses?

Anyone who has listened to me on the Health in 30™ radio show knows hospitals cannot exist with only doctors or only nurses, but instead it is a team effort of both doctors and nurses working together for the good of the patients.

Ronald M. Davis, MD, writes about the importance of the team approach, and credits nurses for their outstanding care.

According to Laura Landro: “Of course, with rising medical costs and a shortage of nurses and doctors, hospital will never be a fully staffed on nights and weekends as they are during weekdays.” She is right on target with that statement. Then she writes, “Indeed, hospitals do quiet down at night, when patients sleep, support staff go home and a skeleton crew mans many units. But that’s also the time when dangerous delays in care can occur for patients.” Let’s stop here for a moment. During my nursing career I’ve rotated to the night shift many times and I can see how the assumption can be made that since it is night, patients sleep and it is quiet. Let me emphasize that this is simply not the situation. It is not quiet and for the most part patients do not sleep, and even if patients are sleeping that doesn’t mean they are not cared for; assessments and treatments continue regardless of this. It is true that support staff goes home and there are skeleton crews; and with the shortage of both doctors and nurses mistakes can happen.

Both doctors are nurses are needed in hospitals. Nurses are responsible for the well-being of their patients around-the-clock, and just because it is night doesn’t mean continuous care stops. Nurses are committed to provide quality patient care. Nurses assess, plan, implement and evaluate their patients. They continuously observe patients and teach patients, nurses consult with doctors and other members of the health care team, and not only do they provide physical care, they are a pillar in providing emotional care. The constant eyes of nurses are needed to keep patients safe on a 24/7 basis. With the current nursing shortage perhaps this article could have delved into this area a little more rather than focusing solely on nocturnists as the solution.

The idea of hiring nocturnists makes sense, but the major piece to this maze of chaos is to focus on nurses as well. Even if hospitals get up to par with hiring enough nocturnists, with the shortage of nurses, who’s going to be there to provide care to these patients? Who’s going to question and carry out orders, provide treatments and offer support? Who’s going to man the units? Are hospitals failing?

A shattered system has hope of renewal and vitality. Patients’ safety does not need to be compromised. A culture of denial cannot be prevalent; if a system is failing, it needs to be fixed. It is unacceptable to endanger the lives of patients. There is a system in need of more staff; both physicians and nurses, now it is a matter for the folks in charge to make this happen.

Readers, what has your experience been like? Have you been a patient in a hospital or the family member of a loved one? Do you feel your treatment and care can be carried out solely by physicians? Do you feel a team effort is needed to provide you with the best care and treatment? Describe your experiences. Were your needs met right away? How would you describe the physicians who cared for you? How would you describe the nurses who cared for you? Are you always proactive in your health care? Do you speak up and ask questions if you do not understand something? Do you feel intimidated to ask questions?

(Barbara Ficarra is a registered nurse, executive producer & host of a Health in 30™ a live radio show, founder of Healthin30.com and award-winning journalist. Barbara can be reached at B.Ficarra@Healthin30.com.)

Celebrating Our 25th

Wed, 26 Mar 2008 16:58:49 -0500

Wilderness Medical Society 25th Anniversary and Annual Meeting to be held in Snowmass, Colorado

It is a great pleasure to announce the 25th Anniversary and Annual Meeting of the Wilderness Medical Society (WMS). It's hard to believe that it has been 25 years since I collaborated with Ed Geehr, MD and Ken Kizer, MD to create the WMS. "Combining Your Profession With Your Passion" has been the theme since the beginning, and the meeting this summer is no exception. You can register and learn more about the meeting at the WMS website, specifically at the link to the meeting.

The meeting will be held in Snowmass, Colorado, and will feature up to 49.5 Continuing Medical Education (CME) and 46.25 Fellowship of the Academy of Wilderness Medicine (FAWM) credit hours for participants, including lectures, skills instruction, 49 different workshops, special evening presentations, and a WMS 25th anniversary gala celebration. The Wilderness Medicine Skills Practicum will be presented by the Wilderness Medicine Institute (WMI) of the National Outdoor Leadership School (NOLS), and Military Medicine Lessons: Applications in a Wilderness Environment will be another, additional special pre-conference session.

The evening events are outstanding, and include "The Arctic National Wildlife Refuge," featuring National Geographic Society grantee Jonathan Waterman; "What's Your Everest? - Combining Your Profession with Your Passion," featuring Dr. Luanne Freer; "Public and Global Health Issues in 2008: A Surgeon General's Perspective," featuring Richard H. Carmona, M.D., the 17th Surgeon General of the United States; and the WMS 25th Anniversary Celebration, with reception, silent auction, dinner and awards, and the first-ever "Wilderness Ball."

The faculty for the meeting is a "who's who" of wilderness medicine, including Howard Backer, Brad Bennett, Jolie Bookspan, Michael Callahan,Tom DeLoughery, Lance Ferguson, Peter Hackett, Gordon Giesbrecht, Colin Grissom, Eric Johnson, Lee Kaplan, Peter Kummerfeldt, Jay Lemery, Mel Otten, Phil Rasori, Brownie Schoene, Joe Serra, Chris Van Tilburg, and many others.

Please make plans to join us as we celebrate the 25th anniversary of the WMS with one of the year's outstanding meetings. I look forward to seeing many of you in Snowmass.

(Paul Auerbach, MD, is a clinical professor of surgery in the Division of Emergency Medicine at Stanford University and chief medical officer for Healthline Networks. He can be reached at PSAuerbach@aol.com. Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)