Healthcare Rationing – Hype Or Reality?
Healthcare rationing might not just be media hype. A recent news headline reported that Florida hospitals may turn away those patients with end-stage illnesses and poor prognoses – if a severe pandemic develops. Hospitals may be forced to turn away those patients who have been designated as "DNR" or "Do Not Resuscitate." Doctors will have to turn off life-supporting ventilators on those patients who have little chance of surviving in order to use the limited resources on younger patients who have a better chance.
Hospital overcrowding is not a potential issue … it is a real issue – today – especially in our emergency departments (ED's). If the Swine Flu has even a moderate impact on our ED's, the consequences could be devastating – even to those not infected by the virus. Because of increasing visits and decreasing numbers of inpatient hospital beds, there is often no place for patients who need to be admitted to go. They are referred to as "boarders" – patients who need to be admitted to the hospital but remain in the ED waiting for a bed to open up-sometimes causing massive back-ups.
The hazards of boarding patients in the ED have been recognized for many years but little has been done to solve the problem. Most of the proposed solutions are little more than a band-aid on a severely bleeding system. Although most physicians, nurses, and hospital administrators find this to be an unacceptable patient safety issue, those of us in the trenches of this war can only deal with it one patient at a time.
If you find yourself or your loved one in the situation of being "boarded" in the emergency department, it is crucial to stay informed. This is a time when a family member or friend should stay with their loved one. Find out when a bed is expected to be available. This can often be difficult to estimate because discharges of inpatients are unpredictable. If it is expected to be longer than a few hours, ask about the possibility of a transfer to another facility. This may not be an option, especially in areas where overcrowding is widespread.
Patients who are critically ill, unstable, or require admission to an intensive care unit because of a potentially serious condition should be admitted to that unit immediately. These patients should never be boarded in the ED and should be moved to the ICU within a few hours. In some cases it is just a matter of quickly moving a stable patient out of the ICU bed and cleaning it, but this can take a couple of hours.
Overcrowding is an area in which the healthcare system is broken, and it frustrates and enrages the doctors and nurses as much as it does the patients and their families. We want you to get the best and fastest care possible, but we are functioning at and sometimes beyond our capacity as human beings. Speak up for yourself and help us to help you! But also understand that there are limitations inherent in the system and we have to do the best we can with the resources that are available.
Hopefully we will not be forced to make difficult decisions.