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• W4386585386 abstract "Figure: metrics, COVID, HIPAA, emergency medicine, emergency departments, dataFigureA lot of things have changed since the advent of COVID. I'm confident, for instance, that EMTALA has been violated over and over as hospitals have wrongly refused transfers or transferred patients for reasons they wouldn't have before. HIPAA is a joke. Despite our two-factor identification and secure log-in procedures, we still put multiple patients in the hallway near one another or in shared rooms, and we ask questions about private matters behind only curtains (or less). That brings me to metrics. How are your metrics these days? Are your triage times meeting your hospital's standards? Are ECGs being done in a timely manner on all chest pain patients? How about that door-to-doc time? What about those antibiotic times in sepsis? Are vital signs rechecked appropriately? Is pain medicine given in a timely way? Are your CT scans performed on stroke alerts as fast as you like and are they read with appropriate urgency? How long until admitted patients get beds? I've been working through this mess like most of you, and I'm going to go out on a limb here to say that metrics are dead. Or maybe they're just hibernating. No Room at the Inn I understand why metrics are tracked. I'm not suggesting they aren't useful. We have to measure ourselves to see how we can do better. We know that our patients will benefit greatly from our timely actions. Whether we're managing MI, stroke, or sepsis, there are good reasons for us to be more efficient (although many of those reasons have to do more with coding and billing than anything). But these are truly unprecedented times. I'm writing this in December, so it seems appropriate to say there is no room at the inn. Our hospitals are full, as are our emergency departments. Our nurses are overworked, and our nursing needs are unfilled. Our specialists are overwhelmed and often nowhere to be found outside of major centers. (For a while, I thought that aliens had abducted all of the urologists.) Our ambulances aren't available, and our paramedics are exhausted. Yet our patients are incredibly sick. From standard COPD and pneumonia to RSV (young and old), from residual COVID to early influenza (which rudely arrived far too early and was apparently drunk), from fentanyl to methamphetamine, our patients are having a rough go of it. Consequently, so are we. The problem for all of those tacking metrics is that they can't be measured in some vacuum. I recall being told during COVID that we shouldn't make ambulances stage outside the ED because we should always find a bed. The problem was that there simply weren't any beds. Unless lying on the floor or constructing a makeshift hammock counted, there was no place that waiting patients could lie down. The response, of course, was “just try to find a bed.” Maybe the problem we're facing is that we in modern countries have labored for years under the assumption that there would always be enough of everything. Mind you, those of us at the bedside knew this wasn't true as we struggled to arrange admissions or transfers in the years leading up to COVID. It became all too real when COVID struck. And it didn't just make our job harder, it made things dangerous. And frequently deadly. Suddenly, there weren't enough masks, ventilators, or people to wear masks or manage ventilators. Scarcity reared its ugly head as it had for all of human history. We just thought it would never happen to us. Our modern hubris led us to believe we could always order stuff (or people) at the last minute to avoid investing in preparation. Overwhelmed and Underpaid Now, because we lack so many things, the metrics treasured by our systems just aren't realistic. At least not right now. It's hard to treat a patient effectively in a chair in triage and nearly impossible to do anything when there is not enough staff or stuff. It's difficult to have the CT interpreted when the radiologist is two hours behind due to volume. It's tough to get that MI patient into a cath lab when there's no cardiologist on site, the weather is bad, and there isn't an ambulance to take him elsewhere. Starting antibiotics or fluids on a sepsis patient is important, but when that nurse also has three or seven or 10 sick patients who are holding for inpatient beds (in addition to facing the endless line of new patients), she may not get to it in time. Ditto for pain medication or for overwhelmed and underpaid techs to get bedding changed, meals to the bedside, or that urine sample down to the lab. I can only move so fast when I'm seeing new ambulance patients, rechecking existing sick patients, waiting on the hospitalist to call me back, and trying to chart it all so that it can be coded appropriately. It could be that metrics are on life support not only because we don't have enough people or things, but more importantly, because try as we might, we can't slow down time or create more of it to insert into the day. It's fine to track the data. It's fine to send out those little reminders of where we fail. But maybe those who do can show a little humor and recognize, honestly, that most of it is academic for the foreseeable future. For now, we're just trying to stay afloat emotionally and trying to come to work and avoid clean kills. Measure those metrics! Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected]. Dr. Leappractices emergency medicine in rural South Carolina, and is the author of the column, Life and Limb (https://edwinleap.substack.com) and a blog (http://edwinleap.com). Follow him on Twitter@edwin_leap, and read his past EMN columns athttp://bit.ly/EMN-Emergistan." @default.
• W4386585386 created "2023-09-11" @default.
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• W4386585386 date "2023-02-01" @default.
• W4386585386 modified "2023-09-29" @default.
• W4386585386 title "Life in Emergistan" @default.
• W4386585386 doi "https://doi.org/10.1097/01.eem.0000920052.16303.8f" @default.
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