Medical Errors Report #25
A Four-Year Solution Implementation Study
Most Emergency
Rooms Across the Nation Need Redesign
Emergency rooms across the nation remain very dangerous places for patients because of misdiagnoses and misadventures by physicians and nursing staff. The big push to get patients out of the emergency room and to increase revenue, have led to clinical indications being missed, causing tragic results. Emergency rooms also continue to be money wasters because of elaborate procedures done by physicians who do not have a clue about the patients’ disease process or the tests and procedures needed. Emergency rooms order many elaborate tests that cost a lot of money and have nothing to do with the clinical outlook of the patient. In some emergency rooms, nurses and techs, not physicians, have been known to order tests and procedures at their own discretion.
All hospital laboratories, with the help of pathologists must design a list of STAT tests and clearly to identify routine list of tests offered by each hospital laboratory. Hospitals are losing a great deal of money from many non-STAT tests ordered by physicians as STAT at odd hours of the day with inadequate staff coverage. Part of quality improvement is to design tests to be ordered primarily for a patient’s treatment at a particular hour of the day depending on the staffing. Only commercial labs are able to keep full staff to run the testing operation 24-hours a day. Hospital laboratories and perhaps other departments, must be careful to design staffing to satisfy the needs of the patients during the busiest hours. A hospital lab paralyzed with routine work at odd hours is unable to quickly meet the needs of the hospital during critical emergencies. Take the case of a blood bank tech on the evening shift working alone on six crossmatches for the next day’s surgeries when an emergency bleeder arrived at the emergency room. Although the emergency room did not declare to the blood bank tech that the patient was critical, the slow response by the blood bank tech was associated with paralysis from routine work. By the time the patient finally received the blood, his heart had stopped a couple of time, sustaining irreversible brain damage. Therefore, when a hospital lab is overloaded with routine work at odd hours of the day, it diminishes the department’s capacity to respond with optimum speed to emergency situations.