Hacker News Reader

Comment by hundreddaysoff | Hacker News Reader

Some hospitals do this and it works OK. But patients often believe that they should go to the ER rather than the urgent care part in this situation "just to make sure" or due to other myths. Also, during the day both our main ER and our urgent care are totally saturated at my hospital system.

"Well then your silly system just needs to build more facilities! It's obvious!!" You say.

One thing people need to realize is that it is not necessarily in hospital admins' best interest for all the ER patients to be seen. If it was, they would spend more money on more efficient triage systems so that we could just rake in the bucks. But, in reality they would often lose money on such a gamble in my understanding, due to how patients of different coding levels are reimbursed by payors (and whether a patient is even likely to have a payor).

View on HN

It is interesting to me that a system that had good social housing and guaranteed healthcare would not be affected by this specific problem, and would most likely (looking at places where this is true, like Austria) be cheaper than what we are currently doing.

If you add a level of mandatory screening you can filter out ER to Urgent Care. The problem is still the connotation that ER is for everyone. Just put up posters in the ER lobby that make people uncomfortable things that say ER is for like car accidents. No one wants a reminder, but no one wants to be that asshole cutting in front of the guy who got a broken clavicle from a seatbelt or other various injuries.

This has been suggested many, many times in my career. The problem in the US is that such posters would violate[0] a federal law called EMTALA, which prohibits an ER from turning away any patient for any reason until I or another provider has performed a Medical Screening Exam (MSE) to assess for A Real Emergency (TM).

EMTALA and confusion around it is another common reason why patients often stay in the waiting room for many hours when really it would be in their best interest to go home and go to a clinic during the daytime. It is the main reason I try to ~break all the soft rules at night and just go out into the waiting room and MSE anything that moves so I can send it home.

EMTALA was passed in the 1980s under Reagan I believe. Good luck repealing it or revising it to make sense in our current political environment!

[0] Or appear to violate the law in the optics of some administrator, insurer, healthcare bureaucracy maintenance organization visitor, etc. In this way, in large bureaucracies, magical thinking reigns, optics becomes objectivity, and 2 + 2 = 5 .

It isn't about turning a person away, it is about enqueuing them into another emergency type care, urgent care is still a high priority but it is urgent and not deathly required.

This would allow prioritization of people needing immediate care.

I happen to agree with you. I was writing not my opinion, but my experiences with the actual EMTALA law, or more accurately and importantly my healthcare administrators' perception of said law. I cannot change either of these things.

>but no one wants to be that asshole cutting in front of the guy who got a broken clavicle

Hang around an ER and I think you'll see this isn't remotely true.

>mandatory screening you can filter out

This would be great but is unfortunately illegal.

Illegal if you don't have an urgent care facility attached.

> it is not necessarily in hospital admins' best interest for all the ER patients to be seen

It's still a systemic problem, where admins' interests are not aligned with the health and experiences of patients.

No doubt.

I think that admins' interests not aligning with that of patients/consumers or with those of professionals/practitioners is making millions of people sad in a lot of other fields in addition to medicine.

Ben Hunt has written some great essays about this nebulous concept. His phrases "industrially necessary" and "raccoon" come to mind.

Is there a general solution? Dunno. But I suspect crafting even more regulation would be kinda like trying to make Wikipedia better by firing all the content experts and making all the admin-type people write all the words. It wouldn't result in a very good end product.

I seem do my best work when I am left to my own devices and my contact with admin is minimal.

I don't know much about it, but if hear one more person talk about how hopeless problem X is ... . It's a contagion.

Reply on news.ycombinator.com