ED Volume: Loud

Holy cow, has our volume picked up! And from colleagues it’s not just here, it’s throughout the ED’s of North Texas. Less than 3 years ago my ED occasionally held admitted patients. This morning, we were holding 27, and that’s nowhere near the high for the last several weeks.

We have theories, but no facts, as to why this is occurring, and there’s no end in sight (we’re looking). One of my favorite quotes has to do with personnel management: “You ride your best horses to death”; in this instance, our staff are all thoroughbreads, and they’re tired. Troopers, but tired.

Tangentially, this has made me have some uncharitable thoughts: who were the genuises in the mid to late 80’s I kept reading about who had meetings and decided we had way too much hospital capacity, too many beds, and we needed to close them to avoid disaster. I’d like to have them carry urine samples in my ED, all day long. It’s a fitting punishment.

And, again, we lack any prolonged surge capacity. We’re running full, at top speed, all the time. We could handle something like a plane crash, but an epidemic (natural or manmade) would be nearly impossible to manage.

Where are the pointy haired fortune tellers who set us up? Send them to me, I have something for them to carry.


  1. Allen, its the same stuff here in the midwest. Our ER has been holding large # of admitted pts as well AND to make things worse, administration is trying to muscle us into accepting a policy that says that ER docs should accept all transfers and then contact the appropriate specialist once the pt arrives in the ED-so far we have resisted….

  2. How much of your volume is really emergency, and how much is a naive (or something) population using the ER as a general practioner? Why aren’t there more, well, triage nurses in the community, sending say little Suzie home with her mother, with instructions on how to care for her mild GI infection, while getting Papa into the hospital pronto for his MI that he thought was the same GI problem? Why did we cut home education classes from the high school curriculum, which taught rudimentary practical nursing? Why do low SES workers, in order to get paid for sick days, have to have a note from a physician when they (corrrectly) stay home to nurse a cold?

    I could go on.

  3. Same in our ED. While the EMTALA rule is inherently needed, I would have hoped that uninsured sick people would be able to be cared for without that law. Now, because of the law, little Johnny/Suzie need to be seen by a physician even if all they need is a note from school, or just to get sent across the street to our open 7 days a week pediatric clinic. How I hate hearing “pediatric traige” overhead when I’m in the middle of caring for sick patients. Why can’t the kiddie cop stand in front and direct all sniffles under the age of 18 across the street???

  4. I have seriously considered a trip to the ER today, thinking about your post earlier about the guy with chest pains and “what would grunt doc say” …then remembering the over full ED’s … and … well … I decided that my chest pain was the pleurisy/chostro from lupus … when the fever and mouth sores started in about 3 hours later, I was so glad I’d not gone in … cause I’d be still sitting in the ER … friendly although they might be ;)