I was squawking about this before COViD. For years the regional hospitals would send representatives out to the smaller rural hospitals saying “send us your more challenging patients “. As small rural hospitals could not keep up with updating equipment and services due to their lack of funds, they closed more services and became “critical access hospitals “, which I have heard referred to as “pack and ships”. Now our system is in dire straits because there (as predicted 35 years ago) are not enough resources, and here we are...
Absolutely. And it's a daily disaster out in those hospitals. In once place I work the hospitalists cap out and then won't even help manage them in the ED (I get it, they're busy too.) But then we're managing things outside our expertise. It's getting really scary. And I remember the same. 'Join our organization and we'll take all of your surgeries, OB, cardiac, etc.' Not now.
It is scary. What was scarier for me in the transfer center was receiving calls from midlevel providers who were really out of their practice level. Some PA’s could intubate, but had no in house ventilators; other practitioners were desperate to get folks out before they crashed. I spent many days going to the house manager and administrators begging for permission to at least do an ER to ER; we had vents and RT’s if we didn’t have beds...Other days I would have to say “I’m sorry, we really will not have immediate availability to meet your needs.” Especially when my main ER already had 60 patients...
I was squawking about this before COViD. For years the regional hospitals would send representatives out to the smaller rural hospitals saying “send us your more challenging patients “. As small rural hospitals could not keep up with updating equipment and services due to their lack of funds, they closed more services and became “critical access hospitals “, which I have heard referred to as “pack and ships”. Now our system is in dire straits because there (as predicted 35 years ago) are not enough resources, and here we are...
Absolutely. And it's a daily disaster out in those hospitals. In once place I work the hospitalists cap out and then won't even help manage them in the ED (I get it, they're busy too.) But then we're managing things outside our expertise. It's getting really scary. And I remember the same. 'Join our organization and we'll take all of your surgeries, OB, cardiac, etc.' Not now.
It is scary. What was scarier for me in the transfer center was receiving calls from midlevel providers who were really out of their practice level. Some PA’s could intubate, but had no in house ventilators; other practitioners were desperate to get folks out before they crashed. I spent many days going to the house manager and administrators begging for permission to at least do an ER to ER; we had vents and RT’s if we didn’t have beds...Other days I would have to say “I’m sorry, we really will not have immediate availability to meet your needs.” Especially when my main ER already had 60 patients...
Ed Leap for Surgeon General!
Here’s a good illustration: https://youtu.be/sXsIJ2rPVvE