Thread by @RosenthalHealth

Healthcare rant of the week: My husband has recently spent 7 days (2 admissions) in a kind of new invention of US healthcare hell: the “emergency department overflow unit.” Help me solve the
mystery of how these places of purgatory came to be 1/9

They are for patients who came in through the ED, who need admission, but for whom there is no open inpatient bed. They are kind of part of the ED, many floors away. And kind of part of the admitting ward, also distant. But offer the care of neither. 2/9

(PS my husband’s oncologist, who is in the same hospital complex, sent him to the ED from the office because he needed admission. Advised us the best way to be seen expeditiously was to call an ambulance. Can’t wait for that bill. Not.) 3/9

I worked in the same ED as an attending a few decades back. There were waits for beds to open up for patients who needed admission. But it was hours not days. 4/9

What’s going on? Observation: the ER is now 4 or 5 times the size than when I worked there. But the number of true inpatient beds hasn’t increased proportionately. Hospitals can charge you for an inpatient room in the overflow unit. 5/9

Observation: hospitals endeavor to run at 100 percent capacity, like hotels. Better for profit but they should leave some beds vacant for an uptick in demand. They are overbooking like airlines. Patient can’t get a $500 coupon to take a later flight. 6/9

The overflow units were never meant for full inpatient care. No call buttons, understaffed, no individual TV. When I asked if a soiled sheet could be changed I was told I could do it. They are holding/parking units where docs (or more often PAs) pop in.7/9

It is very hard to get out because there are literally many dozens of patients in the spaces. All in waiting in healthcare limbo, as insurance is paying as if care was rendered. 8/9

Possible that regulators loosened restrictions on creating real beds during the early days of the Covid emergency when the surge of cases made it necessary? Made sense then, not now! You alternate theories/insights welcome? 🙏 9/9