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Are emergency departments really the most expensive place of all?
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Are emergency departments really the most expensive place of all?
Dear Editor. A r e e m e r g e n c y d e p a r t m e n t s really t h e b e s t p l a c e for p r i m a r y c a r e ? I w o u l d s a y "no." We h a v e s e e n a n i n c r e a s e in t h e u s e of e m e r g e n c y d e p a r t m e n t s for a v a r i e t y of r e a s o n s : lack of p r i m a r y care, "free lunch," "quick fix" mentality, a n d i n t e r f e r e n c e in m a r k e t factors. A m e r i c a c a n n o t afford to c o n t i n u e to s p e n d a d i s p r o p o r t i o n a t e a m o u n t on a c u t e c a r e at t h e exp e n s e of p r i m a r y care. 1 E m e r g e n c y d e p a r t m e n t s are n o t d e s i g n e d to m e e t t h e o b j e c t i v e s of p r i m a r y c a r e a n d Healthy People 2000.2 N o n u r g e n t c a r e visits in e m e r g e n c y d e p a r t m e n t s result in m i s s e d o p p o r t u n i t i e s for p r i m a r y care. E m e r g e n c y d e p a r t m e n t s are n o t s t r u c t u r e d for p r i m a r y care. No s i g n i f i c a n t financial i n c e n t i v e s to k e e p p e o p l e h e a l t h y exist. Staff are n o t t r a i n e d in t h e p r e v e n t i o n of d i s e a s e , m e d i c a l s c r e e n i n g , i m m u n i z a tions, a n d c o u n s e l i n g on d i s e a s e p r e v e n t i o n . T h e s e a s p e c t s of c a r e t a k e time, a n d n o n u r g e n t p a t i e n t s do n o t p r e s e n t only d u r i n g d o w n time. M a n y t i m e s m i n o r p r o b l e m s a r e s y m p t o m s of larger p r o b l e m s t h a t will n o t b e d e a l t w i t h in one visit. Liability a n d e p i s o d i c c a r e often result in e x p e n s i v e d i a g n o s t i c t e s t i n g a n d c o m m u n i c a t i o n issues. M o r e over, ED staff do n o t w a n t to s e e "frequent fliers." A s a society, w e n e e d to e n c o u r a g e c e n t e r s of exc e l l e n c e in e m e r g e n c y care. C o m m u n i t y r e s o u r c e s n e e d to b e p o o l e d to p r e v e n t d u p l i c a t e d services. E m e r g e n c y c a r e t a k e s s p e c i a l skills a n d talent, a n d c o m p e t e n c e in t h e s e skills t a k e s volume. We n e e d to k n o w t h e c o s t of this c a r e for g o o d financial d e c i s i o n s . A r e e m e r g e n c y d e p a r t m e n t s really t h e m o s t e x p e n s i v e p l a c e of all? For p r i m a r y c a r e / n o n u r g e n t care, "yes"; for e m e r g e n c y care, t h e y a r e t h e only p l a c e to go. A p e d i a t r i c i a n of 30 y e a r s o n c e a s k e d me, "Are e m e r g e n c y d e p a r t m e n t s really g o o d at a n y J Emerg Nuts 1998;24:116-9. Copyright © 1998 by the Emergency Nurses Association. 0099-1767/97 $5.00 + 0 18/64/89070
916 Volume 24, Number 2
thing?" I quickly r e s p o n d e d , " E m e r g e n c i e s ! " L e t ' s s t i c k to our original purpose.--Joy Zajac, RN, MSN,
Grapevine, Texas References 1. Hastings K. Health care reform: we need it, but do we have the national will to shape our future? Nurse Practitioner 1995;20:52-7. 2. Healthy People 2000 National Health Promotion and Disease Prevention Objectives. Washington: U.S. Government Printing Office; 1990. DHHS Pub No.: (PHS) 91-50213.
'~yson Squats" as a cause of rhabdomyolysis
Dear Editor." E x c e s s i v e p h y s i c a l a c t i v i t y is a w e l l - k n o w n c a u s e of r h a b d o m y o l y s i s . T h e v a r i a t i o n called "Tyson Squats" b y i n m a t e s at our local c o r r e c t i o n a l facility was a new etiology that we have experienced twice in r e c e n t m o n t h s a t our c o m m u n i t y h o s p i t a l (27,000 ED p a t i e n t visits p e r year). A c c o r d i n g to t h e r e g i s t e r e d n u r s e at our c o u n t y jail, "Tyson S q u a t s " a r e d o n e in r e s p o n s e to a chall e n g e from o n e p e r s o n or g r o u p to another. A d e c k of c a r d s is t h r o w n on t h e floor 8 to 10 t i m e s a n d t h e pers o n b e i n g d a r e d h a s to s q u a t to p i c k u p e a c h c a r d in a s r a p i d s u c c e s s i o n a s possible. A p p a r e n t l y t h e c a r d s s e r v e a s a m e a n s to a c c u r a t e l y c o u n t t h e n u m b e r of s q u a t s performed. P a t i e n t B.B. w a s a 19-year-old m a n w h o w a s told b y i n m a t e s h e " w a s n ' t m a n e n o u g h " to do t h e s q u a t s a n d so p r o c e e d e d to do 500 s q u a t s . W i t h i n 36 h o u r s h e w a s c o m p l a i n i n g of l e g pains, e s p e c i a l l y in t h e t h i g h s , for w h i c h h e r e c e i v e d a c e t a m i n o p h e n . W h e n h e v o i d e d "bloody urine" h e w a s b r o u g h t to our e m e r g e n c y d e p a r t m e n t . His b r i g h t o r a n g e jail uniform s e r v e d as a visual r e m i n d e r to t h i s RN of a n i n m a t e s e e n earlier this y e a r w i t h t h e s a m e p r e s e n t a t i o n . T h a t p a t i e n t w a s t r a n s f e r r e d to a level I t r a u m a c e n ter for e m e r g e n c y dialysis. W h e n B.B. w a s a s k e d a t t r i a g e if h e h a d b e e n d o i n g t h e s q u a t s h e a n s w e r e d affirmatively. H e w a s g i v e n a brief s y n o p s i s of t h e t y p e of d a m a g e t h a t
Are emergency departments really the most expensive place of all?
Dear Editor. A r e e m e r g e n c y d e p a r t m e n t s really t h e b e s t p l a c e for p r i m a r y c a r e ? I w o u l d s a y "no." We h a v e s e e n a n i n c r e a s e in t h e u s e of e m e r g e n c y d e p a r t m e n t s for a v a r i e t y of r e a s o n s : lack of p r i m a r y care, "free lunch," "quick fix" mentality, a n d i n t e r f e r e n c e in m a r k e t factors. A m e r i c a c a n n o t afford to c o n t i n u e to s p e n d a d i s p r o p o r t i o n a t e a m o u n t on a c u t e c a r e at t h e exp e n s e of p r i m a r y care. 1 E m e r g e n c y d e p a r t m e n t s are n o t d e s i g n e d to m e e t t h e o b j e c t i v e s of p r i m a r y c a r e a n d Healthy People 2000.2 N o n u r g e n t c a r e visits in e m e r g e n c y d e p a r t m e n t s result in m i s s e d o p p o r t u n i t i e s for p r i m a r y care. E m e r g e n c y d e p a r t m e n t s are n o t s t r u c t u r e d for p r i m a r y care. No s i g n i f i c a n t financial i n c e n t i v e s to k e e p p e o p l e h e a l t h y exist. Staff are n o t t r a i n e d in t h e p r e v e n t i o n of d i s e a s e , m e d i c a l s c r e e n i n g , i m m u n i z a tions, a n d c o u n s e l i n g on d i s e a s e p r e v e n t i o n . T h e s e a s p e c t s of c a r e t a k e time, a n d n o n u r g e n t p a t i e n t s do n o t p r e s e n t only d u r i n g d o w n time. M a n y t i m e s m i n o r p r o b l e m s a r e s y m p t o m s of larger p r o b l e m s t h a t will n o t b e d e a l t w i t h in one visit. Liability a n d e p i s o d i c c a r e often result in e x p e n s i v e d i a g n o s t i c t e s t i n g a n d c o m m u n i c a t i o n issues. M o r e over, ED staff do n o t w a n t to s e e "frequent fliers." A s a society, w e n e e d to e n c o u r a g e c e n t e r s of exc e l l e n c e in e m e r g e n c y care. C o m m u n i t y r e s o u r c e s n e e d to b e p o o l e d to p r e v e n t d u p l i c a t e d services. E m e r g e n c y c a r e t a k e s s p e c i a l skills a n d talent, a n d c o m p e t e n c e in t h e s e skills t a k e s volume. We n e e d to k n o w t h e c o s t of this c a r e for g o o d financial d e c i s i o n s . A r e e m e r g e n c y d e p a r t m e n t s really t h e m o s t e x p e n s i v e p l a c e of all? For p r i m a r y c a r e / n o n u r g e n t care, "yes"; for e m e r g e n c y care, t h e y a r e t h e only p l a c e to go. A p e d i a t r i c i a n of 30 y e a r s o n c e a s k e d me, "Are e m e r g e n c y d e p a r t m e n t s really g o o d at a n y J Emerg Nuts 1998;24:116-9. Copyright © 1998 by the Emergency Nurses Association. 0099-1767/97 $5.00 + 0 18/64/89070
916 Volume 24, Number 2
thing?" I quickly r e s p o n d e d , " E m e r g e n c i e s ! " L e t ' s s t i c k to our original purpose.--Joy Zajac, RN, MSN,
Grapevine, Texas References 1. Hastings K. Health care reform: we need it, but do we have the national will to shape our future? Nurse Practitioner 1995;20:52-7. 2. Healthy People 2000 National Health Promotion and Disease Prevention Objectives. Washington: U.S. Government Printing Office; 1990. DHHS Pub No.: (PHS) 91-50213.
'~yson Squats" as a cause of rhabdomyolysis
Dear Editor." E x c e s s i v e p h y s i c a l a c t i v i t y is a w e l l - k n o w n c a u s e of r h a b d o m y o l y s i s . T h e v a r i a t i o n called "Tyson Squats" b y i n m a t e s at our local c o r r e c t i o n a l facility was a new etiology that we have experienced twice in r e c e n t m o n t h s a t our c o m m u n i t y h o s p i t a l (27,000 ED p a t i e n t visits p e r year). A c c o r d i n g to t h e r e g i s t e r e d n u r s e at our c o u n t y jail, "Tyson S q u a t s " a r e d o n e in r e s p o n s e to a chall e n g e from o n e p e r s o n or g r o u p to another. A d e c k of c a r d s is t h r o w n on t h e floor 8 to 10 t i m e s a n d t h e pers o n b e i n g d a r e d h a s to s q u a t to p i c k u p e a c h c a r d in a s r a p i d s u c c e s s i o n a s possible. A p p a r e n t l y t h e c a r d s s e r v e a s a m e a n s to a c c u r a t e l y c o u n t t h e n u m b e r of s q u a t s performed. P a t i e n t B.B. w a s a 19-year-old m a n w h o w a s told b y i n m a t e s h e " w a s n ' t m a n e n o u g h " to do t h e s q u a t s a n d so p r o c e e d e d to do 500 s q u a t s . W i t h i n 36 h o u r s h e w a s c o m p l a i n i n g of l e g pains, e s p e c i a l l y in t h e t h i g h s , for w h i c h h e r e c e i v e d a c e t a m i n o p h e n . W h e n h e v o i d e d "bloody urine" h e w a s b r o u g h t to our e m e r g e n c y d e p a r t m e n t . His b r i g h t o r a n g e jail uniform s e r v e d as a visual r e m i n d e r to t h i s RN of a n i n m a t e s e e n earlier this y e a r w i t h t h e s a m e p r e s e n t a t i o n . T h a t p a t i e n t w a s t r a n s f e r r e d to a level I t r a u m a c e n ter for e m e r g e n c y dialysis. W h e n B.B. w a s a s k e d a t t r i a g e if h e h a d b e e n d o i n g t h e s q u a t s h e a n s w e r e d affirmatively. H e w a s g i v e n a brief s y n o p s i s of t h e t y p e of d a m a g e t h a t