ER: Real-Life Drama in a Hospital Emergency Department

Last week I spent half a day shadowing Dr. Al Sacchetti, an emergency room physician at Our Lady of Lourdes Medical Center in Camden. It was an experience of a lifetime.

When we started, the ER was pretty empty except for the 12 behavioral health patients that were awaiting placement in specialized psychiatric care. Some had been waiting for a couple of days, but there were no identified beds available within the state system of psychiatric care. This is a persistent problem in New Jersey's hospital emergency rooms, and it was sad and sobering to witness it firsthand. These patients waited, with a hospital staffer assigned oversight for every two patients. It was an incredible but necessary dedication of Lourdes' staff to ensure the patients' care and safety, yet a drain on the hospital. Some patients were waiting not hours but days until an appropriate care site opened up. These were patients in need of psychiatric care... fragile, waiting.

I next observed a stroke patient - a dapper gentleman who looked just like my grandfather, Frank "Dewey" Ryan. Dr. Sacchetti assessed him, ordered tests and asked for Neuro (that is, the Neurology department) to check the patient. As we wore out my sneakers running from one patient to another, Dr. Sacchetti (who all the ER team simply called "Al") bantered with nurses, techs, physician assistants, patients and their families. One employee named "Dibs," who sat at the desk and efficiently took calls, told Al he had "angel wings." It was an appropriate description; Dr. Sacchetti almost flew through the ER giving care and touching patients and their families.

I simply tried to keep up, and I listened and learned. New patients came in with EMTs and paramedics. (Happy EMS Week to them, by the way.) Dr. Sacchetti quickly assessed each and ordered tests, but he always took the time to speak to the patient - including an Alzheimer's patient, a patient with an insect bite (I diagnosed spider bite based on personal experience but my lawyer's credentials hampered my diagnosis), a paralyzed young man from a nursing home who had his life inalterably changed by a gunshot wound, a woman with back pain, a young man with dizziness and vomiting and a terribly distressed young women who smoked crack or wet (a potent cocktail of street drugs.) I also observed a successful cardioversion - most impressive for fixing the patient's arrhythmia.

I was terribly impressed with the entire team - Dr. Sacchetti, a young PA named Bonnie, the nurses, the techs, the other docs, the social workers, the clerks. They worked together like a seamless unit, yet always found time for a gentle word to the patient or family, and at the same time joked with each other. I found that patients were calmed by Dr. Sacchetti, to be asked what had happened and to be told he would take care of them. It was like an oasis of calm in a frenetic place. After spending the entire morning there, I had to leave for another commitment, but I didn't want to (even though my feet hurt.) I said my goodbyes to Al, Bonnie, the nurses, the clerks, the techs. It was a fulfilling experience, but even as I left I saw that only one of the 12 psych patients had been transferred, despite the incredible efforts of the Lourdes team and the Steininger Center at Lourdes, which is one of two primary crisis screening centers in Camden County. And while that one patient moved on to the care he needed, another came in. That left 12 ER beds held by psych patients waiting for the right placement. Still.

(My sincere thanks to Dr. Al Sacchetti, the Lourdes ER team, Beverly Lynch and the N.J. chapter of the American College of Emergency Physicians for making my shadowing experience possible.)

Written by Betsy Ryan at 17:03

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David Moore said...
While community and county behavior health beds are being utilized to capacity, behavioral health beds at the state facilities are being utilized at levels lower than I have witnessed in my 20 year career. The DMHS has taken direct control of the referral process to state run psychiatric facilities through a "centralized admission process". In many ways this centralized system helps consumers receive treatment close to home, however the systems main objective often seems to be to maintain a low state facility patient census. Barriers from community and county referrals to state facilities ultimately lead to the ED delays. Hard to imagine that while ED's across the state hold behavioral health patients awaiting placement our state government is planning on closing one of the four state run psychiatric facilities due to low utilization.
May 18, 2011 01:56