Slowing Pains

My on call dry spell continues. Another week gone by and nothing. This week I had three days with no scheduled cases and call of one persuasion or the other Monday thru Friday. I've figured out part of the problem. It's hard to find work when your hospital is one divert status or another. The town I live in had a rapid growth spurt which, in my opinion, has destroyed the clean air, open spaces, water supply, traffic flow, cost of living and overall quality of life in my home town - but that is a whole other rant. There are four major hospitals here, a 538 bed level II trauma center which is in the completion stage of expansion, another similar sized (380 bed) hospital, and two smaller hospitals with a combined total of 165 beds, all with "full service" (the latest advertising phrase) ER's. (photo credit)

Here is my impression of how the game goes...keep in mind, I am talking about patients arriving by ambulance only. Patients arriving by private vehicle or on foot can still come in and join the party. The trauma center ER usually fills up first. People without insurance that don't express a preference seem to end up there. Once all the ER rooms and hallways are full, the ER informs ambulance dispatch that they are on ER capacity divert. This generally shifts the flow to the next largest hospital until they too end up on ER capacity divert. It doesn't take long for the two smaller hospitals to join in on the fun and now all four are on divert. So where does the ambulance deliver at this point? Well, this is where the game gets fun! Since all four hospitals are on divert, they all have to be considered open again. I think there is some sort of time frame that they have to honor, say 2-4 hours (?) before they can reclaim ER capacity divert. This seems to be the most common divert status, however there are more options.

Critical Care Divert means that all of the ICU beds are full. I believe this includes all ICU's, trauma, general, pediatric, cardiac, the one exception may be neonatal. Sometimes surgeons on general ER call love to hear this. When I am on call, I hate to hear this! Even though the trauma center may be on critical care divert, a patient meeting trauma criteria and an appropriate trauma score still comes to the trauma center. So where would this patient go after surgery if there is no ICU bed? If you can't go to the ICU, sometimes the ICU comes to you. Qualified recovery room nurses and an ICU nurse (more than likely one who has been called in) will manage an ICU patient in the recovery room overnight or until an ICU bed becomes available. Nobody likes to play this game.

And the final divert status I have not quite figured out yet. It is the coveted Closed Divert. I imagine that it is just as it sounds. Closed. Period. No ICU beds, no ER rooms, no floor beds, no room at the Inn. Fortunately this status doesn't happen too often and I have never heard of all hospitals being closed. I believe that when the trauma center is on closed divert, and it always seems to be the trauma center, patients are shipped to the next regional trauma center. When the OR staff walks by and see's CLOSED DIVERT written on the grease board, you can almost hear an audible sigh of relief. It means the case load you see, is the case load you get. No add on's unless the hospital re-opens or it's an emergent inpatient. When I hear closed divert I also utter a sigh but it holds a different meaning.

The rapid growth has obviously exceeded the hospital capacities. I can't wait for the trauma center expansion to be up and running so I can get back to work.