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home : opinion : columnist March 23, 2019

3/7/2019 6:06:00 PM
How Healthcare Delivered Today Is To Blame

Dianne Steele
Guest Writer

A few weeks ago, my sister, who is 75 years old, experienced a fall down four concrete steps onto a concrete sidewalk.  She was taken to a hospital, in her area, where she was placed on a stretcher in the hall in the Emergency Department because they had no available rooms.  A nurse greeted her and told her that they would get her into a room as soon as possible.  That nurse also told her that she would not be her nurse, but that a nurse from the oncoming shift would be caring for her.  At this point, no one had assessed her injuries, asked her any questions, checked vital signs, nothing.

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Eventually she was placed in a room with her daughter in attendance.  She waited in this room for approximately three hours before she saw another medical person in that ED.  Her daughter had assisted her to the bathroom several times to address her bleeding nose.  The physician came in, did a quick assessment, and ordered a CT scan of her head which showed a subdural hematoma and a subarachnoid bleed.  She also had a fractured mandible, many bruises, and a severe laceration to a finger, which was never sutured.

For any non-medical people reading this, these are life threatening injuries.  The subarachnoid bleed could have been life ending had it not stopped on its own.  It was certainly Divine intervention and not medical intervention that kept her from having permanent deficits, or even death.

Having spent most of my career as an ED nurse, I was appalled at the lack of care she received in that ED.  I could not, and still cannot imagine a major trauma patient lying in an Emergency Department for three hours and not being assessed or even spoken to by anyone. I was looking for someone to blame.  I complained formerly to that hospital though a Care Line, and this situation was addressed with my sister. 

However, after reflection on her experience, and from what I have seen in other cases, I do not believe that people have changed so much from when I worked in the ED.  The nurses and doctors still care about their patients.  People become doctors and nurses because they do care about people and want to make a positive difference in their lives.

What has changed is the system of how we deliver that healthcare.  I remember when I was a little girl, both my parents worked in the mill. My mother, who is quite a perfectionist, hated working “on production”.  They were paid by how much they produced, and she fretted about the quality of her work.

Well, my friends, healthcare has been put “on production”.  Our measures are by productivity.  The productivity is measured by the number of patients that are cared for, and not by the type of illness, or the severity of their illness, just by the number. And just like in the cotton mill, the quality suffers.

I fully realize that costs had to be cut in medical care, and that it is horrible how expensive healthcare has become.

But let us please get on a bandwagon!  Let us not cut costs in the very people who deliver that care! Let us cut the cost of medications.  The markup there is almost criminal!  Let’s reduce the cost of medical equipment! 

The cost of healthcare would be reduced tremendously if we cut into the profit margin of those two big ticket items, medications and medical equipment.

If we reduced the number of patients a doctor, nurse and Healthcare Tech were responsible for, instances like what happened with my sister would no longer occur.  Falls would be reduced; medication errors would also be reduced.  Nursing care would become great again, just like it once was.

Yes, there will still be issues, there always are when dealing with people.  But imagine how wonderful it would be if we no longer had to work to a certain PRODUCTIVITY!

Therefore I am no longer looking for someone to blame for the delayed care of my sister.  I know what is to blame.  And it is the method in which we are required to deliver healthcare today.  Why are we, the greatest country on earth, allowing reimbursement dictate how care is delivered?  Insurance companies dictate if a patient can have surgery or not, and how long they can stay in the hospital.  They also dictate how much reimbursement is given for a certain procedure, no matter what the cost.

Perhaps I can make this a late in my career project.  I love nursing and making a difference for people.  I want to be able to see that continue in the future for younger nurses!

Thank you to all who took the time to read this!

--- Dianne Steele is a Lincoln County native and a graduate of West Lincoln High School. She obtained her Diploma in Nursing from Cabarrus Hospital School of Nursing and a Bachelor of Science in Nursing from Kaplan University. She worked for Cabarrus Memorial Hospital (now known as Atrium Health Northeast) for 25 years with 13 of them in the Emergency Department. While at Moses Cone Hospital in Greensboro from 1999-2004 Steele worked in the Emergency Department and was also a Critical Care Transport. Since 2004 Steele presently is an Administrative Supervisor at Atrium Health Lincoln. She enjoys spending time with her family especially her grandchildren and trains in TaeKwonDo in which she has obtained the Red Belt level. 

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