Thursday, December 22, 2011


Ten years ago last week my relationship with OSF-SFMC ended. It was really a shame for so many reasons. I had worked at OSF for twenty years and really believed in the Sister's Mission. I just loved the place.

I wrote this letter to OSF-SFMC CEO Keith Steffen in September, 2001.

As the letter and post explains, I was worried about the safety of the patients in the OSF-SFMC Emergency Department. In my opinion, the patients were waiting too long in the Emergency Department to be admitted to the hospital.

I was put on probation the day after I wrote the letter. Mr. Steffen told me that "when you have a cancer somewhere, you need to cut it out before it spreads". And over the next several months (October and November, 2001) Mr. Steffen would smile, look down, and say to me "when this comes out about you, John, it won't be good." He was obviously up to no good while both the Emergency Department patient satisfaction and employee satisfaction were the worst at OSF.

Five years ago Mr. Steffen stated in the Journal Star that the Emergency Department would be expanded because OSF was seeing 62,000 patients per year in SFMC-Emergency Department that was built to see 32,000 patients. The entire patient waiting problem was not just the Emergency Department over crowding. The hospital was poorly run and rooms were not available to accept sick Emergency Department patients who needed admission in a timely fashion.

The article below, published in Academic Emergency Medicine in 2011, describes how patient mortality and hospital length of stay increases when patients are kept ("boarded") in the Emergency Department for prolonged periods of time.

Now in 2011 "Occupy America" is a big thing. The 99% are saying that the 1% have not done things in a moral way.

And nurses unions around the country are striking for the same reasons. The nurses worry about patient care being poor due to corporate greed. This is not really "news" but is spoken about more openly now than it was a decade ago.

This is what happened at OSF in my opinion. Emergency Department patients just didn't count compared to OSF's bottom line.

Please see article below.

Acad Emerg Med. 2011; 18(12):1324-9 (ISSN: 1553-2712)

Singer AJ ; Thode HC ; Viccellio P ; Pines JM

From the Department of Emergency Medicine, Stony Brook University (AJS, HCT, PV), Stony Brook, NY; the Department of Emergency Medicine, George Washington University School of Medicine, and the Department of Health Policy, George Washington University School of Public Health and Health Sciences (JMP), Washington, DC.

Objectives:  Emergency department (ED) boarding has been associated with several negative patient-oriented outcomes, from worse satisfaction to higher inpatient mortality rates. The current study evaluates the association between length of ED boarding and outcomes. The authors expected that prolonged ED boarding of admitted patients would be associated with higher mortality rates and longer hospital lengths of stay (LOS).

Methods:  This was a retrospective cohort study set at a suburban academic ED with an annual ED census of 90,000 visits. Consecutive patients admitted to the hospital from the ED and discharged between October 2005 and September 2008 were included. An electronic medical record (EMR) system was used to extract patient demographics, ED disposition (discharge, admit to floor), ED and hospital LOS, and in-hospital mortality. Boarding was defined as ED LOS 2 hours or more after decision for admission. Descriptive statistics were used to evaluate the association between length of ED boarding and hospital LOS, subsequent transfer to an intensive care unit (ICU), and mortality controlling for comorbidities.

Results:  There were 41,256 admissions from the ED. Mortality generally increased with increasing boarding time, from 2.5% in patients boarded less than 2 hours to 4.5% in patients boarding 12 hours or more (p < 0.001). Mean hospital LOS also showed an increase with boarding time (p < 0.001), from 5.6 days (SD ± 11.4 days) for those who stayed in the ED for less than 2 hours to 8.7 days (SD ± 16.3 days) for those who boarded for more than 24 hours. The increases were still apparent after adjustment for comorbid conditions and other factors.

Conclusions:  Hospital mortality and hospital LOS are associated with length of ED boarding. ACADEMIC EMERGENCY MEDICINE 2011; 18:1324-1329 © 2011 by the Society for Academic Emergency Medicine.

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