Let’s say that you go to the ED with a complaint that could be an infection. The team is going to evaluate you to see if you meet sepsis criteria. I posted about that back in August right here on this blog. If the patient meets sepsis criteria, the nurse will enter a standardized set of orders for tests. Those tests include tests for lactic acid, a CBC, CMP, and if appropriate, COVID/Flu tests, urinalysis, and other tests. If the patient has a lactic acid level of 2.0 or more, they are going to get IV fluids. Lots of them, like 30mL per kilogram of body weight. If you weigh 100kg, that means 3 liters of fluid. The lactic acid level will be checked and rechecked until the level is below 2.0.
So think about this when you consider the cost:
- The triage nurse and their team briefly evaluates you and assigns you to the appropriate nurse.
- You then become one of the 3 or 4 patients that nurse is caring for. You get a full evaluation, including an EKG, an IV line, along with blood and urine tests. This nurse has years of education and years or even decades more experience.
- The lab team then runs the tests, the X-ray team shoots your pictures, a radiologist reviews them and sends the results to your nurse.
- The ED physician evaluates all of that information and, in cooperation with your nurse comes up with the treatment plan. Then he orders the medications.
- The pharmacy reviews the patient’s previous medications, condition, and the ordered medication to ensure that this is a safe course of medicine, then releases it.
- The nurse then triple checks everything and gives the medicine.
In all, a visit to the ED involves no fewer than 12 specially trained medical personnel, who perform tests and treatment across no fewer than 9 different specialties. Each of those people is college educated from a 2 year degree to full on doctors. Most of them have a decade or more of experience. That doesn’t count all of the other people involved from the hospital’s chief nursing officer, the administrative people, janitors, security, and others involved in running a large business.
Now consider that Americans demand flawless health care on a 24/7 schedule, and want to be seen and leaving the hospital in less than 3 hours. Sometimes, we actually meet that deadline. Most of the time, we come close, but there are too many patients there for too many silly complaints. I had a patient this week who came in for constipation and was demanding to know why we were so understaffed that he had to wait an hour and a half to see the doctor.
So if you want to know why it costs $10k for an ED visit, that’s why. The old saying is that all businesses offer one of three services:
You can only get two- if it is cheap and fast, it won’t be good. If it is good and cheap, it won’t be fast. If it is good and fast, it won’t be cheap.
We as a nation demand good and fast. That means it won’t be cheap. On top of it, the patients want to be pampered like they are in a day spa. My patients are frequently more concerned with what I am going to feed them than they are in the quality of their care. They expect to be cured in an hour for a problem that has been years in the making: you are a long term smoker, a diabetic, are 100 pounds overweight, and have high blood pressure, then expect to come in and be cured of your shortness of breath in an hour so you can make it to half priced wing and beer night at your local watering hole. Then you blame the health care personnel when it takes too long.
Another of my patients came in and the first thing he said to me is that he wanted a sandwich followed by a cup of coffee brought to him every hour. I told him that I was holding him without anything by mouth at least until we were done evaluating him, so he demanded to see my boss. When the boss told him the same thing, he told us that we were inhumane for denying him food, then stormed out.
That’s my rant.