How_ER

Physicians and nurses are on duty while the world celebrates the holidays. It doesn’t matter if it is Christmas, Hanukkah, or New Year’s Eve, hospitals toil while the world is filled with revelry. Clinicians are the keepers of the flame as it were and always at the ready to help those who need emergency medical care during the holidays. How many patients appear at their door? Not as many as you would think.

Urban myth has it that emergency room volume increases on Christmas and New Year’s Day, but the statistics show a different picture. Visits do increase in the weeks before and after the holidays but quiet down on the days themselves. For example, when Howard University Hospital in Washington, D.C. looked at their emergency room statistics for 2011 they found that there were 125 ER visits on Christmas eve, 98 on Christmas day and 161 on the day after Christmas. Whether for physical or mental health, patients seem to avoid seeking care on the holidays.

The Christmas Effect on Psychopathology”, published in Innovations in Clinical Neuroscience reports that fewer psychiatric patients use emergency rooms on Christmas and New Year’s Day and that “self-harm behavior” and suicide attempts/completions are lower as well. An article in the Annals of Emergency Medicine also reported the existence of a “Christmas effect” that reduces ED visitations by patients with psychiatric symptoms. After analyzing emergency department records of 8,750 patients over a 6-year period, researchers found that there was a general decrease in visits before the holiday with an increase afterward.

Unfortunately, this does not mean that people are healthier. It means that celebrations delay care and that the merrymaking itself will bring patients to the ER when the parties are over. People with chronic diseases who pay attention to their diet year-round tend to throw caution to the wind during the holidays. Eating too much salt, sugar, rich foods and drinking too much alcohol increases the number of patients who visit the ER for treatment of hypertension, hyperglycemia, gastristis, pancreatitis and congestive heart failure. Some hospitals report seeing dialysis patients who have missed their treatments because of holiday celebrations.

Then there are the holiday specific injuries, some of which may end up in the annals of ER physician anecdotes for years. While humorous, they are nonetheless serious. There are decorating injuries; the U.S. Consumer Product Safety Commission estimates that there were 15,000 of them in November and December of 2012. There are cooking and carving injuries; burns, scalds, slips and falls. Food poisoning is seen and heart burn can mimic the symptoms of a heart attack.

Perhaps the riskiest patients for ER physicians are the ones who have nowhere to go and no one to turn to when their stability is thrown off balance by the holidays. They can pose a physical danger to staff and the goal is to reduce their agitation immediately. Specific guidelines are included in a Consensus Statement by the American Association for Emergency Psychiatry and they are worth reading in detail. The four main objectives are:

  1. Ensure the safety of the patient, staff, and others in the area
  2. Help the patient manage emotions and distress and maintain or regain control of behavior
  3. Avoid the use of restraints when at all possible
  4. Avoid coercive interventions that escalate agitation

These objectives are achieved with a 3 step process that includes:

  1. The patient is verbally engaged
  2. A collaborative relationship is established
  3. The patient is verbally de-escalated out of the agitated state.

Then evaluation and treatment can take place.

The bottom line is that no one wants to work during the holidays. However, you can reaffirm the importance of your physicians and clinical staff work during the holidays by reminding them that their presence can help to reassure and treat patients and ease their sense of loss. It may be the one day of the year that they can truly experience why they went into medicine in the first place- to care for people and heal them.

When a patient has the opportunity to tell you how they feel about their care, they feel empowered, and acknowledged. Using HCXP for rounding and point of Care (POC) collection of feedback data, allows patients to do this. The result is a better patient experience and that ultimately leads to a better HCAHPS scores and a greater reimbursement. Find out more at HCXP, creator of a five point, 5 Star rating system for all in house satisfaction questionnaires and one comparison/benchmark reporting system.

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