Iranian Chill Thread

[HGV]

Not a surprise. Quite brave/stupid for them to do this in public, though. And what's the point of wearing hijab but not fasting during Ramadan?

https://twitter.com/x/status/1642622564131373061

 

[Cthulhu]

Lots of Khayemals have been activated, I see.

 

[Hack-Hook]

Average work intensity in Iran is lower than in the west. 12 hours of work in Iran is like 18 or so over here.

Not in emergency ward .
There an emergency specialist don't have to all patients who come to hospitals . He choose how many he can handle and take them and it's not strange that less severe cases wait several hours in waiting room to be visited.
It's not the case here .I had to visit all patients no matter how many I'm managing right now.
On the first day of farvardin I had more than 60 patient and that is a disaster for patients and doctors.specially that around 2/3rd of them were complicated multiple trauma patients thanks to our roads and police who gave responsibility of issuing driver license to driving schools and they are private so you can guess what is the results.

 

[SalarHaqq]

For sure you didn't experienced the Karaj and Tehran metro at begging of work time and end of it ...

Is it anything like this? :

This is the real picture outside Iran, for those who prefer not to bury their head in the sand.

---

Not in emergency ward .

But about everywhere else.

There an emergency specialist don't have to all patients who come to hospitals . He choose how many he can handle and take them and it's not strange that less severe cases wait several hours in waiting room to be visited.
It's not the case here .I had to visit all patients no matter how many I'm managing right now.
On the first day of farvardin I had more than 60 patient and that is a disaster for patients and doctors.specially that around 2/3rd of them were complicated multiple trauma patients thanks to our roads and police who gave responsibility of issuing driver license to driving schools and they are private so you can guess what is the results.

So what you're saying is that there's pressure on the medical personnel but that patients are benefiting from it. Not a lose-lose situation, thus (although I empathize with the physicians burdened as a result).

 

[HGV]

Not in emergency ward .
There an emergency specialist don't have to all patients who come to hospitals . He choose how many he can handle and take them and it's not strange that less severe cases wait several hours in waiting room to be visited.
It's not the case here .I had to visit all patients no matter how many I'm managing right now.
On the first day of farvardin I had more than 60 patient and that is a disaster for patients and doctors.specially that around 2/3rd of them were complicated multiple trauma patients thanks to our roads and police who gave responsibility of issuing driver license to driving schools and they are private so you can guess what is the results.

Do you work in one fixed hospital in Tehran, or rotate around different hospitals in different cities?

 

[Hack-Hook]

Do you work in one fixed hospital in Tehran, or rotate around different hospitals in different cities?

Till last year I was resident in a fixed hospital in Tehran from winter I work in a fixed hospital in a small city as emergency medicine specialist.

So what you're saying is that there's pressure on the medical personnel but that patients are benefiting from it. Not a lose-lose situation, thus (although I empathize with the physicians burdened as a result).

Who says patient benefit from it. We have no time to evaluate patients throughly . It's a disaster for patients and many time many problem get missed. There will be miscommunication between personal and patients get wrong dose of drugs even wrong drug. I knew even cases that patients died because the physician didn't had time to evaluate patient a second or third time after 1 or 2 hours

 

[HGV]

Till last year I was resident in a fixed hospital in Tehran from winter I work in a fixed hospital in a small city as emergency medicine specialist.

Great. People working in hospitals and emergency wards are heroes, especially in small cities and rural areas. Nobody becomes a doctor for money (maybe in the USA), in the UK junior doctors have to work crazy shifts and hours and their pay per hour is even below minimum wage sometimes. A very commendable profession.

 

[SalarHaqq]

Who says patient benefit from it. We have no time to evaluate patients throughly . It's a disaster for patients and many time many problem get missed. There will be miscommunication between personal and patients get wrong dose of drugs even wrong drug.

You suggested they don't have to wait as much if their condition isn't too severe, which onto itself would be an advantage.

Either way, my point was that work intensity in Iran on average is lower than it is around here and that's factual.

I knew even cases that patients died because the physician didn't had time to evaluate patient a second or third time after 1 or 2 hours

In "paradise west" patients die in emergency waiting rooms without having the opportunity to see a doctor at all.

_____

Patients Are Dying in Emergency Department Waiting Rooms​

— We call on HHS and CMS to help address the issue of ED boarding​

by Alexander T. Janke, MD, MHS, Jennifer Tsai, MD, Med, and Kristen Panthagani, MD, PhD

February 19, 2023

A special session of Congress was called 35 years ago to make lawmakers and the public aware of stories of patients left to die in hospital parking lots for lack of insurance.

Around the time of that congressional testimony, called "Equal Access to Health Care: Patient Dumping," a new guarantee came about: that any individual who comes to the emergency department (ED) must be given a medical screening evaluation and appropriate stabilization. This codifies the ED, by federal law, as the front door to hospital-based care in the U.S.

In its ideal form, the ED is well-calibrated for the rapid identification of life- and limb-threatening acute illness and injury. For the vast majority of patients, no such dangerous pathology is present, and for a small subset of the sickest patients, our core mission is resuscitative care. After that, we act as a flexible acute diagnostic and therapeutic center that ends in disposition: discharge or hospital admission.

But what happens when there aren't any open beds upstairs, on the inpatient side? As most of us have seen all too often, hospitals' preferred fix is to have patients pile up, waiting in the ED until rooms open up. This is what we call "boarding," and it is an ever-present threat to our role in the resuscitative care of the sickest patients. As the mismatch between acute care needs and available capacity mounts, our work environment descends to chaos.

Patients are now waiting hours, days, and sometimes weeks in the ED. It's like asking a teacher to take on a whole new class of students when last year's class hasn't left yet.
New data from two studies we recently published in JAMA Network Open document what patients, nurses, and doctors already know: the levees have broken. The system has collapsed under the weight of acute care needs.

At the end of 2021, in the hardest-hit hospitals, more than one in 10 ED patients left without care. Half of the sickest patients in the department -- those requiring admission -- waited 9 or more hours for an inpatient bed. More and more, patients are placed in hallways: patients who need sensitive exams, patients with highly infectious respiratory viruses, and elderly patients with sepsis who must endure the bright hall lights through the night.

The problem isn't just physical space -- it's staff. Nurses, crushed under the weight of a profit-driven staffing crisis years in the making, must now care for both admitted boarding patients and new patients. In practice, there are often no limits on staffing ratios for ED nurses. On the medical floor, a single nurse may have four to five patients. In the ICU, two patients. In the ED, a single nurse is often asked to cover 10 patients or more, some critically ill who are "admitted" but in the ED waiting for an ICU bed, without regard for the safety or sustainability of this arrangement.

A recent survey by the American College of Emergency Physicians (ACEP) invited ED doctors to share what they've seen happen as a result of ED boarding. Patients with brain bleeds, hip fractures, and even necrotizing genital infections are being treated in the waiting room because there are no rooms or even hallway beds available in the ED.

Multiple physicians shared stories of patients dying in the waiting room because the ED was so overwhelmed, they had to wait for hours to see a physician.

Why Aren't Hospitals Ready for Patients?

ED boarding is not simply a matter of too many ED patients or inefficient ED staff. Staffing shortages throughout the hospital, reduced capacity at nursing facilities, and "business hours" scheduling of inpatient specialized services all lead to inefficient patient flow through the hospital, ultimately causing a backup in the ED.

But perhaps the most significant roadblock to solving ED boarding is that hospitals are financially disincentivized from fixing it.

A recent commentary in the New England Journal of Medicine identified "misaligned healthcare economics" as one of the primary drivers of boarding. It is better business for hospitals to keep their medical floors near capacity, prioritize beds for surgical patients who bring in more money, and not leave a buffer of open rooms available for predictable surges of ED patients (every Monday afternoon). If more than 90% of beds are full upstairs on Sunday, hospital revenues may be optimized, but dangerous ED gridlock becomes inevitable.

Despite decades of academic work demonstrating the dangers, the only standard set by the Centers for Medicare & Medicaid Services (CMS) on ED boarding is a recommended 4-hour maximum boarding time (we're way past that on a good day), with no mandatory reporting requirements. In 2016, CMS introduced a second metric: an option for hospitals to report boarding times as a part of their quality measures. In 2021, when CMS saw hospitals who voluntarily reported boarding times were not reaching crisis levels, they discontinued the metric, concluding ED boarding was not an issue. Of course, it's highly likely that when hospitals did reach crisis levels, they simply chose not to report that data.

We call on HHS, in cooperation with CMS, to announce a multi-pronged approach to clarifying the problem of ED boarding and identifying solutions. We recommend up-to-date, rapidly-updating, and public reporting from hospitals on waiting room times, boarding times, and rates of patients leaving without being seen. These measures, more so than the simple occupancy measures released to dateopens in a new tab or window, are more often representative of dangerous gridlock. In addition, an anonymized reporting mechanism should be created for healthcare providers to share their staffing ratios. This commission should prepare a report for Congress including detailed data on ED boarding as well as stories from healthcare workers on the tragedies they've seen. Transparency on the state of hospital preparedness is an essential first step. In combination with the right regulatory mechanismsopens in a new tab or window and financial incentives, we can incentivize the availability of flexible capacity and cooperation among disparate health services organizations to relieve dangerous conditions during times of surge demand for acute care.

The crisis is ongoing. Will policymakers and health system leaders take note?

Alexander T. Janke, MD, MHS, is a fellow in the National Clinician Scholars Program at the VA Ann Arbor Healthcare System and the University of Michigan Institute for Healthcare Policy and Innovation. Jennifer Tsai, MD, MEd, is an emergency medicine resident physician at Yale School of Medicine. Kirsten Panthagani, MD, PhD, is an emergency resident physician and Yale Emergency Scholar at Yale School of Medicine.

https://www.medpagetoday.com/opinion/second-opinions/103166

 

[tsunset]

Do most of Pakistanis like Israel?

 

[Hack-Hook]

You stated they have to wait less, which is an advantage. Either way, my point was that work intensity in Iran on average is lower and that's a fact. I'm not interested in dwelling on exceptions to the rule.

Quality of the care is important not how long a level 3 or 4 or even 5 patients had to wait.
When you had to admit all of them because there is no alternative place to go and if they are not visited at once they learned to raise hell to being seen sooner the quality of care for level 1 or 2 patient get reduced dramatically and as result the underlying life threatening situation get missed until it's too late.

 

[SalarHaqq]

Quality of the care is important not how long a level 3 or 4 or even 5 patients had to wait.
When you had to admit all of them because there is no alternative place to go and if they are not visited at once they learned to raise hell to being seen sooner the quality of care for level 1 or 2 patient get reduced dramatically and as result the underlying life threatening situation get missed until it's too late.

1) Average work intensity in Iran is lower than it is in the west.

2) In the west the question of good or bad treatment does not arise for significant numbers of level 1 and 2 patients who do not receive any treatment at all: they're left to die in waiting rooms.

Opinion | Patients Are Dying in Emergency Department Waiting Rooms

We call on HHS and CMS to help address the issue of ED boarding

www.medpagetoday.com

 

[HGV]

https://twitter.com/x/status/1643317678227030017

 

[Hack-Hook]

1) Average work intensity in Iran is lower than it is in the west.

2) In the west the question of good or bad treatment does not arise for significant numbers of level 1 and 2 patients who do not receive any treatment at all: they're left to die in waiting rooms.

Opinion | Patients Are Dying in Emergency Department Waiting Rooms

We call on HHS and CMS to help address the issue of ED boarding

www.medpagetoday.com

As you always say don't pick on cases better focus on procedural problems and deal with them and here we have a procedural problem
And your article is about another problem of emergency wards it's about the patients that have been admitted and got their diagnosis and primary treatment then they are transfered to a service for example orthopedy or surgery but because there is no empty bed in those wards or because they want to keep their beds empty for elective patients they stay in emergency ward .
As standard all patients after admission must get their diagnosis in 6 hours and transfered to the respective service and in 12 hours to the ward. But I suggest you go to imam khomeyni medical complex in Tehran and you see patients who are at emergency wards for more than a week .

Honestly if you want to post example of patient who are dying in waiting rooms post the correct article there is no lack of it the must interesting one is a video of a patient who dying after more than 11 hour of waiting in triage and it show all of the waiting time. But that is a triage failure on a case but here I talk about a procedural failure.

 

[TheImmortal]

https://twitter.com/x/status/1643317678227030017

https://twitter.com/x/status/1643349077562650632

 

[SalarHaqq]

And your article is about another problem of emergency wards it's about the patients that have been admitted and got their diagnosis and primary treatment then they are transfered to a service for example orthopedy or surgery but because there is no empty bed in those wards or because they want to keep their beds empty for elective patients they stay in emergency ward .

And that is somehow trivial? It is a procedural issue by definition seeing how it stems from a procedure implemented by hospitals.

At the end of the day the fact speaks for itself: patients are dying in hospitals of the west while waiting for treatment they never receive. It doesn't matter at what level the flaw is situated, when the result is that patients are left to die. This is no better and actually worse than the anecdote you came up with about Iran.

But I suggest you go to imam khomeyni medical complex in Tehran and you see patients who are at emergency wards for more than a week .

And I suggest you pay closer attention to the article because it talks of patients in the USA waiting in emergency departments for several weeks, plural.

Honestly if you want to post example of patient who are dying in waiting rooms post the correct article there is no lack of it the must interesting one is a video of a patient who dying after more than 11 hour of waiting in triage and it show all of the waiting time. But that is a triage failure on a case but here I talk about a procedural failure.

Read the article again. It talks of:

- Hospitals having patients pile up due to a lack of rooms. A structural deficiency of the healthcare system. No excuse for such horrendous mismanagement in the wealthiest country on earth, and one of the most developed ones too.

- 10% of emergency patients leaving without care in the hardest hit hospitals.

- Chronic personnel shortages. Nurses crushed under the weight of a profit-driven staffing crisis. In emergency wards, a single nurse is often asked to cover ten patients including critically ill waiting for an ICU bed.

- Patients with brain bleeds, hip fractures, and even necrotizing genital infections being treated in the waiting room because there are no rooms or even hallway beds available in the emergency department.

- Patients dying in the waiting room of the emergency department because they had to wait for hours to see a physician. It says nothing about prior treatment and transfer to other departments, don't make things up. This is all happening inside emergency wards and victims are people who received no medical care at all.

- Hospitals prioritizing beds for surgical patients who bring in more money, and failing to leave a buffer of open rooms available for predictable surges of emergency cases. In other terms, patients dying because privately owned hospitals want to make more profit.

Anyone attempting to minimize or whitewash the atrocity of these conditions is deprived of basic ethical standards.

And now, back to my point: average work intensity in the west is higher than in Iran, this long off-topic deflection about hospital emergency departments notwithstanding.