Guest Column Brian Patel, MD

Published on October 13, 2018

Concerns on the Impact of Question #1 to Emergency Care

By: Brian Patel, MD

Dr. Brian Patel Chief of Emergency ServicesAs the Chief of Emergency Services and a Clinical Attending Physician working regularly in the Emergency Care Center at Sturdy Memorial Hospital, I have significant concerns that the mandated rigid staffing ratios proposed in Question #1 will significantly hinder our ability to provide emergency care to our community. Requiring staffing ratios that do not allow for adjustments based on surges in patient volume and acute changes in severity of patients’ illnesses—situations that occur in the Emergency Care Center on a daily basis—will result in increased emergency department wait times with the very real potential of delaying life-saving services, not only at Sturdy, but throughout the state.

As an emergency physician, I have the utmost respect for nurses. They work tirelessly each and every day with our doctors and our care teams to ensure the delivery of high quality, safe patient care. Our relationship depends on trust and judgment. For these reasons and others, I oppose nurse staffing ratios. As it stands now, myself and the physicians in our ED trust our nurses to assess and adjust staffing ratios up or down as required by the constantly changing environment and medical conditions of our patients. If we have an influx of patients, we know we can work together to effectively expedite care for all who need to be treated. Question #1 will impede upon this process as it refutes the professional judgment our nurses. Judgment that allows them to recognize their own capabilities of providing safe and effective care. Instead, ratios will limit our nurses from taking on additional patients if they are at their patient maximum, despite their competence and ability to do so, safely.

It is irresponsible to staff based on rigid ratios that do not take into account the dynamic variables affecting ED patient care. We need to be able to staff according to patient acuity, not a rigid, unfounded ratio. Reducing this dynamic process to the inflexible confines proposed in the ballot will adversely affect patient flow. Patients requiring admission to the hospital will be forced to wait in the ED until a nurse is allowed to take another patient based on her ratio. Patients presenting to the ED will be forced to wait for much longer periods of time until a nurse is able to take a new patient. This has the real risk of having delays in diagnosing and treating potentially life threatening illnesses. The increased wait times in our ED could also result in our patients having to travel further for care, which puts them at significant risk.

As a member of our community, you should know that there are no exceptions to this mandate, even in the event of an unexpected influx of patients – such as a multi-car crash or large fire. According to an independent study by MassInsight and BW Research Partners, mandated nurse staffing requirements would exacerbate the current nursing shortage, causing emergency department wait times to sky rocket, and disproportionately affect those in need of behavioral health care. As it stands now, The Massachusetts Association of Behavioral Health Systems report that there will be a loss of 1,000 behavioral health beds across the state if Question #1 passes. As a result of this, patients with acute behavioral health needs will be forced to remain in ED’s for even longer than the several days they often currently already wait. We need to find more resources to treat our behavioral health patients, not create the real possibility of losing a critical service that I know firsthand, due to my experience in the ED, that we need now, more than ever.

Everyone will be affected if this bill passes. Every hospital, every patient, and every community. There are no exceptions. Increased emergency room wait times will be seen throughout the state. This is no way to provide care to the residents of Massachusetts. Data on California, who has had mandated ratios with much fewer restrictions than is proposed in Question #1, clearly shows that quality of care and patient safety has not significantly improved as a result. As it stands now, the hospitals in our state consistently top national rankings in quality of care and safety. The Leapfrog Group, a national group that evaluates and ranks hospitals based on quality and safety, rated Massachusetts 4th in the nation for patient safety while California was ranked 25th. Our current system works, we do not need government mandated nurse staffing ratios to continue to deliver exceptional, high quality and safe care to our patients.

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