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Question 1 to back up emergency rooms statewide

10/10/2018
Tufts Medical Center today joined the statewide Coalition to Protect Patient Safety in voicing concerns about the impact of Ballot Question #1 on hospital emergency services, saying it will lead to long waits and potentially, turning patients away at the ED doors. 
 
“Managing the emergency room is a dynamic process.  We need the flexibility to care for patients based on the severity of their condition. Rigid, government-set rules won’t work,” said Dr. Brien Barnewolt, MD, Chief of the Department of Emergency Medicine at Tufts Medical Center. “Wait times will increase, morale will go down and the quality of care will be worse at every hospital in the state if this measure passes.” 
 
Question 1, sponsored by the union that represents under one-quarter of all nurses in Massachusetts, would set strict nurse-to-patient ratios in emergency departments and throughout hospitals and other health care facilities. The question goes before voters on the November 6th ballot. 
 
“Ratios will not work in the Emergency Room. When a critical patient comes through the door now it’s all hands on deck - a team of people, including nurses, surround that patient with the hope to get them stable,” said Laura Carideo, RN, an emergency room nurse at Tufts MC for nearly 20 years. “If this law passes, nurses will not be able to assist if they have been assigned their set number of patients, even if some of those patients are waiting to be discharged or to be admitted to the hospital. Nurses will not be able to help their colleagues, even if they want to.” 
 
If Question 1 passes, hospitals across the Commonwealth will need to recruit, hire and train many more nurses. In order to manage the current volume of patients in the ED, Tufts Medical Center would need an additional 28 full-time nurses to be compliant with the law, costing an estimated $4.2 million per year. 
 
One of the concerns is that nurse ratios will lead to back-ups in the emergency rooms. The average wait time to see a physician at Tufts Medical Center through the ED is currently about 36 minutes, Dr. Barnewolt said. As seen in California, that number is expected to increase dramatically with the new law, as ED patients who need to be admitted wait until floor nurses can legally take additional patients. 
 
“I don’t know how you look at an EMT who just brought in a very sick patient via ambulance and say ‘I’m sorry, you’ll need to wait,'" said Carideo. 
 
Another concern is the ability for an academic medical center, such as Tufts MC, to manage very sick patients who are Medflighted to a major Boston trauma center or are referred from hospitals in the community for complex care. 
 
“Community hospitals rely on academic medical centers like ours to receive patients with complex issues,” said Dr. Barnewolt. “A hospital emergency department may have to say – ‘we don’t have capacity to legally take your patient right now,’ which is not only inefficient, it can be dangerous.”   

For more on the anticipated impact of Question 1 on Tufts Medical Center and Floating Hospital for Children, visit www.tuftsmedicalcenter.org/NoToRatios.
 
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About Tufts Medical Center and Floating Hospital for Children
Tufts Medical Center is an exceptional, not-for-profit, 415 bed academic medical center that is home to both a full service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, we’re the principle teaching hospital for Tufts University School of Medicine. We offer a level one trauma center with a rooftop helipad, are the largest heart transplant center in New England and our renowned research program ranks among the top 10 percent of independent hospitals to receive federal research funding. Our physician network of 1,800 New England Quality Care Alliance doctors represents our strong commitment to health in the community. Tufts Medical Center is a founding member of Wellforce. More at www.TuftsMedicalCenter.org.