Defining and treating "problem patients" in a hospital emergency room.

Emergency ward doctors and nurses define patients whose illnesses require prolonged and comprehensive care as threats to the mission of the ward. Data were collected by means of direct observation and interviewing of emergency ward doctors and nurses in a 600-bed hospital in the Midwestern United States. In 1973, a total of 270 hours of observational data was collected as part of a larger study of emergency ward social organization. In a setting specializing in emergency treatment of the acutely ill and injured, the presence of the alcoholic, the emotionally disturbed, and the mentally ill patient represent an exercise in futility for emergency ward doctors and nurses. Since these patients often present behavior problems on the ward, one way for medical staff to cope with such patients is to define these patients as management problems rather than as medical cases to be diagnosed and treated. Success or failure with management problems is no longer based on medical criteria, but upon the outcome of management activities. The most successful outcomes are those where the amount of patient's disruptive behavior and the amount of staff time and resources devoted to the patient are held to a minimum.