Sep 5, 2007

Report from the field - a visit to the ER

I spent about two hours in the emergency room last night - got there at around 11:30 - after my husband reached into the garbage can to pull up the liner that had slipped below the level of too much trash. He got a big gash in his thumb on some broken glass. (Home safety note to self - nag husband to put hazardous items in a cardboard box before putting them in the trash.)

When I drove up to the ER door, valet parking was closed. That meant I had to drop off my husband and a security guard had to explain how I had to take my car to the valet lot and call security to open the gate for me. That meant that either the guard or the receptionist had to repeat the same set of instructions to each driver to arrive. Keeping the valet service available would have eliminated the resulting interruption, confusion and stress to families.

There were maybe 20 non-urgent cases in the waiting room. There is also a whole warren of treatment rooms that were full - one of the waits was for rooms to open up.

Morale seemed fine. People were courteous and competent.

Check-in time wasn't bad. It was about 15-20 minutes before two triage nurses administered a tetanus shot and replaced the hand-held dishtowel (really - it was clean!) with a proper dressing. The second nurse happened to be going through the triage area and the first asked him to throw on a bandage while he went to get the tetanus shot. They teamed up nicely.

Then a long wait. There was a minimum frequency of patient complaints (patients were getting impatient) to the receptionist, however. Maybe the furnishing of the room had an influence, or the generally courteous treatment. As I mentioned, it seemed like the bottleneck was finding treatment rooms. Or changeover time from the release of one patient until the room was ready for the next. Or someone to see the people warehoused in the treatment rooms.

Other causes of congestion in the waiting room:

No standard process for assigning cases to rooms as they opened. The receptionist had her own system that didn't seem to suit a new person coming on shift who was going to escort patients to rooms.

Waiting for transport of expectant moms to the labor and delivery section of the hospital.

Waiting for patients who were visiting the restroom or standing outside when their names came up.

There was a person assigned to help family coming in to find a patient, but that station was at the back of the waiting room. The receptionist had to direct people there.

A long, long walk to the treatment room. If turnover had been faster, fewer rooms would have been needed.

The main bottleneck was likely a shortage of doctors. After we were in a room, we still had to wait about 20 minutes for her to come in, agree that there was a gash in Mike's hand, and assign the sewing to a physician's assistant.

Short waits then followed:

PA had to get to room. PA had to go get suture cart. PA had to go get saline to loosen the bandage that had stuck to wound. PA had to rummage through the cart to find the tools and materials she needed. PA had to set up.

Value added time, finally. PA disinfected wound, numb it up, and place four stitches - she did a nice job. Then she gave instructions for wound care and following up with a family doctor to have stitches removed.

Another wait for "paperwork."

Throughout, there were several apologies for the wait - "It was a really busy night." Along the way, someone let slip that it was always a "busy night." Clearly they know more about demand rate than they claim, and probably have resources geared to something lower, and possibly could have been trained to be more flexible. Can a nurse or PA be certified to treat simple wounds, perhaps? Of course, there's a shortage of those folks too.

All in all, I'd say the hospital gets B or B+ for last night. Wonder if they'd like to know.

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