Dispatched to the ER Waiting Room?

[Just Plain Ruff]

Just a random thought:

If you are sitting in the waiting room...have you been triaged yet? Sometimes there is a wait to even be triaged and if you are just waiting for them to triage you no chart has been initiated so technically you'd just be in the hospital not registered yet in the ER.

Also I have heard of ambulances being dispatched for calls outside of hospitals but never to an ER.

If you are waiting on a triage then yes you are in the system. You at least have been what they call Quick regged. That puts you in the system and get's your name in the system.

The nurse then if they work electronically (almost all hospitals these days have some form of electronic system)then the nurse works off the list of patients waiting to be triaged.

Once triaged you are truly in the system and you are either taken to a room or put back in the waiting room based on severity.

I can go on and on but yes, if you are waiting to be triaged then you are in the system. And yes, being in the system means that some type of chart is generated, it might not be what you historically think of as a chart but there is a chart made up in the system. So yes, a chart is generated.

[medic_texas]

You started a good list, but you missed the most important reason for ER backlog, but thats ok cause its an inside industry secret that will not get published. Those hospitals that have improved ER flow have done so by attacking the problem on the floors and in the ER. In most hospitals, doctors come and make rounds once; they see all their patients, sit in a cubicle for an hour or two, and then dump 12 charts at the nurse's station at one time. When doctors are forced to round at certain times, turn in charts as they complete them, and are forced to take care of potential discharges first, the flow of patients moves much better throughout the facility. The second sacred cow is the OR. Doctors are assigned blocks of time in the ER, and those times are never altered. If Doctor A has OR room one reserved from 9a-12p, no other surgeries occur in that room, even if he has no procedures that day. By forcing the surgeons to use time and rooms efficiently, again flow improves, but no one will touch the sacred surgeons.

There should be a new law passed nationally, if your hospital is on diversion, you should not be allowed to perform elective surgeries until such time that you are off diversion. The Diversion Problem would be solved overnight.

I don't think your example is accurate at all. I've worked at several ER's and I've never seen anything similar.

I think Ruff and doc have posted very good information and also ACCURATE info.

Edited June 6, 2011 by medic_texas

[Richard B the EMT]

I have to possibly go a bit off topic, by mentioning a recent court case, which has been in the news.

Kings County Hospital (Brooklyn, AKA Kings County, NY) has a separate building for Psych cases, the "G" building. A woman collapsed in the Psych ER waiting area, ON SECURITY VIDEO, but nobody, nurses, doctors, or even the NYC Health and Hospitals Corporation Police, actually approached her for several hours. If anything, they just looked from across the room at her, laying face down on the floor.

When someone came into the waiting area to actually check her, she had died.

Several doctors, nurses, and even the hospital cops were either reassigned, disciplined, or fired, and the woman's family sued. They got a large settlement, by the way, for events leading to a "Wrongful Death".

[croaker260]

I don't think your example is accurate at all. I've worked at several ER's and I've never seen anything similar.

I think Ruff and doc have posted very good information and also ACCURATE info.

I on the other hand have seen similar situations. Usually ER wait times is not a single source or large delay its a collection of smaller, more subtle and harder to define delays.

One of our local larger tertiary care hospitals tried a fast track system. The problem is that the docs and PA's working this side of the ER were doing the same time consuming test that the rest of thee ER was doing, and the total time in the ER did not go down.

I have heard of an ER that actually sends a PA out into the waiting room to get some tests already started, like strep tests, while you are still waiting to be seen. I have heard that helps.

One of our local hospitals is a semi-rural community hospital. It used to have horrible service. In the past 5 years it has been taken over by HCA, and scene then it has dramatically reworked its who system not only from a process point of view but a customer service point of view. BTW, in most hospitals that are not on the east coast the delays are on the floor, not in the ER.

They got their staff motivated to improve the hospital, and diversion times went out the window. I recently took my son there for a medical issue, and I have never been treated so nice in the middle of the night at any hospital ever...and the staff (for the most part) did not recognize me out of uniform. I was in and out in under an hour!!! I Kid you not..and they were STEADY.

This same hospital has embraced technology, but also a culture of "being nice". They started using technology to post their current (w/in 15 minutes I believe) average wait time in their ER on major billboards across town and on the interstate. A similar sized hospital nearby is the complete opposite. Both serve a high volume of uninsured and under insured people. Both are community hospitsl. It just depends on leadership ad it can be done.

S

Edited June 6, 2011 by croaker260