Another day of emergency department overcrowding due to high access block.
In the middle of it all one of the specialists wanders in to review his patient. He checks in at triage.
Specialist: “Is Mr Castle still down here?”
Triage: (checking computer) Um, yes. He is in the corridor. 4th bed down.
Specialist: “What the heck is my patient doing in a corridor?”
Triage: “Let me take you to see him.”
Specialist (with his medical staff in tow) is escorted down to see his patient, out of the packed waiting room and zig-zag-squeezing past all the ambulance trolleys queued up at the doorway waiting for an empty bed.
Specialist: “Crikey. Are you always this busy down here?”
And I’m thinking: Well actually no. It is you who are always this busy down here.
You just don’t realise it.
This patient is admitted under your care now. Just like those others over there. We have assessed him, alleviated his pain, established a working diagnosis, begun his treatment and now he is waiting for a bed on your ward.
This is our duty of care.
He has been moved to a corridor so we can continue to perform our duty on another of the many sick people rapidly filling our waiting room. This, despite now also stretching our resources to deliver the best quality care to your patients that we can manage.
And that specialists patients.
And that specialists patients.
And that specialists patients.
This patient cannot go to your ward until you do something to facilitate it.
Yes, it is you who are always this busy down here.
it’s not our ward that’s full, it’s the non-surgical patients we are boarding on our ward that make it full.
(one of the surgical wards at my hospital runs at >50% medical patients on average.)
This is so true. The difficult thing I find is that when patients are sent in by these specialists/consultants to be reviewed and admitted, they think this means they will arrive and be seen and taken to a bed immediately. This has resulted in me dealing with many upset and angry families, and having to explain the process and reason why they have to wait, only to cop their wrath. I think specialists sometimes live in an ideal world of their own…
You know, it was only when I started working in health services research that I GOT this!?! The general public think it’s the ED’s fault! They don’t realise that when the ED goes on bypass, and talkback radio start yabbering about sick people ping-ponging from ED to ED all night, that it’s because the wards are full*!! They start hammering their MPs for more ED nurses and emergency clinicians… um, no, unfortunately it’s not that simple. Decreasing ED wait times requires “fixing” the entire healthcare system, right down to better GP training, and preventative medicine programs. How’s them apples!
It was interesting to read in Yosef Liebman’s EMU about the JEmergMed paper on the trial of compulsory staffing numbers in an ED in California (his link was wrong – this is the paper: http://www.ncbi.nlm.nih.gov/pubmed/19345043). Nothing much changed, if anything the wait times were longer. Would be interested to hear your take on that as an ED nurse Ian.
*descriptor may not be representative of the whole truth