Monday January 21, 2008
January 21 2008
This week, White Coat Black Art deconstructs the wait in emerg...why you wait in the waiting room and inside the sliding doors themselves. As I mentioned in the show, the triage nurse at the front door to the ED assigns you a priority of 1 to 5 based on how sick you are. Ones and Twos (for example, people in cardiac arrest, with severe breathing problems, or unconscious) get in pretty much right away. Fours and fives are people with fairly minor problems.
It's the 'three's' that I worry about. These are people with urgent problems that aren't immediately life threatening....things like appendicitis, a tubal pregnancy or a bowel blockage. Threes are supposed to be brought in fairly quickly, yet overcrowding and lack of beds mean they often wait far longer to be seen by a doctor than they should. I've seen patients with appendicitis whose appendix burst while they were in the waiting room. I've also seen women with a tubal pregnancy that burst while they waited.
All the more reason why you should check out our interview on this week's show with two experienced triage nurses who work in Calgary. Triage nurses not only assess you at the front door; they keep reassessing you to make sure you're stable while you wait. And they do that while taking verbal and sometimes physical abuse from angry patients. I wouldn't want their job. I'm amazed they do it as well as they do!
Here's some take home advice. Next time you seek treatment in emerg, and you're asked to take a seat, ask the triage nurse what number you've been assigned. If you're a three, keep asking the nurse when you're going to be brought it, especially if you're feeling sicker. Just do it nicely!
In the weeks to come, we'll visit the emergency department at Hotel Dieu Grace Hospital in Windsor, Ontario, to show you the innovative things they're doing to shorten the wait.
Next week, we look at a very uncomfortable subject for people on the inside of medicine: how to deal with incompetent doctors. If you have an opinion on the subject, check out our latest question. That's medicine -- on my side of the gurney!
Previous Comments (5)
Listening to your program as I type. I visited an ER last Tuesday evening with pain in the groin area and the back. I was there over 6 hours and during that time from the triage nurse to the other nurses to the 3rd yr med student to the doctor to the staff who transported me to X-Ray and CAT Scan to the staff at X-Ray and CAT Scan I was treated with courtesy and expertise. I left knowing that I had a kidney stone and there would be follow up at a later date. I was given prescriptions for pain and an antibiotic.
Not an experience I would want to repeat but the people who dealt with me made it not too bad.
I had a frightening experience in the ER during my second pregnancy. I started to bleed in my 12th week of pregnancy and hurried to the hospital ER. I ended up sitting in the waiting room for 7 hours thinking that I was loosing my baby. At one point I went to the triage nurse and asked her if I could go home, I knew that if I was miscarrying there was nothing that could be done about it at this point anyways. She told me to stay, just in case, and I did. 4 hours later I finally saw a doctor, who told me exactly what I had said to the nurse - nothing could be done. It turned out that I was not miscarrying, but I had a small abruption of my placenta. I managed to carry my baby to term through a miserable pregnancy in and out of the hospital and months of bed rest.
I know it's not the worst ER experience in the world, but it was awfully traumatic for me. I certainly don't blame the nurses or the doctors in the ER, I could see how overworked and understaffed they were. I just wish there was some way to fix the system so that people who are in pain and frightened don't have to go through what I did.Jennifer Dixon, January 28, 2008 10:50 AM
Just listened to this podcast. I'm struck by the parallels in the comments in what the nurses and doctors were making in your piece, and the comments that I face when working on projects to reduce wait times and improve processes in businesses. What's amazing is that in the second case, we're able to make real progress when we get those folks together, start to address the real problems, and shorten those cycle times.
I can't wait to hear more about how Hotel Dieu is doing, through applying continuous improvement. Health care is certainly struggling, and I hope some of the new solutions Hotel Dieu and other hospitals are trying take hold and start to improve the system. We can't keep relying on the heroism of the nurses & doctors in emergency to keep the system going and treating patients.David, March 1, 2008 11:54 PM
"Here's some take home advice. Next time you seek treatment in emerg, and you're asked to take a seat, ask the triage nurse what number you've been assigned. If you're a three, keep asking the nurse when you're going to be brought it, especially if you're feeling sicker. Just do it nicely!"
Oohh, BAD ADVICE!! Want to piss off a triage nurse?!--keep coming up asking when you're getting in. First, we DON'T KNOW when you're getting in--it depends on when someone else leaves and makes a space, and on what else rolls in the door. Second, we've already got your name and your chart and it's been placed in order in the pile of other people's charts--if it was your turn now, somebody would be calling your name. And third, CAN'T YOU SEE I'M BUSY TRIAGING THE NEXT TEN PEOPLE IN LINE AND TRYING TO REASSESS THE 20 OTHER PEOPLE IN THE WAITING ROOM??!!! If your condition is worsening, by all means, speak up--but DO NOT, UNDER ANY CIRCUMSTANCES keep asking me to look into my crystal ball and tell you how long the wait is going to be!!Beth, March 11, 2008 8:06 PM
its very reasonable article.
realy good post
thank you ;)