There is a report that talked about who had the shortest waiting time in ERs and it turned out to be lil 'ol Ioway. Bravo. My state was not in the top 15.
Got me to thinkin'- what causes people to spend so much time in the ER. In our ER, it has become rare for people to be waiting 1-2 hours. In the last year, we opened up 8 more beds and that has helped people get back faster. It is a blessing to the triage staff believe me.
So the patient goes back in a timely manner. Usually the nurse or the doc sees the patient within 5 minutes. In the last 6 months the docs in our ER have made a big push to see people sooner, and they are succeeding for the most part. Sometimes they get in before the nurses.
So nurse and doc see patient. Doc orders tests, IV, etc. Most nurses who have been around a while are already anticipating what will happen. They know what will happen. Its not that complicated 95% of the time. So unless your have 3-4 patients and everything is ordered at once, you're getting in their pretty fast.
IVs are started, meds are given, xrays are taken. Then the wait begins. The wait for test results. These are really pretty timely too. Within a half hour in most cases. Xray readings sometimes take longer. So tests are back, patient is more comfortable. Wait goes on.
Wait goes on? Whats the problem? Doc has to gather test results, determine problem and do disposition. This is where things can get hung up. Doc can have up to 7-8 patients at once. So takes time to get to all of them. Once doc gets to them and decides disposition, if they are admitted, doc must call private doc and convince that doc to admit patient. Another opportunity to get hung up. Staff doctor does not call ER doc back in a timely manner. Or multiple calls have to be made to figure out which doc on call.
In our ER, the docs will not order a bed until all tests are back, admitting doc has been called. So then the wait for the bed begins. This is where the real delay comes. No beds available. Floor refuses patient (process starts over). Floor delays admit because "nurse at lunch", "nurse is busy".
There are many steps to an ER visit. If a critical patient comes in, everybody else comes to a grinding halt. Where the hang up seems to be is: 1) docs trying to
juggle so many patients at once 2) having to wait for admitting MD to call back
3) Waiting for room to be available.
Would more docs solve the problem? Probably. I don't know what the statistical average is for how many an ER doc should see at one time. I know they don't want more because it decreases their income. The admitting doc piece is not solvable as far as I can see. I think the best thing to do would be to have hospitalists and intensivists care for patients in the hospital. How do you solve the problem in delaying getting patients upstairs? 1) more timely discharges on the inpatient side. People stay to long on the day they are discharged. 2) hire more nurses so more beds can be available. HAHAHAHA
So the next time you sit in ER for hours wondering what is taking so long, realize that you are in the middle of a very inefficient system.
5 comments:
Damn x-ray people takin so long to get the results back!! Somebody should talk to them:)
I also think that part of the problem is how hospital's bill for the room. The hospital, in my area, charges per 24 hours. If they changed the way the room was billed to a per hour fee more people might leave sooner rather than later.
We have a very rapid x-ray system that allows our er docs to see the x-rays before the pts get back to the dept. Another thing we are going to start this fall is an overflow unit. We will hire 2 nurses and a tech to staff an area for ER and Direct admits to have all initial tests completed, and part of the admission process started. Kind of a "finish ER's job, and help M/S out" thing. We'll see.
Most large hospitals have timely admitting doc call-backs and floors refusing patients is a rare occurance. But I agree that patients leave the hospital way too late on the day of their discharge.
Usually this is because the hospitalist hasn't seen yet and/or consulting docs (and there can be more than several) haven't signed off yet.
A big player in all this is information. Hospitals are notorious for mish-mashed information systems and blockades by 'privacy protection' safeguards.
One day a doc may be able to click on their PDA to see a patient's current lab values and other test results, current vital signs, case-manager notes, etc. But to integrate all the systems that carry all that various information is incredibly slow-moving.
You also have to remember that patients' hospital stays are remarkably shorter than they used to be.
I forgot to also mention all the litigation-threat that influences hospitalizations. Tons of patients are admitted for things that they could've gone to a clinic for (thanks ETMALA!), thus a lot of resources are used up for trivial things and patients are admitted who shouldn't be.
"Failure to Thrive" is a favorite ER diagnosis to cover one's ass.
In our experience as parents, the biggest delays to moving our daughter to the floor are
1) which doctor is taking our daughter's case (she has complex medical needs - lots of specialists)?
2) are there enough nurses on shift to take a child that uses a ventilator?
We only go to the hospital as a last resort (partially because we have tremendous access to a good clinic and home health nurses), so when we show up, we've had doctors call ahead, etc.. Even with that, the move to the floor takes 2-4 hours (or more if they need to call in additional nurses to cover).
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