Wednesday, August 1, 2007

ER's test the patience of patients

I used to work in a hospital emergency room, although it seems like 100 years ago.

It was back in the mid-70s, in Lexington County, SC, and I imagine the same challenges we faced there are still bedeviling ER personnel today.

This was, I always tell people, the perfect preparation for a later job in journalism. The hours were uncertain, the pay wasn't great, and I had to ask personal questions of people who didn't want to answer them.

Even with all that, though, the Lexington County General Hospital ER fulfilled my No. 1 requirement of any job, that every day at work be different.

We had shootings and stabbings and car wrecks. We had close encounters with chainsaws and fire ants and fish hooks and vicious dogs (as well as vicious husbands and boyfriends). At the same time, we also had a steady flow of patients who probably shouldn't have been there.

My favorite exchange between nurse and patient at that hospital was with a man who came in for treatment of what used to be called, in polite company, a "social disease." This was duly noted on the chart that I, as the primary conduit of information, filled out and placed in the window behind me.

With this individual, "patient" was a misnomer. He became increasingly agitated as later arrivals were treated ahead of him (never mind that they had suffered heart attacks and seizures), and finally he stalked over to the nurse's window and said: "Can I please be seen by someone? I'm a very busy man."

The nurse, an older woman who had seen it all, looked at his chart and replied dryly: "Yes. I can see that."

I thought about all this when I read Cynthia Pegram's story a couple of Sundays ago about long waits for emergency room patients. At Lynchburg General, one of the busiest ER's in the state, the median time before treatment was more than three hours.

The centerpiece of this article was a cautionary tale about a woman who was referred to the ER by her doctor with a possible urinary tract infection. She and her husband first walked through the doors at 1 p.m. on a Sunday and didn't leave until 13 hours later.

Some doctors can perform open-heart surgery in a lot less time than that. Put another way, that's 13 episodes of "ER," back-to-back. And in the end, the woman was told: "Just keep taking the medication you've been taking."

The couple made a point of telling Cynthia that they had no complaints about the quality of care, or the compassion with which they were treated. But 13 hours?

Here's the problem, I think. Running a hospital emergency room is like trying to operate a fast food place and a fine-dining restaurant in the same space.

Some people are there because they'd be dead otherwise. Some are there because their doctors told them to go there. And others, with more minor complaints, are there because they don't have any other place to go.

When you try to funnel all this diverse humanity through one portal, it can get crazy. The usual rule of "First come, first served" doesn't apply when you're waiting for three stitches in the end of your finger and ambulance attendants suddenly burst through the door bearing someone who has been struck by lightning. That's what happened to the woman in Cynthia's story -- she kept being trumped by worse-case scenarios.

It seems to me, however, that there must be some logical way to deal with this. How about reserving one area of the ER for the more routine cases, and let that operate indepedently of the trauma and cardiac areas?

Moreover, isn't there some way of determining how serious something might be before that person gets to the ER? Perhaps the problem is fear of lawsuits, but couldn't some of this be handled by a nurse practitioner, even over the telephone?

Emergency room visits are never pleasant, and they're not cheap. But maybe they could at least be shorter.


Bedford Hawk said...

Darrell, you're right on the money about ER's but I am thankful we have ours in Bedford. Would hate to have to travel to Lynchburg or Roanoke and get caught up in all of that metropolitan coming and going with the moaning and groaning all about. Thanks

L. Pitcher said...

Bottom line is if you're bleeding or unconscious- you get seen pronto. If you can speak a sentence fairly coherently- then you sit and wait.

This probably sounds like a common sense approach but not all serious problems are visually obvious. The prospective patient is at the mercy of the person manning the triage desk.

I speak from experience. I suffer from asthma and was having a tough time breathing. I had my husband drive me to the ER- my regular dr.'s office was closed and I knew enough about asthma that I knew I needed to be seen by medical professionals before they opened their office the following day.

I can only assume that because I was coherent and polite they deemed me someone who could wait. And wait I did.....for 3 hours. Once I was seen- I was immediately admitted to the hospital and ended up staying for 5 days. I was sick...very sick- but not up to the standard of the triage nurse to be moved to the head of the line to be seen.

The second time I had to visit the ER it was with the same problem but I came by ambulance....and I didn't wait at all. I was immediately seen by a nurse, then a dr. and was admitted to the hospital again.

Same diagnosis....same patient...the only difference was how I got to the ER.

To me- it seems that the fault of our local ER lies with the triage procedures, how these procedures are implemented and the training of the person who is manning the desk.

The ER buck stops there.

Anonymous said...

You have had an interesting life, Darrell. I hope you will keep having life adventures that you can share with us. You should post your Resume. I would love to be able to put all these tales and memories in some chronological order. I mean, it seems that you have been in Lynchburg for quite a while and yet you keep coming up with these vignettes of your past life in other places. But I am not sure that a four year old should be out playing unsupervised; that is the kind of situation that might lead to a visit to the ER in the older, simpler days as well as in our current more complex and dangerous times. I got better once waiting in an ER. I can't remember what they charged me.

GistOut said...

"Running a hospital emergency room is like trying to operate a fast food...."

Cited as quotable metaphors-analogies in Metaphor-Analogy Archive".
Thank you.