Alternative to shouting a name

[heavydmg]

Good afternoon everyone!

had a question for all of you ER nurses out there. How do you call up a patient from the waiting room? We currently have a split waiting room with 2 sides. What we find is our ESC or CNA will walk to the split and shout a first and last name for the patient to come up and be seen. This is not only abrupt but also disruptive. I have been asked by our leadership to come up with ways we can avoid shouting for patients. a few notes i have thought of as well as assets we already have in the ED we could use.

1. buzzer style from the restaurant industry. When a patient is called the buzzer goes off. Problem with that is if the patient leaves or decides to "get back" at the hospital for long wait times they throw it away or simply walk out. Also no real ROI is attached to this so its hard to justify a cost.

2. number system. Having a number would work great but what you would find is a lot of jumping as higher acuity patients are seen before esi 3,4,5s This could potentially lead to altercations and a lot of questions.

3. Cell phone text messages. not everyone has a cell phone. (we have a high homeless population) also not everyone is checking it all the time. In our ER when you call the patient you want them NOW not in 5 minutes.

assets- We currently have a rotation of high school volunteers that walk around and try and stay on top of the patient locations.

I appreciate any suggestions and or stories you may have! thank you in advance!!!

[Ruby Vee, BSN]

I've been a patient in an ER that uses the buzzer system like restaurants -- I was a fan. However, I can see that it might be problematic if angry patients decide to just leave with the buzzer or toss it in the trash. Any way those volunteers could circulate and softly call out the first name? When someone looks up at the first name, then ask them for their last name.

[amoLucia]

1 - Alphabetize the waiting rooms?? Names A thru L sit on the left and M to Z is on the R. Your ER tech could just circulate thru the side and SOFTLY announce the name.

I could see problem of lopsidedness if an overabundance of names on one side outnumbered the avail seats. Or if a huge group of 'associates' were to show up and also overload one side.

2 - With your buzzer system, could security be stationed at the doorway to collect buzzers as folk exited? Would improve the retrieval of buzzers (better for cost containment).

(What is ROI - return on investment?)

[Nalon1 RN/EMT-P, BSN, RN]

If there was a better way, it would be done industry wide already.

Abrupt and disruptive? It is an ER waiting room, not a hotel lobby. What is being disrupted?

You have already posted the negative of some of the alternatives.

Cost of the buzzers is prohibitive, as well as the continued cost of replacing ones that are lost. If they are OK with this continued cost, this would probably be the best option, since regardless of where the patient sits, they can easily be notified. Problems do arise when they don't feel or see it alert, or if they misplace it.

Number systems would only cause more anger. People that have a tooth ache and are number 3 will complain that number 4, 8, 10, 14 and 18 have gone ahead of them. A non-sequential numbering system may work, but still requires somebody coming out and yelling the number.

Texting, will never work. What do you do for those that don't have texting?

Yelling the name is still the most efficient.

Not really sure what else may work.

[mrricland]

I realy can't see Any alternative to shouting. I mean IF you use different systemens you still need to keep explaining to a LOT Of People how IT works. But i guess that depends On the size Of the hospital and how many People you expect in the waitingroom.

[SilleLu]

I don't work in ER. However, having been on the other side, I wonder if a system like the OR waiting room would work? The patient is given a number/letter code which can be shared with family as the patient wishes. The board is color coded with the progress of the patient. Pre-op, operating room, post op, recovery, etc.

Would that work in ER? No pager to lose, when the code comes up for patient to be called back, a flashing green color. Patient actively in ER another color, being admitted another color, pending discharge, etc. Of course if patient isn't watching, calling out name would be the backup.

[Nalon1 RN/EMT-P, BSN, RN]

I don't work in ER. However, having been on the other side, I wonder if a system like the OR waiting room would work? The patient is given a number/letter code which can be shared with family as the patient wishes. The board is color coded with the progress of the patient. Pre-op, operating room, post op, recovery, etc.

Would that work in ER? No pager to lose, when the code comes up for patient to be called back, a flashing green color. Patient actively in ER another color, being admitted another color, pending discharge, etc. Of course if patient isn't watching, calling out name would be the backup.

Could it work yes, would it, probably not. They would have to watch the board (as well as have enough boards in the waiting room to be seen from every seat in the waiting rooms(s). They would have to not loose the number. They would still wonder why others are going before them.

It is similar to what I had said about a non-sequential numbering system, but in the end you will still have to end up yelling out numbers/names.

[Lev, MSN, RN, NP]

My old ED- Very busy, >100k visits/year, frequently 50+ people waiting - we had a microphone on the wall and a number system.

[Nalon1 RN/EMT-P, BSN, RN]

My old ED- Very busy >100k visits/year, frequently 50+ people waiting - we had a microphone on the wall and a number system.[/quote']

So a sequntial number system? So 15 would go back before 7 depending on acuity, not number in line?

You still have the "problem" of calling out overhead with the microphone, which is what it seems the OP management has an issue with (which I still don't get, it is an ER, not a hotel (Oh wait, some patients think it is)).

[skylark, BSN, RN]

I've always wondered about the "please take a number" deli counter system, where there is a dispenser with a paper roll of printed numbers, and the number being called is displayed on a screen.

The receptionist could easily issue the number when they book in, and note it on the computer for when they are called in.

It might also help with the problem of non-English speakers, who often don't respond even when their name is called correctly, as they don't know what to say.

And I do wonder about the ethics of shouting out a name to a crowded waiting room. Especially when we call patients through to specific areas, like gyne, which can be a confidentiality nightmare.

But then again, here in La La Land Hospital we give verbal reports to the floor nurses by phone, so the whole department can hear that the patient in bed -- has HIV.

I've always given a written/electronic report in the past, including a note of my extension in case they have questions.

But not here.

We have to shout the info down the phone at the floor nurse, repeating everything at least three times and spelling the patients name to them. Loudly.

How is that even legal, never mind policy?

[canoehead, BSN, RN]

I don't see an issue with stating the patient's name in front of the waiting room...its the shouting that is not so great. You could circulate in the WR and state the name in a conversational tone instead of shouting from the door. As far as name privacy, if the patient is in the waiting room, likely they brought their face with them, and anyone that knows them already knows they are here.

[Nalon1 RN/EMT-P, BSN, RN]

...

And I do wonder about the ethics of shouting out a name to a crowded waiting room. Especially when we call patients through to specific areas, like gyne, which can be a confidentiality nightmare.

...

What ethics? Calling out just a name is no violation of anything. It is not like you are calling "Jane Doe with lady partsl bleeding" multiple times.

How do people in the waiting room know your calling them to the gyn (or any other) area (you have a specific area just for gyn)?

... You could circulate in the WR and state the name in a conversational tone instead of shouting from the door. As far as name privacy, if the patient is in the waiting room, likely they brought their face with them, and anyone that knows them already knows they are here.

5 seconds to call out "John Doe" one or two times vs 1 minute (or more) walking around the waiting room(s) saying "John Doe", doing this 60 + times in a shift, 3 minutes for calling out vs 1 hour walking around, it adds up quickly.