Bad ER experience...what went wrong?

Monica RN,BSN · Apr 10, 2004

It is really hard for anyone to tell you what was going on that night in the hospital. But I can tell you in our ER, we wait hours before we get labs, tests ect. An average ER visit is not uncommon to be 6-8 hours, sometimes longer.. in fact on a busy day or night a person can expect to wait in the waiting room that long alone before getting in to be seen. In our smaller hospital, on weekends, a person has to be called in to do suc things as a CT scan.. perhaps this was the delay?? Again, noone can speculate on what happened with your experiance.. but an ER is not an Express service.

Hope all is well.

Gompers, BSN, RN · Apr 10, 2004

In our smaller hospital, on weekends, a person has to be called in to do suc things as a CT scan.. perhaps this was the delay??

I was thinking the exact same thing. Even if it doesn't look like the ER is busy, that doesn't tell you how the other parts of the hospital are going. I'll bet either CT was backed up or the scanner operator was en route. Especially if the hospital is having financial problems, it makes more sense to not staff areas like CT scan 24/7. I work in a huge trauma hospital and even by us, only one of the four CT rooms is up and running at night.

I hope he goes back and has the CT ASAP. When the doc said it was an emergency, he meant he wanted the scan that night, not next week! But understand that real ERs are NOT like on TV! Unless you're bleeding to death or coding, things usually take a few hours, even for "emergency" tests like the one the doc wanted on your hubby! There still might be bleeding or problems and it's really best to have him looked at, so please try to schedule an appointment for a CT!.

memphispanda, RN · Apr 10, 2004

I agree with the previous poster...

Smaller hospitals often have radiology on-call for nights and weekends instead of having someone in-house all the time. That is a benefit of going to a larger medical center--they usually staff all areas 24-7.

If he was that concerned with why he wasn't getting the CT right then, why didn't he just ask? Leaving before getting care surely wasn't a great choice...not only did he not find out whether or not there is something going on in his brain that could cause a problem, he probably had some poor person scrambling out of bed to get to the hospital only to find the patient had left.

Just knowing "he is still alive" today doesn't mean there was no problem. Bleeding in the brain can sometimes take WEEKS to show up.

eak16 · Apr 10, 2004

that must have been frustrating- and it MAY have been that the staff was just not on the ball that day, OR it may have been that there were sicker people in line to get a CAT scan that weren't visible to your husband. Honestly an hour and a half is not that long to wait in a busy ER, and sometimes people waiting dont see what is going on "behind the scenes" or they cannot be told (hipaa anyone?) about the major traumas next door. Being that it was a small hospital i doubt there were MAJOR major traumas going on, but just yesterday I was in a level one ER (my practicum) and several VERY critical paitents came in all at the same time. To fit them in the main trauma room the nurses moved some other fairly sick people out into the hallway and had to leave them there for a while. To those people they must have been wondering what was going on- you get my drift, there are just always two sides to the story. Part of nursing is prioritizing. The sickest always get care first. Another part is managing scarce resources. If a unit is short staffed, the nurses will try to keep everyone safe, but somethings may not get done as quickly as they might have with full staffing. I hope your husband is feeling better though. :)

luv2yoga · Apr 10, 2004

Good information - that helps me understand. Also sounds like he needs to schedule the CT. Thanks.

Heartattaq · Apr 11, 2004

Sorry to hear he had to wait so long, but it pretty much goes like the others said. If the town is small enough, either a tech had to be called in and took their sweet butt time, or it is a possibility that a trauma or something else could have happened or a stroke that, (in my hospital anyway,) is automatically next on the CT table when it comes in.

Because your husband heard 4 people at the nursing station talking does not necessarily mean that the only reason he didn't get into CT quickly was because they were doddling.

As well another thing I have noticed now that I have been on both sides of the fence. Even if you are triaged and in a room and assessed by the nurse, it doesn't guarantee you are gonna have a fast turnaround time. Last night in the ambulatory section for instance, we had people triaged and assessed by nurses waiting in rooms. So we had all our beds filled and some people were going on a 3 hour wait to be seen by the doctor. Meanwhile there was no more we could do, so we waited at the nursing station for doctor's orders so we could get in gear again. As well during that 3 hours we were dealing with some very irate patient's wondeirng why they are in rooms waiting when we are just "sitting at the nursing station." They just don't understand that we can only go so far then we have to wait for others.

Again it is unfortunate your husband had to wait and I won't speculate on the circumstances, but I strongly suggets he go back for the CT, considering the Dr. seemed concerned. And I sincerely hope all turns out well for him.

stressednurse · Apr 11, 2004

As a nurse that sends patients to hospitals from a sub acute facility, I wait at least 4 hours from when I figure the patient will arrive at the ER before I call to ask if they might be admitted or sent back.

Testing on acute patients takes that long. Nurse looks at you asks questions and does exam. Doc looks at nurses exam and does his own. Doc orders tests and blood work. Nurse does blood work after she gets food for 5 other people who are in the ER. Nurse calls for radiology to do that part of testing. Radiology is busy and asks that the nurse bring the patient over to them. Nurse does that after she puts 2 patients on bed pans and orders more food for 2 others. On the way to x-ray the nurse drops off some papers in nuclear medicine for a test that needs to be done.

After nurse comes back to ER she is verbally abused by one of the patients she put on a bed pan cuz she didnt come back quickly, patient will report her for her bad patient care.

Welcome to nursing

veetach · Apr 11, 2004

You have been given very good advice so far. I would like to add that in our hospital, we only have one CT scanner, and we usually have 6-8 patients backed up at a time. It is the obligation of the RN to keep the patient updated on what is taking so long, though.

Our average wait in the ER is also 6 hours. It takes time to get to the scanner and time for the Rad to read the scan (after 11:00pm we telerad everything to Australia for interpretation :rolleyes: )

Just a reminder, if you hear nurses talking or laughing it doesnt mean they arent working, there are times when we are at a standstill waiting on lab or xray or ct or even the docs.... the general misconception is that if the nurses arent running around like crazy then they must be wasting time....not true.

It does sound like your husband needs a ct scan, I would make sure he gets one. Also dont be surprised when you get a bill for the ER visit, even though he didnt stay for treatment he will be billed.

Stressednurse, I think you must work in my er you have described our dept and patients perfectly!! LOLOL :rotfl: :rotfl: :rotfl:

Stitchie · Apr 11, 2004

I know it's frustrating to think that your husband didn't get the care he deserved, but I do agree with the above posters. The nurse should have kept your husband informed, but he also has a duty to ask questions about what his plan of care is.

The CT machine is a complex and sophisticated piece of machinery that takes some specialized training to operate, even though the test itself is relatively straightforward and quick.

Waiting is always the toughest part. But nausea/vomiting with a head injury isn't something to be taken lightly. And yes, sometimes waiting for CT to get a room / machine / tech / radiologist all on board can be a difficult chain of events to put together. The ED doc may not be all that experienced in radiology, and have to refer the films to a larger center for reading anyway, so perhaps the test didn't get done until there was someone available to read the films.

But I think you're right about the nurses not keeping you informed. That's not really fair, since it's pretty scary to be in an ER by yourself and no one is telling you anything. But since he left without being seen, you'll get a bill.

caroladybelle, BSN, RN · Apr 11, 2004

Several points.

Last time that I went to the ER for a CT of the brain, following a car crash with significant symptoms, It took over 6 hours before I was scanned and released. This was on a "slow" night of the week. I had a headache and was between a little child that screamed the entire time and an old man with dementia, that screamed the entire time.

If there is only one or two scanners, well it will take hours before being scanned as emergencies must go first. And if the patient is "well" to complain about their treatment or to be discomforted by waiting, or for that matter aware of the time (eg. conscious), then they are probably not the worst emergency in the ER ...and they are going to wait.

It also does not make sense to transport a patient until the scanner is ready for them. Sure, they could transport him but then he would be waiting in the mean time. And those gurneys are small, and CT scan is usually cold.

And were you sure that those were nurses talking outside the room? They could have been techs/aides, phlebotomists, residents, interns, respiratory therapy, social work, EMT/paramedics, transport, dietary, housekeeping, engineering, patient reps, chaplains, physical therapists, students.

For that matter, if they were on break and CT were occupied, well yes they needed to be in a breakroom, but as someone that works nights, and has no relief, our nurses frequently have to eat and "break" at the desk..because we have no choice. And on a 12 hour shift, you better hope that we eat something so that we do not pass out in a code. Unfortunately sometimes we don't even get to eat, or even pee, even though we will always be docked for the break time.

I regret that the "service" could have been better. But ER care is not about service, it is about getting the worst cared for first, and the rest as best you can and just keeping people alive.

veetach · Apr 11, 2004

words of wisdom, caroladybelle! Way to go!!! :)