How long is the wait???

First, if they were Gucci sandals, retail, I can understand her angest!

Seriously, in our ER, lately, it seems we get slammed at night and the wait, especially for the truly minor toenail can be even 10 hours! Now, if you've shown up at 11pm, after minor care closes, for a toenail problem you've had for 6 months (had that happen on Christmas Morning!), then you're going to wait. Sheesh, it'd be faster to go home and get some sleep and come back at 10am when minor care opens. At least you'd sleep in your own bed! But nope - they can't take it anymore.

On night shift, we have a rockin' team, so we move 'em through pretty quick when we can, but when we've had 19 rescues and 5 BLS units in 6 hours, you're gonna wait unless you're dying!

Lately, past 3 months or so, it seems to have gotten insanely busier on nights, and with SICK people, not just BS. Anyone else notice this? I was in triage Christmas Eve and a woman in her 40's came in with CP - she was having an MI and we got her fast enough to get her retavased and squared away. Is acuity suddenly going up everywhere or am I just lucky?

My answer: "We're not too bad right now so it shouldn't be too long, but that can change at any time", or "We're pretty busy today so it's going to be awhile, but I can't tell you how long."

When people in the waiting room complain we tell them (without any of the bosses around, of course!) "You are more than welcome to go to another hopsital, but they're usually much busier than we are and you will have to wait longer there. Your choice."

What I hate even more are the phone calls: "Can you tell me how long the wait is if I come in right now?" Even if we have no pts right then I will lie through my teeth and answer that we're very busy, I don't know how long it will be, and "If you have an urgent or emergent problem it shouldn't matter to you."

I answer, "I'm not able to answer that, because we constantly juggle the acuity of our patients to provide everyone with the most appropriate care." Period. I do not go on. Doesn't matter how busy it is, or what I know is or isn't coming. I do ask if anything has changed since the pt. was triaged, so that I have some reassessment of the situation.

Bottom line ... if you're waiting, you are by definition less acute than others.

My pat answer. "We do not give out that information. If you are having an EMERGENCY, then check in and we will be happy to see you."

I just know in the bottom of my heart that one day someone is going to think, "My sore toe really isn't an emergency I will just go to the doctor/clinic in the morning....."

There is just no way to forcast how long a wait is going to be, especially in triage. I cannot see what is coming in the back door per ems.

I also work in an Urgent Care every once in a while, and the day after Christmas I had a girl go postal on me because I couldn't answer how long the wait would be (the waiting room was full and people were sitting out in the hall.) I was completely shocked! She said "Well if you can't tell me, I'm going to go to the ER" And I just replied that it was her choice, but we would most likely get her seen in less than an hour, all the while thinking "Go ahead, last I heard our parent hospital had 45 in the WR."

In the ER, I just reply similarly to the above.

EmerNurse....I feel like our acuity goes up around this time every year. We've had a lot of "real" CP and just very sick people. Not that I enjoy when people are pulled out of cars unresponsive and you start to code them in the WR, but it does shut the complainers up pretty quickly!!

we're not allowed to give time estimates. someone in risk management thinks it could potentially be construed as an emtala violation if we do.

(i think they are afraid we would be accused of telling the uninsured that the wait is longer to get them to leave.)

so, whenever i'm asked, be it a patient i have triaged or a phone call, i just tell them "there is no way to tell. that changes from minute to minute."

you'd think the people in the wr would get it after getting that answer a few times, but it doesn't keep them from coming to the window every 10 min. i feel your pain. it is one of the things that i hate about triage.

it always amuses me when they get really upset, and say (threateningly) in a huff "well, i've been waiting for hours. i guess i'll just have to go home and see my doctor in the morning."

i always want to answer "sounds like a great idea to me!" instead, i have to say, "well, if you want to leave i need you to sign this form...." and sometimes, those few words are enough to "convice" them to stay. :trout:

On a good day when I am not crabby I answer, " I really cannot answer that we see patients by how sick they are, not by what time they get here which includes all of the ambulances and helicoptors that we get in."

I did loose it once when a patient with a hangnail came to the window 25 minutes after waiting and demanded to be seen because she had a hair appointment and I told her, "When someone dies or gets discharged we will take care of you." I felt really bad afterwards and apologized to her for being rude, but sometimes you just loose it.

Our wait times have been in the vicinity of 2-4 hours after 11am. Our acuity has skyrocketed also. Yesterday I had 4 vented patients, to later find out that the ICU got one of our resource nurses so that all the nurses could have a 1 on 1 nurse to patient ratio in the ICU.:angryfire

One of the things that irritates me the most when I am in triage is the employees that work at the hospital. I can understand the general publics ignorance, but the people that work in my hospital kill me. I will get a nurse, resident, CA, whoever that comes to triage and tells me that, "My change nurse and or manager told me to come down here to get checked out and that you would see me right away." When you tell them that you are unable to do that because they got their big toe ran over by a wheel chair you get looked at like you have three heads. Then you have that units charge nurse calling you complaining that they need the employee upstairs because they have x amount of patients and blah blah blah. It is always a big ugly scenerio.

We are computerized and everyone has a timer that started when they signed in to the ER so when I am in triage I usually look at the timers and will say "if we don't have another life threatening emergency come in the next person that will be taken to a room has been in the waiting room 2 hours and 51 minutes (or whatever the times says). I then tell them how many other people are also waiting to be seen. I then say "We will get to you as soon as we can but it is going to be a while. Let me know it you develop any new symptoms. "Then when they tell me they don't feel good I explain that everyone who is in the ER is here because they aren't feeling well . I also tell them I understand but after taking their history and assessing them in triage I don't see anything that makes me think they need to be seen ahead of someone who has been waiting longer than them." We often have LONG waits this time of year (2-10 hours) so I do try to seem helpful and always, always tell them to let me know if they develop new sx or are getting worse. If they aren't sick and they want to leave I sign them out AMA. If they are sick I tell them when I triage them "It is going to be a long wait...but no matter how long it is you have to have medical treatment today. Do not leave without talking to me." I write myself a note with their name and my Dx and I retriage them every 2 hours. I also make sure if I leave triage that the next person is aware of my concerns. This usually works well on most sober reasonable

patients. When they get obnoxious I just say "I don't know" and move on.

I know there are busy ERs and even busy days in the slower ones... but there have been times when I've been in an ER on a Sunday morning or the like. The staff were smiling & chatting, some sitting around, and it still took a couple hours or more to get through and get out. What's up with that?

i know there are busy ers and even busy days in the slower ones... but there have been times when i've been in an er on a sunday morning or the like. the staff were smiling & chatting, some sitting around, and it still took a couple hours or more to get through and get out. what's up with that?

simply the nursing staff can't do everything. there are lab tests to be run, xrays to be shot and interpreted, fluids to infuse, and most of all, doctors to disposition a patient.

all i can do is be sure the labs are collected and in the lab, the xrays are ordered and prep done (such as oral contrast for some cts), fluids are hanging and infusing without difficulty, and that the doctor is aware that all is back and ready for the doctor.

we cannot:

--make the doctor see the patient (though i sure do try sometimes)

-- run the lab tests and release the results (except for point-of-care testing)

--take the xrays/cts

--interpret the xrays/cts

--make the fluids go in faster (well, i guess we can....but we only use those pressure bags when really needed, not for patient convenience)

--make the doctor chart and disposition the patient.

-- during the night, we also can't make the on-call ultrasound tech/nuclear med tech/ etc get there any faster.

we also can't help it when all the tests are back, and the doc decides to order a few more, just to be sure. trust me, we want to choke him/her then, too.

so yes, there may be some "down time" for the staff when a patient is waiting to be dispositioned. we're waiting, too.

My answer: "We're not too bad right now so it shouldn't be too long, but that can change at any time", or "We're pretty busy today so it's going to be awhile, but I can't tell you how long."

When people in the waiting room complain we tell them (without any of the bosses around, of course!) "You are more than welcome to go to another hopsital, but they're usually much busier than we are and you will have to wait longer there. Your choice."

What I hate even more are the phone calls: "Can you tell me how long the wait is if I come in right now?" Even if we have no pts right then I will lie through my teeth and answer that we're very busy, I don't know how long it will be, and "If you have an urgent or emergent problem it shouldn't matter to you."

Why lie and why be judgemental? Maybe you've never had to go to an ER. Just say you really can't answer that with any certainty because even though it's quiet now, it could get busy the instant you hang up. Maybe you could even do a little screening and try to help the person figure out how to avoid the ER. You could suggest that the person call the private doc, if the person has one.

And don't forget - doctors often tell their patients to go to the ER. It isn't necessarily the patient's choice.

I know there are busy ERs and even busy days in the slower ones... but there have been times when I've been in an ER on a Sunday morning or the like. The staff were smiling & chatting, some sitting around, and it still took a couple hours or more to get through and get out. What's up with that?

Maybe the doc is catching a few winks. We used to let our docs do that whenever possible, without unreasonably increasing the patients' wait. And if it was a true emergency, we'd grab the doc instantly, exhausted or not.