ER wait-times a customer service, clinical concern

RunnerRN, BSN, RN · Dec 8, 2006

For people that don't want to access the whole article, here are a few paragraphs that summarize it pretty well...

"The Rapid Medical Evaluation and Express Care program positions an RME physician, a triage nurse, and a triage technician in the triage area to care for the patients who are not truly in need of emergency services. Many people choose to walk into hospital EDs with minor injuries or ailments because they see it as the best option during the hours in which their primary care physician is too busy or unavailable.

During the peak hours, the RME team is hard at work. For example, a mother may show up with her son, who is complaining of an earache and a fever. "The physician at triage can do [his or her] triage assessment, look inside the ear, prescribe the medication, give the boy the discharge medication, and discharge the patient," says Leinen.

In the past, for example, a woman may have shown up complaining of dysuria. The patient would have to wait in the ER waiting area for a bed. When the bed became available-perhaps hours later-the patient would undergo tests and wait for those results. "It could take a long time," Leinen says. "Now we can effectively treat about 20 percent of the patients at the front door." In the event that a person arrives with a serious condition (e.g., a heart attack) he or she receives the same care as in the past, except the workup begins at the front door."

I'll be the first to say that I don't really care about "customer service" as long as the sick people are being seen and treated. I can be a "warm and fuzzy" nurse, but my first priority is not making sure Auntie is comfortable, it is making sure she isn't having an MI. But I am for anything that ensures beds will be available for the sick people, and this sounds pretty interesting. What bothers me is that the motivation here seems to be making the "convenience" patients happier (because they're the ones who have the CHOICE in which ED they come to) instead of decreasing overcrowding.

We've all had the patient come in after 2 weeks of a cough (suddenly can't handle it after 14 days and it is Sunday) who, as you're assessing her, nonchalantly asks when she'll be seen. She's only been signed in for 30 minutes, but "I really don't want to be here." No poop lady, neither does the unconscious intubated MVC, but he is, so sit down and wait your turn. And what about the people who come in for a nonemergent issue and try to choose their doc? FYI, if you've been here enough that you know our docs by name, then you can wait.

Going off on a tangent here.....I'm interested to see others' opinions on this issue.

Katnip, RN · Dec 8, 2006

So now it's all about customer service instead of patient care? Typical.

LuvMyGamecocks · Dec 8, 2006

Not trying to hijack the thread, but I'm hoping this ties right into it....

What happens if there are simply NO staff members available?

I'm talking if all available staff members are treating actually EMERGENT conditions, people in the waiting area are...waiting...and afterwards they fill out "customer service" surveys complaining about the wait time. You, as ER staff, are doing what you're paid to do (treat emergent conditions)....why does anyone have the right to complain about the job you're doing?

Does that ever happen? Do ERs ever get tied up with all staff members treating emergencies without being able to do anything but focus on keeping those emergent cases alive? Just curious....

I think that once efforts are made NOT NECESSARILY TO CHANGE THE HEALTHCARE SYSTEM, but to change the mindsets and misconceptions about emergency room care (urgent versus emergent care), then we might get somewhere. Shouldn't that originate with those so concerned about "customer service"? Instead of putting so much time, energy and money into being assured your patients are "happy" with their care, be sure that they understand WHAT the emergency room is actually for.

RunnerRN, BSN, RN · Dec 11, 2006

Does that ever happen? Do ERs ever get tied up with all staff members treating emergencies without being able to do anything but focus on keeping those emergent cases alive?

Oh yes it happens a lot! Especially on noc shifts when we are just at minimum (or slightly above) staffing. I've had nights where we all get pulled into one very sick trauma, doing everything possible to keep ABCs, and you get a CP, a toothache, a HA, and abd pn at once. Obviously, someone books it to the CP, and nurses will eyeball the others to make sure they aren't sick, but you do what you have to do. It gets very frustrating because I don't think much of the public understands that triage doesn't just happen at the front door - we are continually triaging our patients, and if there is someone sicker than you, then I will be in with that pt.

I've said before and will again -- I don't care how happy the nonsick ppl are, as long as the sick pts are beings taken care of. We all do the best we can, but I just with people would understand how their actions affect the lives of many other people, esp in a busy ER. I pity the fool who catches me at the end of a crazy shift and starts to complain about how I haven't given them enough attention. If it weren't for HIPAA, I would pull them into the intubated stroke/MVC/GI bleed and show them exactly how lucky they are that I haven't had to give them extra attention....