How to Clear Out a Waiting Room

A couple of weeks ago we had a spectacularly bad day, traumas, codes, STEMIs, septic shock, status asthmaticus, what have you, plus (of course) a department filled with the haunted faces of the damned admitted patients and volumes of epic proportions. Faced with an angry and hostile waiting room overflowing with the walking wounded, the triage nurse made an announcement.

“Can I have your attention, please!” she shouted. “Because of four critically ill patients in the department, THERE WILL BE EXTENSIVE DELAYS TO SEE A PHYSICIAN. Thank you for your understanding.”

Ten patients immediately got up and left.

I know patients come to an emergency department for reasons the health care  professionals treating them might question, and that what we consider to be an emergency often diverges wildly from how a patient might perceive it. Nevertheless — I’m thinking, maybe, for those patients it wasn’t that much of an emergency, and just maybe, their GP or (God forbid) a walk-in clinic might have been a better option and better use of health care resources.

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  1. #1 by Jenn Jilks on Tuesday 21 June 2011 - 1116

    Excellent point! I think it a great thing that you are transparent about this. People need to know that there are extreme true emergencies.

    However, I slit my thumb open and my doctor’s office sent me to emergency. I had no option. He wouldn’t see me. It would have been a 10-minute issue. My Family Health Team, in my previous rural community, had walk-in clinics.
    There are no walk-in clinics around here.

    I visited emergency for what I thought might have been a sprain, there were several people bleeding all around the room.

    I think, with an explanation, people will understand crowded ERs. I waited to have my foot seen, x-ray taken, while ambulances brought in stretchers. I knew why I was waiting.
    I think physicians need to figure out how to manage, in order to keep non-emergencies out of waiting rooms.
    That said, my doctor also does shifts in the ER.
    Discussions need to happen.

  2. #2 by CC on Tuesday 21 June 2011 - 1843

    Definitely. You would not believe how many people I keep out of ED….wanting to go for silly things….I keep telling them they DON’T want to go there….unless they are in an *actual* emergency….then I define what an emergency would be…..and then I tell them that spending time in the ED can actually make you sicker…..

  3. #3 by NoniMausa on Tuesday 21 June 2011 - 2125

    Hmm. I wonder how many who left, came back later? Perhaps the announcement merely told the less urgent people that they had time to visit the washroom, have a meal, or go get a book for the long haul.

    About that meal, bye the way — a friend in her 90s had head pain, a few days after hospitalization for a fall on the bus that had cut her scalp and knocked her out. Her niece took her to the emerg and sat with her because my friend is deaf and wouldn’t have responded to a summons. As the hours went on, my friend got increasingly hungry, but neither of them dared to leave and risk losing their place. Four or five hours of waiting would have been all right, I suppose, but by the time they were seen, around dawn, my friend would have qualified for a full set of fasting blood tests.

    People don’t always leave because they’re dabblers. Thank God my friend had someone with her, or she might have taken a cab home and died of bleeding in the brain. I don’t imagine there’s a way to solve the food problem that wouldn’t cause worse problems, but dismissing those who leave as dabblers isn’t helpful.

  4. #4 by Barry on Wednesday 22 June 2011 - 0118

    This is not a simple problem. When I live in Hamilton – renowned for a great medical school and a dire shortage of family doctors – I wound up with a doctor who was overbooked to an insane degree. Every appointment was at least two and half MONTHS away.

    And because they wanted to keep the business within the practice, they strenuously discouraged patients from going to walk in clinics. That didn’t stop me, but I’m sure it did for many people.

    Besides, let’s face it – a visit to Emergency usually means at least SIX hours in my experience, and it’s rather insulting to suggest that people choose this route for frivolous reasons.

    • #5 by torontoemerg on Thursday 23 June 2011 - 1208

      In my emerg, six hours to see a doc is now the exception, not the rule. Your choice of the word frivolous makes me think of all sorts of rude comebacks, but suffice to say, it is a waste of health care resources to treat a presenting complaint of ‘vomiting x 1 hr'” with no other symptoms in the ED — at any time of day.

      • #6 by Barry on Thursday 23 June 2011 - 1743

        My reference to six hours was to the real time it takes to walk into a Hamilton emerg, have a problem diagnosed and treated, and leave the hospital.

        I was nieghbours with an emerg doc who also was proud to tell me that in his dept the average time before seeing a doctor was less than an hour. As a patient the problem is that even though you may have an initial consultation with a doctor, you’re likely still there for three or four hours – mostly spent waiting – before you escape.

        In the last few years when I visited emerg, for myself, or for kids and others with serious problems the timeline generally ran: WAIT 5 minutes. Triage 10 minutes, WAIT +/- one hour. Move out of outer waiting room into inner waiting room – half hour. See doctor for 5 minutes. WAIT for blood taking, x-rays etc 1-2 hours. WAIT for doctor to tell you results of the above 1-2 hours. Go home.

        Need I point out that the “average” time to see a doctor is skewed in favour of those who arrive by ambulance, and that those needing non-critical care invariably wait much, much longer.

        Obviously the root of much of this is short staffing – I’m sorry, “efficiencies” – and the closing of beds. Any emerg patient can see that the nurses and doctor are run ragged.

        I’ve known doctors, and I’ve known a few emerg nurses – and I love this blog.

        I’ll grant you that there are idiots out there, and people who waste your time with petty complaints, but in a lot of places the health care system has been dismantled or mismanaged to the point where patients are at their wit’s end.

        If I walk into an emerg it’s because I fear there is a serious problem, and I do so with the expectation I’ll be there for several hours.

        I guess I’m saying let’s not blame patients, let’s blame the polititians who’ve created the mess.

        • #7 by torontoemerg on Thursday 23 June 2011 - 2050

          Barry

          Thanks for the love this blog part — and I apologize if I sound crusty. Undoubtedly everything you say is more or less correct — and the times to physician initial assessement and then to disposition times are still far too high. In my idea world, I would like to see a dispositon time in under an hour, not the 4 or 5 hour waits which are the MoH benchmarks for CTAS 4s and 5s.

  5. #8 by Julie on Wednesday 22 June 2011 - 1850

    I had moved to a new town, so I didn’t have a family doctor. I have a history of colostomy with perforation, obstructions and acute diverticulitis. Sometimes I wait too long, and this time I did, I was very ill. I live in a small city.

    Anyway, I thought I had better get to emergency as fast as I could. The E.R. was empty, but the admitting nurse was angry. She asked me what I was doing there. I told her, I felt awfully ill. The nurse then asked, what are you doing here, this time of day. I was confused by her anger, and said, I was feeling worse by the minute. Then she asked, who my doctor was, I told her I didn’t have a family doctor, that I was on a waiting list. She very angrily sighed and took my information. I had always been told to get to a hospital immediately. As I am always in danger of a bowel rupture. I once had that happen. I was fortunate I lived.

    The small emerg was right in with admitting. The E.M. nurse went to put an I.V. in the back of my hand. From long experience, I told her the vein would blow. Then she was angry at me too. So I asked her if she could put a little freezing in the back of my hand. I have considerable pain, when the needle goes in. She said, we don’t do freezing. We have ointment, that is if you want to sit here for 45 minutes, until it works. So I gritted my teeth, while she put the I.V. needle in.

    The doctor waited for my blood work . He gave me a requ’ for an xray. My vein blew in my hand, and the entire back of my hand, was black and blue. The emerg nurse, looked very scared, when she saw my hand. I took the requ’ to x-ray. I went to hand in my requ’, the tech said she couldn’t do me, she wouldn’t even take the requ, to see the x-ray was to be done asap. She was also angry at me, as well. Now I am really light headed and dizzy, from fever. There was no way I was going to go back and tell the doctor, I couldn’t get my x-ray. I was afraid, there would be more trouble. So because of my very high fever, I knew I had better get home as fast as I could, and try again the next day, to have my x-ray. That’s the last thing I remember, I don’t how I got home. As my son had dropped me off. I said I would cab home. I remember nothing to this day, how I got home.

    The phone woke me in the morning. I had made it to the sofa, my handbag was dumped on the floor, I had left the door open, all night. My son wanted to know, how I was. I said I didn’t know, that I couldn’t get my x-ray. I wasn’t making too much sense. He came and took me to the city. I had pneumonia, inflamation, in the lining of my stomach, an inflamed gall bladder, acute diverticulitis, a partial obstruction, and inflamation in the bursa of my hip. And a 40.5% fever. They considered doing a colostomy, as my bowel was very inflamed, and I could have ruptured again. They gave me some powerful antibiotics, in the morning, I was still holding my own, so I escaped without another colostomy. That is a miserable surgery, which I hated, tubes down my nose and all.

    The nurse asked me, what in the world had happened to my hand. I explained, my veins always blow and left it at that. I had forgotten to take the I.V. needle out of my hand. So, the nurse, had a grim look on her face. I was admitted for two weeks. Went home, got very ill in the night. Called my son, back to the city. I was again admitted, I had got a super bug. Thank Heaven, it was a bug they could treat me for and not the VRE. I was in hospital for another week.

    This is health care in BC.

  6. #9 by Daniel on Saturday 28 April 2012 - 0206

    Couldn’t agree more. Emergency rooms are more and more becoming the “one stop shopping area” for all your healthcare needs. Unless something is wracked with agony or the patient fears imminent demise SAY OUT OF EMERG! You’re also right about there being plenty of other options, even within the hospital itself.

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