A Visit to the Emerg*

Interesting post from this blogger, which seems to boil down to 1) I waited too long, 2) and the nurses from Sunnybrook ER suck. A reminder that a patient’s perspective isn’t quite the same as the nurses. Three quotes:

(1)

Got into Green-ER (Sunnybrook has different areas of ER, each colour indicating the severity of the emergency) and onto a stretcher at 19:30. At about 20:30 I asked one of the nurses at the nursing station if someone was going to come and check in on me, as I had been on the stretcher for an hour. I was told that they were quite busy, and that they were handling patients in terms of their severity.. I kept my mouth shut, but only about a third of the beds in Green-ER were filled, so there was no chaos going on.

What you see in one part of Emerg is hardly indicative of what is going on in any other part of the department. I mean, they could have been running three codes and a trauma while you were sitting in the low acuity area (the “Green-ER”), and you would never know it.  I’ve been in Sunnybrook Emergency, and it’s huge.

Aside from that, I think there is a underlying attitude in the general population that if you show up at the Emergency, and especially if you are sent by your GP or specialist, it must be a real emergency. Unfortunately, this isn’t true, even if you have a complicated medical history.  Patients are sent to emergency for all sorts of reasons having nothing to do with their actual condition. You were triaged, and I am guessing your CTAS score was something somewhat less than “life-threatening emergency”.  (Yes, we do know what we are doing. We’ve only done it millions of  times before.) Patients are treated in order of severity, not first come first served.  It isn’t McDonalds.

Also, I am a bit unclear as to what you expected the nurses to do while you were waiting to see the doc. Hold your hand? Rub your back? Fluff your pillow? Check your vital signs every 10 minutes for non-existent sepsis?

(2)

-when I spoke to the charge nurse (I assumed she was such, not once did she get up between 19:30 to 23:30 to see any patients, she just sat at the station plucking away at the keyboard) she seemed to act as if I was a huge burden asking for a kidney dish and having the unmitigated gall to suggest that there was a lack of care cos I was not seen for over an hour

I’m guessing the “charge nurse” referenced here was the ward clerk — from the many times I’ve been in charge, it has been a rare night indeed I was able to sit for any length of time, especially an hour. And in any case, I doubt the charge nurse would be hanging out in the low acuity area.

(3)

-the nurse who “took care of me” (and I use that phrase loosely) had a serious attitude problem, not once taking note that if a patient has been discharged that they should be released in a timely manner.. no one was being resuscitated, there was no heart attacks, no vomitting, no one being placed on a ventilator…nothing like that in Green-ER, so the place was very quiet.. why ignore the patients?

I agree completely. But as I pointed out above, MIs and codes aren’t likely to be happening in a low acuity area. And be aware that even in low acuity areas in the Emerg, we can still have patients with high complexity — in other words patients who aren’t especially sick, but have a large number of problems to be dealt with.  A simple IV start and blood draw, on a tricky patient, for example, can easily take a half-hour or more — then start adding time for preparing medications, assessments and on and on.  And in the scheme of things, I am sorry to say, pulling out IVs is pretty low on the priority list.  And then there is the problem of getting the physician to write the discharge orders —which is a another issue altogether. But I can’t discharge you until I see them. However my inclination, for what it’s worth, is to discharge patients as expeditiously as possible because, believe it or not, I do understand that ERs are a lousy place to be.

__________

*The funniest thing about all of this is that I’m about to defend Sunnybrook nurses. Hahahahaha.

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  1. #1 by opinionatedbean on Sunday 25 October 2009 - 2052

    hmmm each ER section at Sunnybrook operates as in independant unit. AS you took the quotes from my blog maybe you could have asked for more details.

    The details were – there were a collection of nurses getting “training” during a quiet period in the ER. They sat around the computer terminal, right in front of me, for over an hour. A third of the beds were full, the other 2 thirds weren’t. Out of the whole collection of nurses working the Green ER only 2 were busy, the rest were flocking around this computer terminal for some “health & safety training”. As for my being pushy about the kidney dish, I have a stoma (I am a Bladder Exstrophy patient and had a mitrofanoff done 2 years ago). I am not some run of the mill creature with a splinter in my finger. If I don’t empty on a regular basis I can get sick, as I also have a reflux of the left ureter and am highly prone to Kidney infections.

    This is the same ER that nearly killed me this past July cos they sent me home with a script for macrobid for me to return a few hours later with severe abdominal pain, a BP of 175 and me ending up in CrCU (ICU) for 10 days cos I went septic and had pneumonia – not once did the nurses or even the ER doctor take my concerns seriously then, thinking I only had a UTI.

    I am well aware that a ward/section is only as good as the Charge Nurse.. ergo, my blaming the Charge Nurse for Green ER.

  2. #2 by torontoemerg on Sunday 25 October 2009 - 2242

    Thanks for taking the time to write your reply. Again I note how this an object lesson in the difference between a patient’s perspective andthat of a nurse.

    I understand your concern and frustration, but I think you’re misunderstanding something about how emergency departments work. The issue isn’t the nurses per se. It’s the waiting for the physician to actually come see you. There are many reasons that they may be delayed, such as sicker patients in another part of the department (I would be very surprised if there is a physician dedicated at all times to Sunnybrook’s Green area), or waiting for lab results (more efficient for the docs not to see you twice, if it can be helped). As an emerg RN, I sometimes wish I had a magical whistle that would instantaneously summon the docs to see my patients. But I don’t.

    As for the nurses, if you thought your care was poor I would definitely encourage you to speak to patient relations. The k-basin thing is more or less inexcusable. But again, I am unclear what you expected from the nursing staff once you had a bed, were assessed, and were waiting for the physician. I think if you were my patient, I would assess you, recheck your vitals, make sure you were comfortable as possible, explain what would happen next and hospital procedures and answer any concerns or questions; I would probably check on you every hour or so afterwards while you were waiting or as needed. I think this would be an acceptable standard of care. If your care varied, you indeed may have cause to complain.

    I can’t comment on the whys or wherefores of your previous experience at Sunnybrook, other than to say I am not sure that your previous discharge was a nursing issue. And if your previous care was so bad, why did you return?

    As for me asking for more details and — I wasn’t aware it was necessary. I thought you were rather straightforward in making your case.

    Thanks again.

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