Wait Times

I don't know about your ED, but in mine we're all about getting patients back to their rooms as fast as greased lightening. We advertise wait times on bill boards and there is even a triage app for the lay public. They can input their symptoms and get an idea if they need to come in or not (Hahaha, like that will stop them). I had one lady who was directing me what to type while I was triaging her baby daddy's abdominal pain. Really, you don't think I've seen like 9 million abdominal pains, sweetie?

So, this don't stop, go straight back to a bed has me worried. For instance, that's all fine and dandy when we're half empty like at 0700 on Sunday mornings, but by 1100 we're hopping. My job as the triage nurse during these hours is to look in my computer at what the initial complaint is that the meeter greeter typed in upon arrival, and assign a bed based on that. Now, me being old-fashioned, I like to at least eyeball them so I sit at the entry desk. But, some of the other nurses will just sit in their triage room, see the complaint and assign a bed. The meeter greeter then walks them back for the nurse in the back to triage. Next, the scribe signs up the doctor they are working with and this is what they call door to Doc time and the corporate hacks are all shitting diamonds and gold over these great wait times. In the meantime, the patient may have stated they have a cough but really, they are in fulminating pulmonary edema and nobody sees them until that nurse first realizes she has a patient in the room and second goes in there, which could be a while.

When the back is full, we start doing the triage out front and I've had the charge nurses send out a medic to snatch the patient right out of their triage chair and take them to the back, not triaged. How is that triage? A triage takes a couple of minutes. The nurses who are in the back that day are hating life. The doctors hate it because their paycheck is based on their door to doc times. When the place is bursting at the seams, the docs get behind because you know, they're running a code or something equally important. But hey, the times still look good because the scribes are signing up their docs, but they really aren't seen for hours.

In my opinion, it seems that this is a disaster waiting to happen. The way I understand ESI, if you're a level 2, you go straight back to a room where a nurse right away starts doing stuff and the doctor comes in and stuff happens to help you. If you're a level 4 with the sniffles, you're just as important as that gasping COPD'er because you know it's all about customer service.

Another new rule is over 80 and under 1 go straight back, no questions asked. So, I had an 84 yr old female who was a level 4 and a 52 yr old chest pain with HTN. The 84 yr old got the very last bed in the department, while my chest pain guy went to a hall bed with no monitoring equipment. Seriously, I'm very concerned.

When the balls hit the walls, the charge then takes over bed placement. Good for me, sometimes bad for the meeter greeter walking them back to dirty rooms. Since the charge never leaves CentCom (or their chair), they really don't know if the bed vacated 2 seconds ago is clean, they just assign the next one to it and here comes Nancy Upscale from the Burbs and oh my god, she sees a slaughterhouse in the room she's assigned to. So, I say to the charges how is this customer service when our er, customers, see such mayhem? I was told it doesn't matter, all that matters is the time they sign in to the time they are placed in a bed. They all said that corporate doesn't care about that, yet. When they do, then they will address it.

I've been scouring the net for any studies done on this wait time phenomenon. So far, nothing that shows outcomes medically. All they talk about is patient satisfaction like the ED is McWendyKing or something. They even installed a patient satisfaction survey at a couple of kiosks around the department.

Just shoot me now.