Wednesday, May 9, 2012

No Savesies

Yeah, our ER is already waayy beyond capacity.  The whole hospital, in fact, but especially the ER.  We need about 50% more beds and twice as much staff on any given day to actually treat all of the patients we're getting these days.  Doctors who have privledges here at some point come to the ER to admit patients, so I assume they know this, unless they're just really dumb or think that we set up all these hall beds because we don't feel like cleaning rooms or some shit. So why do they routinely send their patients up here with the big fat lie "they'll have a room waiting for you" when anyone with half a brain knows that we don't have the luxury of saving a room for anything save a STEMI, acute stroke, or CPR? Really?
It's a sad state of affairs, but the fact is that if you are well enough to call your doctor's office and ask what to do and then drive yourself or have someone else drive you by private vehicle to the ER, you're going to spend some time in the waiting room.  We're not doing it to disappoint you, or to be dicks, but when other people are coming in dying or have been waiting for 5 hours to be seen for the exact same complaint you have, we can't just give you their bed because your doctor said we would.  We don't work for your doctor and he/she hasn't been up here triaging all these other patients and as a result, has no frame of reference. 
It sucks, because these people are really just being good patients and doing what their doctors tell them to do, yet we seriously cannot accommodate them and it reflects poorly on us. I used to kind of try to cover these guys assess, but at some point I just started being real with people.  Not like "your doctor was bullshitting you and he's a dick", but I just say something like "Unfortunately, unless the doctor goes through the process of getting you admitted directly,  a bed can't be guaranteed.  With how unpredictable it is down here it's impossible to save a bed in the ER, I'm sorry."
The waits have gotten progressively worse over the last 3 years, and recently people have started calling the doctor's offices back like "WTF dude", which then leads to the doctors calling up the charge nurses and bitching them out over the phone.  Now the other stuff could definitely be lost in translation between doctor and patient (although it'd be shocking if it went down that way every time with as often as it happens), but that shit is just ridiculous.
Look here, D-bags.  If you really are concerned about your patients, get your shit together and take the necessary steps to direct admit them.  If that isn't possible, meet them here and write their damn orders in the lobby if you have to, if it's such a fucking emergency.  If it's not, then send them down to the ER with some reasonable expectations like yeah, I think you should be at the hospital for this and your only option right now is to go to the ER, it may take a little bit but I'll let the staff there know why I'm concerned.  Really, that's all we ask. But if you can't tear yourself away from you dinner/golf game/re-runs of the Big Bang Theory long enough to come demand a bed and deal with your emergent patient that came in via private vehicle in person, that don't call and scream at us when we can't stop and rearrange the whole ER for them.  Freaking primadonas.

11 comments:

  1. I know I should look at your blog as a cautionary tale, but I swear it only makes me want to work in the ER even more. That craziness sounds right up my alley. Maybe I have a problem??

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  2. "Your doctor hasn't set foot in this ER since 1996"

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  3. ...and while we're at it, don't call and tell us your patient is coming. I don't care. You telling me that wastes my time and guess what, I don't write down the information anyway.

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    1. Right? They always call me in triage when I'm in the middle of trying to talk to a patient. It's all I can do to keep from hanging up in their faces.

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  4. Okay, disclaimer here....I live in a small town, and I get the impression that Hood Hospital is in a large city and deals with a lot of things that we simply don't come across very often. I'm also a nurse. But from a patient's point of view....what do you do when: you call your PCP's office first (like you're supposed to) for a little thing like a UTI (frank blood in your urine, peeing every 5 minutes, etc. Yep, UTI). PCP's office says, "we're totally booked. If you feel like you need to be seen, you'll have to go to the ER." (Well, yeah...if I didn't want to be seen, I wouldn't have called.) So...you go to the ER, feeling like an idiot for taking up their time. But that blood in the urine and the peeing every 5 minutes is only going to get worse. As a nurse, I wish the Dr would just believe me and call in some antibiotics, saving us both time, money, and hassle. Believe me, I KNOW that there are lots of other people who are sicker than me, but what's the alternative? Waiting a few more days till I'm REALLY sick, therefore costing me, my insurance, the taxpayer (cause my insurance is through my military-retiree husband), and my employer (because of lost worktime) even more money and myself more hassle and pain?

    Yep, I think I went off on a tangent there....but what's the solution? Longer office hours? (doubt the doctor wants that) More doctors? (most doctors don't want to work out in the boonies, thus explaining why the PCP is so busy he can't fit anyone else in) Antibiotics over the counter? (there goes even MORE antibiotic resistant infections). Hmmm...no good suggestions there.

    Anyway, I really do enjoy your blog. You are always good for a laugh, but you do make me glad that I don't live in a large city OR work in the ER!

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    1. Is there an urgent care clinic where you live? I know there are little doc in the box places like this in the burbs for stuff like that, but I don't know the situation in the country. But yeah, it's not that it's unacceptable to me for people to use us for non-emergent stuff- it's pretty much the way of the ER now and there's no end in sight. Hell, I give people bonus points for even trying to call their doctor first. The real issue is docs sending their patients over with the explicit expectation that they aren't going to have to wait for something like this. It's just bullshit, and they know it's bullshit. Sometimes the ER is the only option, but waiting is unfortunately probably unavoidable- I just wish docs would be more honest with their patients about that.

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    2. Yep, I hear ya! Even when I worked in an even smaller hospital these things happen. "so, my doctor said to come in, are you ready for me?" "umm...no. Who are you and what's wrong?" LOL. Unfortunately, no urgent care. It's either the Doc's office (if you can get in) or the ER. Sad, but true.
      :-)

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  5. Ok I have to admit ONCE when I was working in a county clinic, we had a patient that seriously needed to go the ER. Wouldn't take a waambulance wouldn't go unless we promised her she wouldn't have to wait. Yes we lied. The doctor said they would take her right back but she really needed to go. She wouldn't wait for us to find a bed for her. She was sobbing in pain but refused her vicodin script and asked for tylenol. She wouldn't even go sit down and wait in our own urgent to wait for a bed. So we lied just that once. Everyone else got the line. "Oh honey this is county"

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  6. The worst offenders were the docs who would promise to "meet (the patient) in the ER." So we'd get these incredibly needy patients who, basically, expected to be escorted upstairs to a hospital bed in a golden wheelchair by their PCP.

    Natch, the PCP hadn't even called to let us know that they were coming, let alone arranged for admission orders.

    Actually, we did have one private practice neurologist with privs who did routinely show up at the ER after ambulancing the patient to us. He'd usually beat the ambulance, have direct order admits in the system, AND insist on taking the patient upstairs, personally. I'm pretty sure he's dead now.

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    1. That's one hell of a neurologist! We had one PCP show up and bust through the triage doors with one of his patients in a wheelchair and basically run around the ER looking for an open bed for this patient. It was for kind of a bullshit reason on a balls to the wall day, so one of our medics got pissed and basically herded the patient back out onto one of the triage stretchers till we'd figured out where all our ambulances were going. Annoying? Definitely, but you had to admire his commitment.

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