Tag: Triage

One last post on the ER….for awhile.

As I mentioned in an earlier post, the ER is the portal of entry to our hospitals now, for better and for worse.

On the plus side, this means that most patients being admitted to general medical and surgical services (the big exception here is elective surgery–patients having elective operations don’t need to be triaged) have a workup at least started and are triaged appropriately to their destination.

A good ER evaluation should answer the following questions:

1. What’s the nature of the illness?

Are we dealing with the heart, the brain, or an abdominal organ?  Is the cause an infection, a blockage, or a blood clot?

2. Based on #1, where will the patient best be situated?

Will the patient need intensive care, or will the “regular” floor be sufficient to attend to the issues at hand?  Should the patient be admitted to a surgical team or a medical (non-surgical) team? Continue reading

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And waits, and waits, and waits……

The ER is the portal of admission to the hospital for what we might call undifferentiated illness.  Shortness of breath.  Chest pain.  Fevers with localizing symptoms (like pneumonia, appendicitis, or gall bladder infections).  “Changes in mental status”–confusion, delirium, or dementia, caused by Alzheimer’s, strokes, and many other diagnoses.  Of course, other emergencies are usually well taken care of in the ER: fractures, lacerations, bleeding, etc.

Why do we have to wait so long to get seen and treated in the Emergency Room?

Well, crowding is one problem.  You’ve heard endless commentary about ER crowding.  Too many people using the ER for non-emergency issues: colds, sprains, back pain–all things that could be better treated in the office or over the phone. Too much difficulty getting seen by your primary care physician.  There are simply more people waiting to be seen than can be accommodated in a “reasonable” time frame.  [Of course, this all depends who is defining ‘reasonable.’]

The ER is a victim of its own success.  The ER “brand” if you will, is sexy.  Start with those TV dramas that glorify the gritty heroes who work on the front lines.   Then, the simple message of an ER’s mission:  “We’re always open, and we can’t turn you away.”  For people who don’t have insurance, or who are frustrated by lack of access to their (or any!) doctor’s office, the idea that the light is always on makes the ER an attractive beacon.

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Everyone knows about the crowding problem in Emergency Rooms (ERs).

Too many people show up to be seen by medical professionals at similar times. This creates bottleneck: more customers than gurneys on which to park them; many more patients than doctors and nurses (and PAs–physician assistants–a growing cadre of medical professionals in the U.S.)

ERs are the beneficiaries (a mixed blessing, to be sure) of a clear and simple message: “We’re always open. You can always be seen, regardless of ability to pay.” The bargain is that you have to be willing to wait. For thousands of people, perhaps millions, it’s a reasonable bargain. At least when they enter it is. Sometimes the waits are interminable.

Many people wind up leaving without being seen, unsatisfied by sitting so long. On the one hand, ER management wants to send the message: if you’re low priority (your issue is not a true emergency), you’re going to wait. And wait.

And wait. Continue reading

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