Quote:
Originally Posted by rubicon
dbussone; You referenced some of my thinking. Again I said that any business not ready to make reasonable accommodations for its customers/patients should not be allowed to operate. I am sticking to my belief and believe this is especially essential for a medical facility whose first rule is "FIRST DO NO HARM"
Overcrowded chaotic emergency rooms are legendary so much so that for years they have been portrayed in movies and TV sitcoms. One would believe that this would have been enough for medical providers to invent a newer and better model by now? Historical statistical data can provide valuable information for optimum staffing and newer yet safe protocols, etc. Short of a catastrophic event every emergency room should be able to reasonable accommodate patients
Indeed the Rashamon Effect may be an element of story telling but when you are placed in a corner in an uncomfortable chair with cramping belly pains dry heaves and continuing retching you can throw that theory out the window.
As you sit there you watch other patients who can barely hold themselves in their chairs expecting anyone of them to drop to the floor. And when you are the one in such pain and understand that triage is necessary, it however affords little comfort.
And while a medical person does and must remain somewhat callous concerning pain and suffering I do not believe they are barrier to a better and more responsive emergency room.
I lay the blame at the feet of bureaucrats medical, insurance government.
Hospital management , insurance interested in profit margins and government interested in controlling 1/6th of our economy. Some medical providers do cash only business because they do not want to deal with the red tape and I can't blame them.
I was asked to manage a facility that was a complete disaster..there go to guy. I negotiated a great transfer package and said I would accept provided they granted me the freedom in which to act and the essential funds to get the job done. With this clear understanding I accepted. When I assumed that position my customers told me to my face that we were the last place they would do business. when I left these same customers were telling me we were the first place they go to. The fix was easy the problem or would be problem is always the bureaucracy.
Personal Best Regards:
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Your last sentence is completely accurate. And on top of that, the bureaucracy never likes change.
At one time I was responsible for 4 hospitals in Las Vegas. We built a fifth and used its newness to try and improve processes that were creating bottlenecks to care. One of our fixes in the ER was to put a highly competent RN or PA right out in the ER waiting room. That RN was the first person to greet an incoming (non ambulance) patient. He/she made decisions about prioritizing care and told the patient/family where they were in the queue. All waiting room patients were updated by the RN frequently.
It seldom took more than 30 minutes for a patient to be seen by a doc. If the wait was expected to take longer, a non-emergency patient was told they might want to consider going to an urgent care center and given a printed list of alternative care locations.
The process worked so well we moved it into the other hospitals. Some ERs took it well and ran with it. Two ERs had to be dragged kicking and screaming into the future. All the ERs significantly improved throughput, handled increased volume easily, reduced door to door time, and patient satisfaction increased.
Compare that to the TVRH ER. A volunteer with no authority or medical knowledge is the only person whom a patient may see for hours in the waiting room. Rather than take patient data sheets back to the triage nurse (who is hidden in a room where he/she can't see the waiting room) as the patients complete them, the volunteer takes them back after gathering a few. The patient sheets are put in a pile in the triage room without regard to priority- because the volunteer can't make medical decisions.
One experience with the TVRH ER went something like this. My wife fell in the shower, badly fractured her ankle, and went to the ER by ambulance. Inside the ER she was held in a hall on a stretcher because the treatment rooms were all full. I was not allowed to stay with her, so I was in the waiting room. About two hours after arrival she was brought out to the waiting room in a wheelchair. She had not as yet received any tests or treatment and her ankle was not properly protected when she was moved to the wheelchair from the stretcher. After several more hours she still had not been seen so I insisted that the triage nurse come out to talk with me. More time passed before that conversation took place. As I recall it was about five or six hours before she finally had an X-ray. Still no pain med and not seen for that entire time by a doc. Finally she was admitted and moved to an inpatient room. It took several plates and numerous screws to repair her ankle in surgery a day or two later.
Now I know TVRH has built a larger ER, but architecture seldom corrects bad processes. Unless they make some significant changes in the way the ER is operated, things cannot improve.