Quote:
Originally Posted by dbussone
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.
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dbussone:
Medicine is a science of uncertainty and an art of probability (William Osler)
The precursory comment every time a doctor is deposed or sworn in at a trial is "within a medical certainty"does.... Its an known unknown by many that medicine is not precise. Diagnostic testing are measured by their predictive values and likelihood...what I am leading to is that because of these uncertainties its all the more reason that administrative people need to get the heck out of the way between the relationship of doctor-patient.
To employees who work in such chaos day after day it soon becomes normal, "I am paid to do my job and I do my job". To patients in the waiting room its a mystery that these employees can't see what they see?
But administrative people ( medical insurance, government)maintain control for profit, bonuses, , power.
Let's us not forget those heroes who would be honor to handle your claim who force medical people to practice defensive medicine What a waste of resources and time. Clearly the tort laws need to be changed and given that medicine is imprecise its that much more important because many doctors may be held to a higher standard then is realistic