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    Sunday, November 05, 2006

    Those Overcrowded Emergency Rooms: Some things that hospitals are doing to shorten emergency room waits:

    Speeding up emergency-room triage to get patients faster treatment. And offering restaurant-style pagers so not-so-sick patients don't feel stuck in a crowded emergency waiting room.

    Shortening waiting times is part of a nationwide move toward empowering patients, reducing medical errors and improving health care.

    First of all, I would argue that shortening waiting room times for all emergency room visitors regardless of the nature of their illness does not necessarily improve healthcare and reduce errors. It has the opposite effect. The emergency room doctors and nurses and clerks feel the pressure to get people in and out quickly and as a result take short cuts. Short cuts in medicine translate into missed diagnoses.

    The article mentions the case of the Illinois woman who died of a heart attack while waiting to be seen for chest pain. Chest pain is a symptom that should never be left in the waiting room. In this case, the mistake was made during triage, and it's such a basic mistake that it makes one wonder about the level of training of the person who did the triage. Did the hospital have to hire more people for triage duties in order to improve their waiting room time, and in so doing, did they have to reach for people whose training was less than optimal?

    Here's a better solution to emergency room overcrowding - have a doctor or experienced registered nurse do the triage and if the condition of the patient is such that he can be handed a beeper as if he were waiting in the lobby of Red Lobster, send him home instead with instructions to see his doctor in the morning. Keep the emergencies in the emergency room and the minor illnesses in the doctor's offices and clinics.

    posted by Sydney on 11/05/2006 09:28:00 AM 4 comments


    Having a walk-in near the ER also allows people to use their own common sense before they ever talk to a triage person. In the years I spent covering call, I was rarely called to the walk-in clinic. I think most people can identify when they have a serious problem, and when they don't. This arrangement adds another layer of screening, if you will.

    If a person with chest pain does happen to show up in the walk-in clinic, the staff there automatically sends that person to the ER. That way, the staff at the ER already knows that (for at least 18 hours of every day) every patient they see is potentially serious. Both the ERs in my area have this type of arrangement, and it really helps.

    By Anonymous danie, at 5:19 PM  

    Shortening the lines is silly. What happens if you make a service more convenient for the same price? More people will use it of course. Econ 101 which I dimly remember from pre-med days makes this clear.

    Having experienced triage people move people out of the ER and into physician offices and clinics is the correct answer -- but if those offices and clinics were willing to take the patients we wouldn't have the crush we have on the ERs.

    The hospitals will have to provide these clinics and hire the docs and nurses required, because community docs are pretty darned busy right now (as you know better than me). And Medicaid patients, particularly, have fewer choices.

    Make the ER more difficult to get into for minor issues and you'll have less use. Econ 101.

    By Blogger Steve White, at 12:53 AM  

    Too bad you can't turf the not sick patients away without being seen by an MD - the EMTALA law forbids that.

    By Anonymous Anonymous, at 1:05 PM  

    I think also people need to be educated more about their health.

    Recently my husband broke his leg. It was a closed break, but as anyone who has done it knows, we could instantly tell that was going on. So we went to the ER. Because a broken leg is serious.

    He got an ice pack, waited for five hours, and in the end was sent home with a temporary splint and a couple Vicodin and instructions to go to the local orthopedic center the next day.

    If we'd known that, we would have been able to do that at home and save the $500, and leave the ER for people with REAL problems.

    By Blogger Alexandra Lynch, at 8:03 PM  

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