“if anyone thinks a 7 hour wait in an emergency room is acceptable for a patient who is essentially a direct admit”

And that’s the ER’s Fault? I constantly see patients who I document as “sent from clinic for direct admission”. Meanwhile the system is falling apart. But according to Amy Tuteur, who claims to have worked in ER’s (yes I rotated through the ER as a med student too) it’s the ER’s fault when you call the ortho on call and they tell you “go to the ER, get yourself admitted, we’ll see you when we get a chance”. Can’t interrupt that daily routine, even if it clogs up the system. But Amy Tuteur MD, says it’s all the ER’s fault. We’re all busy eating donuts and pie with all the cops who hang out in the ER. I can’t tell you the last time I ate a meal while at work.

Judging by the vehement response, I have clearly touched a nerve. It is precisely this defense of the indefensible that is responsible for a great deal of the misery in the current health care system.

Time management experts agree that hospitals (including ERs) are run in a grossly ineffiecient manner. Quoting from The Boston Globe:

“Boston Medical Center, the city’s safety net hospital, is becoming a model of how to bring relief to the nation’s beleaguered emergency rooms, reducing treatment delays and closures to ambulances when ERs are more crowded than ever. BMC emergency doctors are treating more patients than they did last year and have reduced average time in the waiting room from 60 minutes to 40 minutes.

The secret lies in a radical idea for medicine, but one that has guided airport managers and restaurant hostesses for years: Keep the customers moving.

Urged on by a Boston University consultant, the hospital is eliminating obstacles that force patients to needlessly remain in the ER. It is cleaning up empty hospital rooms faster and rescheduling elective surgeries so surgery patients don’t take up beds that emergency patients need.

Meanwhile, ER nurses stationed in the waiting area assess a patient’s condition within minutes of arrival and then use a color-coded chart to track how long patients have been waiting.”

So it’s pretty obvious that there is lots of room for improvement in the delivery of care in the ER.

The topic of my blog has made some of you angry; you may not have noticed the subtitle: A Doctor’s Plea to the Healthcare Profession.

So here’s my plea to you: Open your mind to the possibility that there is room for improvement in the miserable state of healthcare delivery. Consider how you, your office and your hospital might be part of that process. I’m not talking about doing more than what you do; I’m talking about pushing for efficiency and common courtesy. Most of all I am talking about opening your eyes to the misery all around you and realizing that you have both the abilty and the responsibility to improve the delivery of care.

“what is the problem with the rest of the hospitals in the country?”

Overcrowded ER’s with indigent and uninsured patients and welfare patients that doctors in private practice don’t want to see. About 40 million of them. Some hospitals because of their location don’t have to deal with that population and have the incentive to take care of paying, insured patients. I have worked in both and there’s a world of difference.

anon 5;07

I am not the angry unhinged ER doctor that always posts here, but there is lots of reasons why ER waits are long. I agree with the above poster. In an area of good demographics where a large portion of patients actually pay their bill then it behooves hospitals and physicians to become more efficient in order to compete. In areas where demographics are poor why would hospitals and doctors want to compete for the non-paying illegal alien, no-pay, and medicaid patients? If you are a paying patient you suffer right along with them because of it

Our group has really made a concerted effort for rapid medical evaluation. It is a little bit of a gimmick. You see a doctor right away and might get some tests started but if there is physically NO BEDS in the ER or the hospital then your overall visit isn’t necessarily shortened. In my state, California, there is a shortage of tens of thousands of nurses. If a few call off for the night you are just screwed. You might get seen by a doctor but no nurses to carry out the orders. It is not uncommon for all 15 hospitals in a 20 mile radius to have absolutely NO beds either because they are physically full or no nurse staffing. If you are taking care of illegal aliens and medicaid patients then there is no revenue to expand hopitals or recruit and pay nurses from other states.

There is plenty of sick patients to care for. Since PA’s and NP’s see most of the nonacute stuff my day is spent intubating, putting in central lines, working up 88 year old people with abdominal pain. A couple of resuscitaions simultaneously will occupy all resources and increase the wait for your belly pain a couple of hours.

One thing that is starting to happen at some ER’s as well is a rapid medical evaluation and if it is determined that you do not have an emergency condition you are sent away without treatment and told where some urgent cares are. Not great for customer service but saves the bottom line.

Government targets in the UK state that patients should be seen within 4 hours in A&E (the name for ER). I walked in a hospital that was so good at hitting its targets people were choosing to come to our dept from surrounding cachement areas. Do I think that it is a good idea for these targets – I’m not sure. We see over 80,000 patients a year with only 15 doctors in total (generally between 2 and 6 doctors working at a time) and have basically become a triaging service. Everything the hospital does is skewered to hit government targets. If you have a disease which is auditted good for you but everyone else just gets pushed back in the queue. I do think that spouting certain figures is pointless and clinicains should be left to make their management decisions with minimal bureacracy. If they paid for ten times the number of doctors waiting times would be almost negligible but then it would be a less efficient system with people being paid to sit on their arses. If you don’t want a wait you need the spare capacity around.