Time to treatment equals quality for much of emergency medicine. It’s also the easiest way to decide whether an ED is any good. Missed diagnoses, errors of judgment, and clinical mistakes can be hard to spot by comparison.
Emergency Departments That Lag
1. Long Line up at triage –
The most at-risk patients stand in the line-up for triage. Every day, patients walk in with a deadly process inside of them. Until they have been seen, they are unsafe. A line up to be seen is indefensible.
2. Long triage process –
Triage should be sorting; not a primary nursing assessment. Patients need a diagnosis and treatment. In most cases, this means getting patients and physicians together as fast as possible. A long triage process does not add value for patients.
3. Long Line up at registration and long registration process –
Registration – getting a chart made – does not add value for patients; it only delays care. It must be short!
4. Packed waiting room –
There is no reason for patients to EVER wait in the waiting room. Please argue in the comment section below if you disagree.
5. Patients must repeat their story over and over and over.
Providers should quickly check what others have recorded, verify the facts and ask additional questions. Starting over with every provider drives patients nuts.
6. No discharge excellence
Patients should leave the ED with copies of lab and radiology reports, written discharge instructions (if necessary), and clear instructions for follow-up and return visits to the ED.
7. Dismissive attitude
Patients should be welcomed to the ED for ANY complaint. No complaint is trivial for a patient. We – healthcare providers, media, government, all of society – seem to think healthcare would be just fine if it weren’t for all the patients. Besides being unwelcoming non-verbally, there’s a big difference between “Why are you hear today?” and “How can I help you?”
Rules in case you get sick:
Don’t go to your family doc unless you’ve tried something yourself first.
Don’t go to your specialist unless you go to your family doc first.
Don’t go to the ED unless you’ve gone anywhere else first.
Don’t go to the ED unless you are nearly dying.
If you are dying, you shouldn’t go to the ED because we can’t do anything for you…
Excuses
But all our beds are full of admitted patients!
Definitely the most popular excuse, admitted patients definitely make it almost impossible to provide emergency care some of the time. But, even with admitted patients blocking beds, patients should still be brought into the ED and seen on exam tables. If they can wait on chairs in the waiting room, they can wait on chairs inside after they’ve been assessed.
Thankfully, Ontario has started to hold hospitals accountable for getting admitted patients out of the ED, and up to the wards.
Who owns morale?
Management owns operations; staff owns morale. Sure, you can crush morale in even the most engaged staff, but blaming management for staff attitudes will mire an ED in under-performance. Staff control their own morale, and it must be part of performance management.
How does your ED stack up? As a patient, have you researched your local EDs to see which ones to avoid?