Patients in triage

[CaneMedic]

Here around Atlanta, a considerable about of patients go to triage. Our hospitals are always full, so they are constantly on "diversion" and sometimes I have to call 4 or 5 hospitals to find one who will accept a noncritical patient. What I really love is having a critical CP or CVA pt and getting diverted because "the stroke team isn't available" or "we don't have any ICU beds." Lovely.

Triage in most hospitals around here is putting your pt in a wheelchair (if you can find one), giving their name/info to the registration clerk, and MAYBE getting 10 seconds to talk to the triage nurse. Most don't listen to what you're saying and just sign the PCR and walk away.

We have toughbooks/e-pcr's and we leave a copy with the chart, which of course never gets looked at again. Such is life.

[strippel]

ruff, we have been inserviced. Not that I want to, but I can't take the blame/credit.

Our Director talks of cutomers, as do our "member" hospitals. There are surveys. It is all about customer service.

There are signs hanging everywhere in the hospitals, and we need to follow along.

Also, there are not calls or jobs. They are requests for service. All are to be thought of the same. It doesn't matter if it is a wheel chair transport, litter return to a nursing home, specialized inter facility transport, 911 call to triage, or the biggest wreck you've ever seen.

[Capman]

It is the same at our hospital based service as well strip'. We get the Avatar Score Survey lecture every three months. "Avatar Scores are down, we need to improve customer service" Direct quote. Those who wish to knock it and beat it down.... Go right ahead, but that is how it is!

[JPINFV]

I can see both sides to the entire patient vs customer debate. On one hand, our job is to improve, or at least stop the decline, of the patient's medical condition. What's in the best interest of the patient is not always what the patient wants [drug seekers, for example].

On the other hand, there does tend to be the "Ha! Look at me, I'm on an ambulance and you asked for MY help!" attitude every once in a while. Looking at customer service could serve as a way to remind everyone to treat their patient's with respect when ever possible.

Remember, it could be worse. My first job was as a box office cashier and the theater's general manger decided that we couldn't tell guests (ok, I'll give entertainment venues calling customers "guests," but "cast members" is just stupid) that a movie was sold out (it was "full") or their credit card was being declined (it just "wasn't going through our system). At least when I worked first aid at the waterpark (EMT-B position), the park's director of operations made it a point to exempt us from the hospitality training.

[NREMT-Basic]

I understand hospital ERs getting full and things getting backed up but there is a disturbing trend in my area lately. First, crews will bring someone on the ambulance bay, be told there is no room right now, take the patient off the cot and wheel them to the waiting room without ever being triaged or even being checked in. Every couple of hours (maybe) a nurse or most likely a clerk will stick her head out the door and say "who doesnt have an arm band yet?" whereupon half the occupants surge toward the triage window where she feverishly prints out their arm bands and tells them to take a seat. Now we all know that there are patients who will do ANYTHING to get seen for a multitude of reasons, but when I last had to take a relative to the ER, there was a gentleman sitting across from us, holding a shop towel on his arm which was completely soaked in blood which was now beginning to run down and pool on the floor around his feet. He'd been there for 4 hours. Of course I dont know why the heck he was complaining because the elderly woman sitting two seats down and coughing her head off and just about passing out every time she did showed me her wrist band and she had been in that waiting room with coughing and SOB for a little shy of 16 hours.

The first couple of times I saw this scene, I thought well, its one of those nights. But then when you do get you actually back into the ER (getting a wheelchair in the hall is considered a step up from sitting in the waiting room) you can be screaming bloody murder in pain and nurses walk right by you as do Docs, techs, etc to go back to their conversation about pizza and who they slept with last night. And honestly, alot of it could be cleared up if they, as my EMT instructor said, "put some snap into it" and moved at a speed that indicated they realize they work in a trauma center and are not spending a sunny sunday at the flea market. And it could even be a little more tolerable if they would/could put the ER on diversion, but they cant because the other three hospitals in the city are also the same way so there is no where to send diverted patients. Except for people realizing that they are working in a hospital and moving at the appropriate pace, Im really not sure what the answer to all of this is. Perhaps if we went back to MDs being paid by the patient instead of a salary independent of patient care each year because they are working for XYZ Healthcare in BFE, Nebraska which is really nothing but a glorified call center, things might improve. And maybe if ER staff had to turn their photo IDs around so they could actually be seen instead of hiding them in their pocket or in some other way obscuring them, there might be a little more accountability. Perhaps we need to get a few of the more "efficiency minded" folks from here at the City to assist hospital staff in moving like they gave a &^%*.

I know Im gonna get flamed by Docs and Nurses, but if you arent behaving as mentioned above, Im not saying YOU are the problem

[CBEMT]

Strippel wrote "We take a decent percentage of our customers to triage. There are many regulars, and people with small boo boos who call"

So let me ask you a question - who's idea was it to call your patients customers instead of patients.

Is it your own or your companies idea?

The reason I ask is if it was your companies idea to call them customers instead of patients then your company must be employing someone who came from the customer service arena.

I'm just curious where you got the idea to call your patient a customer.

no slam on you, just a question

My guess is that "patient" would imply that they had an actual medical problem.

[NREMT-Basic]

Calling patients customers comes out of the corporate medicine mentality. In EMS, we treat patients. Leave the customers for the coding and billing departments.

[spenac]

Calling patients customers comes out of the corporate medicine mentality. In EMS, we treat patients. Leave the customers for the coding and billing departments.

While I seem to always disagree with your posts, I agree with you here. I am not selling something, I am there to provide emergency care regardless of persons ability to pay. Saying they are customers implies to me they are required to pay to get treatment. If I required upfront money then I would really be a taxi driver.

[AnthonyM83]

But it also reminds you to provide good customer service. Even if you're not thinking in terms of billing, it puts you in mindset of leaving a good impression as you're representing a company and medical field. I usually think in terms of patient, though, but still remember they're also a customer for us.

[paraloco]

I pick up alot of folks with minor problems who call 911, thinking that they will get a bed faster if they come in by med unit. We give report over the radio, as usual. when we get there, they see the triage nurse, then the charge nurse decides where they go. If they can go to triage, the triage nurse's name is in my PCR. If they can't go to triage, we frequently ride the wall for however long it takes to get a bed. It's gotten better. the 3 hour waits haven't happened for a few months. We finish our electronic PCR's then return later to the transfer office to print. I doubt the ER ever sees the report.