Any down side to 0 wait at ER?

[zippyRN]

UK model is interesting here

effectively obselete standard saying you should be assessed within 15 mins of arrival

current standard saying that people should be out of the department within 4 hours either admitted or discharged ...

strategies to achieve this

1. empower the RN at the initial assessment

- provide initial drug therapies ( analgesia /glucose is almost universal, otherp laces include Nebs etc range and scope varies - often 2 seperate sets for those who are assessment trained and those who are NP qualified

- be able to refer to alternative sources of care ( Walk in centre, OOH primary care... )

- be able to fast track certain presentations for specialist consultation ( usually by specialist NPs) ( mental health with no physical health profblem, early pregnancy, cardiac)

2. preemptive bed booking for obvious admissions

3. observation units - where the ED manages the bed base and the beds are ring fenced for patients under the care of the ED docs but can provide a ward bed environment rather than Ed cubicle

4.

- order bloods

- extremity and in some places CXRs

[ERDoc]

There is one downside to a 0 wait time. It means I have to work harder. Damn.

[tniuqs]

There is one downside to a 0 wait time. It means I have to work harder. Damn.

Well.... don't think of it as HARDER Erdoc.... just FASTER.... Or perhaps more cloning of Doctors in general may help ? ERdocs were not born lazy...just tired is all. (old joke) if I only could just get a Pizza in under 30 minutes (or free) then I would be a one happy camper.

Seriously: I have to absolutely agree with Chbare statements 100% ! An education campaign was attempted here and as per norm it failed miserably and the stats didn't change at all. Why ? Because of today's " INSTANT" society and attitudes.

The general societal misunderstandings:

Health Care's definition of EMERGENCY = a life threating injury or illness.

PUBLIC perception of EMERGENCY = the 24 hour 7/11 of health care "catch all" (or fill in your pertinent gas and convenience corner store as per state or country)

I believe that EMS is not helping to reduce workloads in the ER's globally, concerned with liability issues, here is a point.... So ever hear these words come out of your mouth ?

[align=center:af10eb2c9b]"Hey buddy maybe it would be a good idea to get that checked out"[/align:af10eb2c9b]

Could EMS BE part of the problem as well ?

Perhaps empower Paramedics, as they have in the UK the so called supermedic to treat in the field. This idea certianly makes a lot of sense to me empwering RNs @ Triage to have more input into care is not the answer to stay off the masses, as there is no freaking beds to start with (just my 2 pence)

cheers

[ERDoc]

I think something that might help in the ER was if we were given the ability to tell the pt, "I'm sorry, but that is not an emergency. You will have to see your doctor." No hospital is going to allow this because it looks bad. Pt satisfaction before pt care.

[tniuqs]

I think something that might help in the ER was if we were given the ability to tell the pt, "I'm sorry, but that is not an emergency. You will have to see your doctor." No hospital is going to allow this because it looks bad. Pt satisfaction before pt care.

So Faster care = Better care?

:twisted: :evil: :twisted: :evil:

Hmmm.....then sould we start a fund for new running shoes fer the DOC?

My Evil Twin told me to type that!

[Dustdevil]

Perhaps empower Paramedics, as they have in the UK the so called supermedic to treat in the field. This idea certianly makes a lot of sense to me...

Meh... not a big fan of the supermedic concept. You think we are abused now? Wait til they find out that we will treat then at home for minor ailments! Then even the ones who wouldn't have called us for a taxi ride to the hospital will be calling us.

I don't see it taking a significant burden from the ERs. Totally different group of patients. Consequently, we aren't helping the ERs and we're screwing ourselves.

EMS has no business trying to be all things to all people. Do one thing and do it well.

[tniuqs]

Meh... not a big fan of the supermedic concept. You think we are abused now? Wait til they find out that we will treat then at home for minor ailments! Then even the ones who wouldn't have called us for a taxi ride to the hospital will be calling us.

I don't see it taking a significant burden from the ERs. Totally different group of patients. Consequently, we aren't helping the ERs and we're screwing ourselves.

EMS has no business trying to be all things to all people. Do one thing and do it well.

Dust: First off you are a SUPERMEDIC already!

I am not saying ALL just some, for example treat and release for Hypoglycemic events, wack a couple of sutures in, slip in a folly that gets yanked out in the nursing home stuff like that.

One must consider some other alternatives as not all demographic areas and groups are the equal, so instead of transporting to a facility and sometimes great distances at times, taking a truck out of service for way longer than just treating (get the papers autographed) are you saying yes fill up another ER bed for something that can be treated within-scope-of practice. Hey some ERs are using bunk beds these days...EDMONTON in the spring had up to 10 trucks for up to 6 hours on HOLD...this is not a good use of resorces to my way of thinking either.

In fact we do just that in some remote deployments right now, in Kanukistan. I believe that instead of wasted transport and then "HIT THE WALL IN ER" treat and put the Truck back in service asap, oh yes, then the delivery back home don't forget little detail I saw lots of this at the Katrina thing, man do ERs get there panties in a knot when there is no truck to empty THEIR ER bed...sorry off topic.

Just my 2 cents but I already think we are being abused already as the big red/white taxi service so why fill up the needed ER beds?

[speedygodzilla]

I think something that might help in the ER was if we were given the ability to tell the pt, "I'm sorry, but that is not an emergency. You will have to see your doctor." No hospital is going to allow this because it looks bad. Pt satisfaction before pt care.

I have to agree with you totally. I have discuss this many times when I am working at the slower of the two ERs I work at. One ER doc said the same thing, and I am sure if I ask many of the rest at both ERs they would agree. There are many times where I bite my tongue, where I would love to explain that this is not an emergency, please see your family doctor. Mind you all, I am just a EMT tech so my assessment skills are limited but I do have common sense.

The slow ER I work at takes almost every patient back to the room with 0 to 3-4 mins. The only reason we can do this is because we are a stand alone ER, meaning we receive no ambulances, just walk ins. The other ER I work at is crazy busy as they are a full trauma center. They sent a postcard to all past patients advertising that you will be seen (greeted) by an RN within 5 minutes of arrival or you get a free meal. We were already doing this for the most part anyways, so I think it is an absolute waste of....something. The RN ask what is the c/c and you have been greeted. On a busy day you will still be in the waiting room for 2 to 3 hours sometimes more until you have a room in the ER.

We have been ordering, sending all labs, and x-rays while the patient is in the waiting room so that way the doc has what he needs for the most part to assess and treat the patient.

I do like the idea of the RAT rooms. We only have 3 "triage rooms", where we see most 4 and 5 trauma levels. With only 3 rooms for that, it is a slow process also. We could use like 20 "RAT" rooms but I don't think this would effective treat patients any better, They just may feel that they have a room now while they are still in a "waiting area."

[rayemtjax77]

Our ER here in Florida has a new thing that they have been doing for about 7 months now. If there are empty rooms, the patients are vitalized at the Triage desk and taken straight back to a room. Now.. on the down side to that.. you get your frequent flyers that come in all the time and expect that but the hospital Census is up and we are holding admited pts in the ER awaiting places upstairs, it makes them angry and then they leave. Which looks bad on the ER cause the Left without being seen number goes up.

[whit72]

I cant see any community or MD opening themselves up to litigation, by allowing their EMS personnel to treat and street.