Monday, January 8, 2018

The Long Wait - A Bandaid for the Emergency Room Crisis

This is just an off-the-cuff comment, but enduring a long wait in a crowded, infection-ridden emergency room just once should be enough to spur people into action - or at least into innovation. At the time of my first extended wait, I asked a nurse if I could just take a number or somehow find out where I am in line and/or have a means to hold my place so I could leave to get food and come back again later.

She said, "No, you just have to wait with everyone else."

Fair enough, but what if we could wait at home??

When we first sign-in at the hospital now, it's all on a computer. It seems feasible, to me, to develop a means of signing-in from home. I mean, we can check the general wait-times online already:

But because that time can vary depending on what type of illness or injury shows up after we get there, it doesn't tell us much. And the longer we wait to make our way to the hospital, the longer we could end up waiting there because there are no guarantees that the wait time will diminish.

The computer log-in provides the first line of triage, and that wouldn't change. But patients could provide more information to the triage nurses online instead of having a waiting period followed by a brief interview and then another waiting period. Most people can take their own temperature at least, provide a sense of their pain or distress on a scale of 1-10, and fill in a questionnaire about symptom onset, duration, and severity, enough to get a sense of if their condition is emergent, urgent, less urgent or non-urgent. I realize triage is a complicated process, so a trained nurse could ask further questions as needed or even ask for photos to be sent if necessary, and the system could be made to flag any typical symptoms that might indicate a fatal condition. The system could estimate wait time based on each patient's own specific need for treatment, and sick people could stay home until just 15 minutes  before their name is likely to be called. Anyone anxious about the system not working effectively, can wait the five hours on a hard chair potentially surrounded by people with contagious conditions and a TV blaring nearby. People would need to sign in with a valid health card number to prevent any shenanigans. Abusers of the system would have to face consequences similar to those faced by 911 prank callers.

Of course there's nothing that can match a professional seeing a patient in person to judge if they're just uncomfortable or scared and in need of reassurance rather than actually needing emergency care, and they'll have to err on the side of assessing people as more urgent, but, until we're able to actually fix the system, maybe something like this might at least make it more bearable. Any time I've called Telehealth, they've just sent me to emerge anyway. Maybe putting it in the hospitals as a first-line  assessment service could make the waiting easier. I wouldn't be as annoyed about waiting for hours if I could do it in my living room.


Anonymous said...

This makes so much sense, I have grave doubt it could possibly be implemented. Someone up the food chain would complain about it.

Having spent six hours with my mother in emergency, accompanied all the while by my brother - himself an emergency room doctor from another jurisdiction (!) who believed mum had suffered a stroke - the frustration was beyond the pale. He could not get through to the incompetent staff that something needed to be done RIGHT NOW. Then we were told the neurologist had popped home for supper! Beyond belief.

As I said the placid seat warmers running the admittance at emergency and apparently unaware of triage, would be highly annoyed if they had to text patients who had left the room to escape catching anything from a cold to the flu to C-difficile, but who still wanted to see a doc. The official seat warmers would rather file their nails than be bothered to do a decent job. Saw it with my own eyes. So no, in our free system every patient is just a number who must sit and wait their turn right there, not being allowed to wander off for a coffee or a stretch.

I spit on the stupidity I saw, the rank organizational incompetence. My brother was fit to be tied as you can imagine. He knew what to do but couldn't do a thing because you can't treat relatives.


Marie Snyder said...

Sorry to hear that, BM. It's so frustrating to be made to wait without any real sense of the time you'll be there, especially if you believe a life is on the line. There are lots of other things that could be done, like have more family doctors and train them to deal with more issues (both times I went recently, I was sent by my doctor, and then sent home without treatment in emerge). And, to pay for that, they could get rid of duplicating services. But this might be a quick fix for now. But, you're right, it's unlikely to ever be implemented.

B. said...

The medical advances made in my lifetime have been astounding, yet in some ways the medical community in America is decades behind the other sciences. Most noticeably, in the U.S., at least, is that they rely solely on fax machines to transmit any kind of written documentation, often to the detriment of patient care. I live in a big city (Philadelphia) with hospitals that have all the latest equipment, but when I'm in their offices it's like I've gone back in time to 1995.

Marie Snyder said...

B, you'd think by now that there'd be an integrated medical system where your files would be accessed by any doctor you visit immediately - and maybe any pharmacy - so you don't get drugs from different doctors that are contraindicated. It seems like it would be easy, but maybe I'm missing something.

Marie Snyder said...

@B. I just stumbled across an article about fax machines in health care:

"The number of hospitals using electronic records grew from 9 percent in 2008 to 83 percent in 2015, a huge change in less than a decade. But the program didn’t account for a critical need: sharing. Hospital and doctor offices generally remain unable to transfer electronic information to other hospitals and doctor offices. Billions of dollars later, they are left printing out documents and faxing them. And so the fax machine remains medicine’s dominant method of communication."