The Waiting (is the Hardest Part)

The Big White Board

The Big White Board

I think we’re all conscious about the amount of time a patient spends in the emergency department:  from being triaged (0 – 30 minutes), to being called back (0 – 6 hours, longer during a Swine Flu epidemic, shorter if you have no heartbeat or a knife sticking out of your belly – then it’s an E ticket straight back), then waiting for the RN exam (5 – 30 minutes depending on shift change, patient load, or coffee/smoke/mandatory union breaks), then the resident exam (5 minutes – 2 hours depending on your triage color and/or what we think about your presenting complaint, us cherrypick – never, or, if you’re a regular EtOH or substance abuser, you could go the entire shift as an EFD – Exam From Doorway and simply get your discharge paperwork when you metabolize off that fifth of vodka, we’ll wave to you on the way out the door), then, in an academic program, presenting to the attending (5 – 30 minutes depending on patient volume and attending to resident/medical student/PA ratios) , then placing orders (5  minutes if I am writing your Lortab to go and discharge paperwork at the same time or 30 minutes if the medical student is trying to order every test conceivable to cover every possible differential for your sudden onset abdominal pain which may or may not be related to your current Dilaudid titers), nurses or clerks entering orders (2 – 20 minutes for the same reasons above as RN exam), labels being printed (did someone replace the ink cartridge today?), labs being sent (3 – 60 minutes depending on how many people the ED tech flirts with/chats with/texts to on the way to the lab or whether or not the tube system is working on this particular day), patients being transported to radiology (is the same ED tech taking them or is the Radiology tech taking them?), lab results being returned (did your lactate level get sent to heme instead of chemistry who then lost the sample by sending it to virology who took it off ice before sending it back to chemistry who threw it out and, when you call an hour later, tells you to redraw since the tube was improperly labeled because virology repacked the sample on ice on the inside of the bag instead of on the outside of the bag which soaked the label rendering it illegible?),  radiology reports coming back (if it’s during that mystery time when your Australian company isn’t reading them and your radiologist is still dropping off the kids before heading to Starbucks for their morning java fix it might be a while).

Of course, once all the results are in, if you’re discharging the patient then there’s more paperwork, scripts, instructions and the patient getting their Pink Ticket to Freedom.  If they’re being admitted then time is spent paging the admitting service, getting called back, placing the admit order, getting a room assignment (remember, this depends on the number of housekeepers available) and then the patient actually being taken upstairs (again by that ED tech, boy, they do get around).  Things get more complicated if a consult needs to be called.  Then you’re paging the service, waiting for the return call, and then waiting for the consulting service to arrive (surgery – in house, neurology – one resident to cover 4 hospitals including the “stroke center” so you might as well get out the camping gear and the deck of cards, it’s going to be a while).  Then, of course, consultants want more labs, more tests.  They then talk to their attending.  You might end up calling for a second consulting service, or admitting to a medicine service.  Rinse wash repeat.

Don’t even get me started on someone needing a procedure done… med student suturing lesson, anyone?

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  1. #1 by Trish - September 10th, 2009 at 14:22

    I can’t believe no one commented on this yet …. too funny because it is sooooo true. I am an RN in a very busy ED. It KILLS me that 30 minutes after a patient gets settled in to their bed, had labs drawn, etc., they ask “How long do yo think I am going to be here? I have to be at work at…” UUGGGHHHH! People think the ED is the fast food of health care – “I’ll just stop by for a quick blood test or xray and be on my way.” Anyway … great post. I want to laminate it and hand to each patient of mine.

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