Re-Inventing the Wheel, and Still Going Nowhere

Every hospital re-invents its treatment area to shave minutes off of processing time. If they don't this, then they get penalized with less governmental funding. How does that make sense? When part of the reason why there's a delay at bedside is that patients out number the delivery of care staff 5 to 1... or more.

We have developed two new such processes in the emergency department. Last year was RAZ, Rapid Assessment Zone. This year it's HAIZ (not haze! I don't like the nomenclature myself), the High Acuity Intake Zone. It is supposed to take those level 2 and 3 ambulatory and non-ambulatory (but potentially admittable) patients in to be seen by a nurse faster... but they end up sitting in a curtained cubicle meant for a single stretcher just staring at each other, without even a TV to distract them. And forget about privacy. And yes, the patients still wait for the same reasons that they would have waited for before in the old system: there are not enough emergency beds because the hospitals are FULL!

Sure the statistics are going to show 5% improvement, 30% improvement etc in overall wait times. What they don't reflect is the ongoing lack of overall patient satisfaction. Delivery of care is never fast enough. Time to a doctor is never expeditious enough. Waiting is the bane of medical practice, regardless of how many minutes you sheer off of it. What people want is walk in, walk out and be fixed. And no amount of yay for us, we're working at 110% of what is humanly capable, dying by the end of a 12 hr shift and leaving HUGE holes open for practice error and deficits will change that.

Oh yeah, and by the way, the statistics of speedy processing also don't account for any ability to actually CARE for your patients.

So, given that hospitals will NEVER be as efficient as the Tim Horton's drive through, which seems to me what 90% of the ED clients want, then why are we pushing our staff beyond professional and legal capability?

Today, a woman was left in the hallway, with a curtain around her for privacy, waiting all day for a nameless patient to be discharged from elsewhere in the hospital. In order to keep up with the people coming into my HAIZ, getting their nursing assessments and lab work done, and finding a place for them to be seen by a doctor, the hall patient was essentially ignored after 8:30 until 2pm, when another member of the extended care team requested some tylenol for her. Damn! I think to myself, I meant to give that to her HOURS AGO! Sure, someone gave her breakfast and lunch, but not one of the three of us nurses in that area were able to follow through with the CARE of nursing this patient.

If you're breathing in the ER, that's 85% of your CARE accomplished. And please don't die whilst we struggle to keep up with everything else.

Once I had an ED physician tell me: (for administrators) the ER is like your a$$hole, no one cares that it's there until it is not working. Maybe, he is right.