You Done Good - But You Had to Run Ragged

We have a system in place, like most emergency departments do, to help manage the delay of discharging a patient from the ambulance into our health system. The delay is called "offload delay". There are all sorts of metrics and politics related to offload delay, and it's not pleasant to experience for anyone.

The purpose of our offload system is to get the ambulance crew back out on the road. To some extent, it's to have the patient access the emergency health system faster, but I've done the same "pre-doctor" second triage on a patient in an EMS stretcher as I do with the patients who have walked in and are waiting in the lobby.

In our hospital, if you take an ambulance to the emergency but you can walk or sit in a wheelchair, and don't have otherwise life threatening symptoms, you'll be "offloaded" into the waiting room, if there isn't an assessment space for you. For the patients who can't walk, we have four offload stretchers with a designated nurse. Once those four stretchers are filled, then the crews waiting in hallway(s) with their patients until the next available spot.

The only folks who don't experience offload delay are those who have stopped breating, are having severe respiratory distress or having an ST-elevation heart attack (STEMI). In other words, true emergencies.

Yesterday, I was the designated offload nurse. From the moment I arrived at 1130 in the morning, until 2:30 in the afternoon, I did not stop bustling from patient to patient, triaging ambulances, drawing blood, changing incontinent patients, walking people to the bathroom, assessing patients, carrying out orders, documenting, giving medications and uber-multitasking. In the first hour I offloaded 5 ambulances - two of which had ambulatory patients that I could move to another area of our department. I managed another three ambulance offloads by 6pm.

My charge nurse and manager complimented my "great work"....

And whilst I appreciate the pat on the back, I have to wonder why I nearly had to kill myself in order for the system to work so efficiently (which got me the compliment). And is working like I've literally thrown a dozen china plates in the air at the same time and have to catch all of them before they hit the ground really worth a pat on the back?