Agraphia Medical Tragicomedy

23Aug/09Off

Owning the Department

I find myself on this rainy Sunday night checking on the waiting times for our Emergency Department (actually, the 4 subsets that we run: Urgent Care, Pediatrics, Medical, and Trauma). I have an excuse - I need to see if my cardiology patients are still in the hospital.

The ED is exploding right now. 4 hours is the minimum to even be brought back to the department; another hour or more to be seen by a doctor once in the room. On a good day, we clear out our waiting room and I see a patient within 10 minutes of triage. Right now, my colleagues are struggling to see them a quarter of a day later.

I can't help but put myself in the shoes of each of my fellow doctors. The intern in Pediatrics is currently seeing 6 patients - far more than any of us can comfortably manage at this point - and her patients have an average length of stay of 4 hours. It's not her fault; complicated patients keep flooding in, needing to be seen. Right now she is being swamped with lab and XRay results, all while trying to sew up a head wound.

The intern in Urgent Care, by contrast, is only managing 2 patients, but this isn't surprising. Urgent Care tends to be serial. See patient with strep throat, give antibiotics, discharge. See next patient with UTI, give antibiotics, discharge. Unlike Trauma or Medical, where everyone needs CAT scans and major blood work, Urgent Care is all about formulating a quick diagnosis - little multitasking is required. Even still, 4 patients are waiting to be seen, and Urgent Care closed 10 minutes ago.

Why do Emergency Physicians care so much about wait time and efficiency? Because maybe one of those 4 patients in Urgent Care is having an atypical heart attack or stroke - and is quickly running out of time for treatment that needs to be given in 90 minutes or less. Maybe someone in the waiting room is dying while the doctor is taking care of someone else.

In the meantime, I'm hitting refresh on my home computer, watching the ebb and flow of life and death in our ER.

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