Emergency Rooms - Where is the Emergency?

I have worked within a hospital system twice in my life. The first time was summers during college as a maintenance worker, mainly mowing the lawns and other duties as they came up. Being a young male in a small hospital which had no male nurses, sometimes I was called upon to be an orderly, to help lift patients, etc. I worked in the X ray department one week when they were short, I mopped the floors if someone was on vacation, and I spent time helping in the storeroom. This was somewhat an idyllic view of healthcare. Two ER rooms that often were unoccupied (but the maternity ward was constantly busy!).

The next stint (no pun intended) was at a 700-bed hospital system with the fancy title I created - Organizational Performance Project Manager. I spent five years trying to improve the patient outcomes, analyzing data, teaching quality improvement tools, helping people figure out Excel, etc. Coming from a manufacturing/industrial background, this was a 180 departure - actual people's lives depended on the quality of the service or product - not selling an item to a customer who then turned it into something else.

I can likely write pages on a variety of healthcare-related topics but this one is centered upon Emergency Rooms. I grew up watching ER, St. Elsewhere, etc. That is TV drama, not real life. My experience is that most of the time Emergency Rooms are not the bustling environment depicted on TV. I would visit, audit, whatever in these Emergency Rooms during those five years and I rarely saw anyone racing around. Often the staff were waiting on something - lab to come and grab a sample, someone to wheel a patient to get a CT scan, etc. etc. etc.

I was shocked and somewhat discouraged whenever I reviewed a complaint back in the day that someone sat in the ER Waiting Room for six hours without being seen, then left, or even being in a room in the ER and not getting the treatment they needed. If I recall correctly what I was told, unless you are bleeding, not breathing or having a stroke or heart attack, you are not an “emergency”. I get that; there is a triage, a hierarchy of healthcare scenarios. Surely someone can explain the situation to that individual and they can understand what is going on versus sitting there waiting and waiting.

That was fifteen years ago. Unfortunately I was with someone in the ER two weeks ago and it was the same experience. Monitors got hooked up, a few people popped in and out, then nothing. An alarm went off for fifteen minutes and no one came until I went searching for the nurse. It took over 90 minutes after we had requested to speak to the doctor to find out what is going on and why all the tests before he stopped by. At least on the wall there was a sign telling you how long you had to wait for results!!

One of the wastes listed in Lean teachings is “Waiting” - waiting for information, people, etc. This hospital is building a new facility about three miles away. I sure hope they design a satellite laboratory close by the ER. At one of the two hospitals I worked at, the lab was on the other end of the hospital. The cafeteria was closer to the ER than the Imaging Services was!

For the patient or family members of the patient if in the room, minutes of not hearing an update can feel like hours. IF someone had simply come in and stated “here are the tests we are going to run, what we are checking for, how long before we will know something”, that can give a sense that SOMETHING is happening versus you are just laying on the gurney while just patiently (again no pun intended) to wait your turn.

Those of you who still work in healthcare, please consider how information can reduce anxiety in patients. It is often that unknowing that causes undue stress on someone. Improving the patient experience IS a quality issue.

Let the debate begin!!