Guess where I am? At the human hospital attending a sick friend’s bedside (his family’s out of town and unavailable). It’s been twelve long hours and counting—five of them spent in the waiting room in the pre-dawn hours (when things are supposed to be slowest).
Indeed, the waiting room was nearly empty when we arrived (and there was little of that behind-the scenes bustling that indicates a slammed shift). But somehow, here we are, waiting for the doc to come see us—a full turn of the clock later.
I often wonder how this happens. What, exactly, goes into a human ER wait? Picture the pie chart with its divisible slices marking the time. Is one-third the waiting room piece and another half-pie spent waiting for the doc? I certainly hope so in this case—that’d mean I only have a little sliver left. Wishful thinking, for sure.
How can it possible go so slow for all us ER victims (even when no ambulances are pulling up and no critical cases seem to be on the floor at the time)? And now the nurses are laughing and giggling gleefully—always a frustrating harbinger of even heftier servings of that distasteful time-pie.
And here’s where the former emergency vet in me launches into a comparison of how much wait-time I consider acceptable in my ER versus what I’m getting served now. But that’s not only an unfair match-up, it also doesn’t reflect too kindly on most vet ERs, given the apples and oranges nature of these two disparate healthcare systems and the long wait times I hear tell about.
Still, I’m a stickler for efficiency in my practice and I can’t stand to see idle chatter while an X-ray needs to be taken or blood needs to be drawn. I detest client wait-times! Moreover, I truly stress when an emergency has to take precedence over waiting clients or when people arrive late and throw me off my game.
My staff thinks it’s almost a pathology, this time thing of mine. And they might be right, but I see it more as a Golden Rule kind of thing. Because I hate to wait—so how can I expect my own clients to suffer the same?
To assuage the stress, I travel with knitting, a book and my computer at all times—just in case. And here in Miami, just in case is just about always. This ER experience is clearly no exception.
While writing this post, that pie has grown by another forty-five minutes. At least I’ve managed a couple of semi-constructive items in that time—of which not strangling the still-screeching-with-hilarity staff is perhaps the most notable accomplishment.
PS: OK so this is one thing that never happens in an animal ER: Apparently, no doc is planning to come into this room and perform a physical examination. The nurse practitioner, much as I might have respected her judgment otherwise, has basically invalidated her usefulness based on her discharge recommendation—without ever performing a full physical. (And this patient can’t even walk and can hardly speak for his severe weakness.) I’m certainly not leaving here until he gets the physical I’m sure his insurance will be paying for anyway.
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I'm sure big-city ERs are quite similar: If it's not a GSW, you don't get seen.
Last time we went to ER for my 75-year-old father, we were told it would be a minimum 15-hour wait. By then, he could have seen his PCP.
So ... we could have taken him home, or put a bullet in him to get him in sooner. We chose the former.
Gina June 13th, 2007 12:13:00 PM
This must be one of those weeks. Tales from the Emergency Room just did a post on ERs and EDs - and I had to respond with one of my most dramatic (human) ER instances. (It's on my blog if you're interested.) I was singularly unimpressed. (Comes from having to beg for lifesaving treatment.)
In comparison to when we took our pekingese to the Vet ER for him throwing out his back, the vets seem more on the ball. (I know appearances are somewhat deceiving at times.) His Majesty was well taken care of by the emergency vets - all of whom fell in love with him. (I've never seen a more charismatic dog, honest.)
This might be unfair, but it was my impression.
MLO June 13th, 2007 01:18:00 PM
Our local ER isn't any better. If the wait doesn't drive a person insane, catching some digusting flu virus will certainly do the trick. Everytime we walk into that place, one or all of us catch something while we're there.
Is your friend doing okay now?
Stacy June 13th, 2007 03:15:00 PM
It's an unwritten rule in this area....if you arrive by any mode other than ambulance, you wait . And wait. And wait. You want in quickly, arrive by ambulance.
agadore's mama June 13th, 2007 06:48:00 PM
Hmmmm....well, I better bite the bullet on this one and (somewhat)defend my profession and colleagues, at least to some extent. I am the charge nurse in the ER where I work, on the 7pm-7am shift. We are NOT a big city hospital, nor are we a Level I trauma center. Ours is a small hospital; 225 beds, in a relatively small town. To remain competitive in a fairly saturated market,our administration has established a goal of 30 minute "door-to-doc" time (in other words, actually be seen by a physician within 30 minutes of arrival). Granted, this does not always happen when we are very busy, or have multiple critical patients, but in most cases, our patients are in an exam room within 10 minutes of arrival. (I actually pulled my monthly census sheet for this post). So far this month, the longest door-to-doc time was 57 minutes in one case, and 54 in another. The average time of all others excluding these two, was 23 minutes. In 2 instances, the patient was seen in 7 minutes.
I am aware of the horrors of city hospitals; long delays, overcrowding, poor staffing; and to some extent, these apply in my own small facility also. One of my primary duties as charge nurse is to keep things moving. In an ideal world, there would always be enough open exam rooms and staff to accomplish this. But in the past couple months, the hospital has been filled to capacity on many occasions, and ER patients requiring admission have been held in the ER for as many as 28 hours before an inpatient bed opened up. The result--sometimes as many as 10-15 inpatients being held overnight in the ER, which ties up our exam rooms and bogs down the process.
As far as ambulance arrival speeding up the process; yes it does if you are truly in need of emergency care. But some of our "frequent fliers" mistakenly believe that their paper cut, sore throat, or ingrown toenail of 4 weeks duration will go to the head of the line if they arrive by ambulance. So in fairness to those already waiting, we often send these kinds of non-emergencies from the ambulance to the waiting room to go through the process like everyone else.
As far as the giggling and noise, an ER is almost always a noisy place, despite all efforts to keep the decibels down. Nurses and doctors laugh a lot; our attempts at sick humor help to defuse stress. And if they are eating at the station, usually it's because they were too busy earlier to get to lunch; and a 12 or 16-hour shift without food doesn't make for a happy, compassionate caregiver. Know why nurses have so many UTI's? Sometimes they're too busy to go to the restroom. One day last week, I had been on duty for 10 hours before I got a chance to go to the bathroom.
I am not trying to make excuses for your delay and discomfort, and I am truly sorry for your bad experience. I hope you never need emergency care, but if you do, I only hope your next experience with the ER will be a better one.
Shellie June 13th, 2007 10:22:00 PM
Shellie: I thought you might respond to this post. I'm especially aware that the behind-the-scenes giggling is human and necessary. I'm also aware that to hear laughter when a pet is dying is disconcerting. It's a tough balance, I know. Your 30 minute time to doc sounds like a godsend! Can you move to Miami?
Dr. Patty Khuly June 14th, 2007 08:18:00 AM
As for getting in faster when you arrived by ambulance: Funny, I always get right in when I'm having a severe allergic reaction, and I've never arrived by ambulance. I always stab myself with an epi-pen and have my boyfriend drive me--I don't want to wait for an ambulance.
I was a little freaked out the first time that they took me before gunshot wounds, but then they explained that they expected me to die really soon without treatment and I was really freaked out! ;)
Seriously--based on my experience, it's all about how quickly they expect you to drop dead (literally).
Katherine June 15th, 2007 12:36:00 PM
Another ER tip: Have a brother who's a firefighter. My dad had an earlier ER experience, and was taken in by ambulance. (Tip No. 1).
We couldn't get any answers on what was happening, hour after hour, until my firefighter brother got off duty and came over. He had the pass code through the ambulance bay, and just walked in and talked to the staff at regular intervals.
So: If you want to get help in a medical emergency:
1) Call an ambulance
2) Be related to a firefighter or cop
or
3) See a veterinarian
:)
Gina June 15th, 2007 06:12:00 PM
Katharine,
You are extremely lucky! Every time I have gone in - even by ambulance - in full anaphylaxis, I have not received proper treatment, ever. According to the most recent literature only about 30% of those presenting with anaphylaxis receive proper treatment. It is one of the most underdiagnosed medical emergencies - and people do die because of this.
As you can probably tell, this is an extremely sensitive topic for me...
Pax,
MLO
MLO June 16th, 2007 03:05:00 AM
Katherine: Your experience reminds me of the couple of times I've been rushed to an ER after being bitten (mauled in one case). Everyone waited while I got whisked in for the IV Timentin drip. Apparently, it's written into their protocols that some atypical triages require immediate attention--regardless of their apparent severity. I got the antibiotics right away but I distinctly recall having to wait a long long time for my pain meds after I was mauled (in the head by a Doberman recovering from anesthesia--not his fault, really).
Dr. Patty Khuly June 19th, 2007 10:15:00 AM
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