Friday, November 28, 2008

Triage Trolls

I love to hear the latest on how long people have had to wait to be seen in the ER. Most of the time it is because they misunderstood that it is the "Emergency Room" and not the "I have a back ache and cant sleep room" or the "I blew off work and need and excuse room". I had to follow up on a complaint by a local attorney who threatened to sue the hospital and the ER doctor because he had to wait 3 hours to be seen for a 1 cm laceration of his finger that did not require sutures. ( I have no clue what he thought his damages were.) This is what I found out. He had signed in and was seen by the triage nurse. They checked his vitals signs and saw that he was not bleeding and he was then triaged to the list of those who would be seen in order for the "minor" complaints. "Minor complaints" are those that mean you are not at risk of dropping dead that instant from your problems. These are who were seen ahead of him. Two people involved in an auto accident who were intubated in the field, one of which went immediately to surgery. A ruptured AAA. Three possible MI's (2 were positive) a copd patient who needed intubated. A pregnant woman with ecclampsia and seizures. A kid with a ruptured globe. 4 acute fractures. 2 pneumonia patients requiring oxygen, a brain bleed, 2 strokes and a slew of others.

I guess that he felt that people should be seen in the order in which they hit the doors and not by how sick they actually are. It doesn't really matter though. People will only look and say that the average wait was 2 hours, it doesn't matter that they didn't have an "Emergency".


WhiteCoat said...

What a dolt.
He'll probably stiff the hospital on the ED bill, too.
Wouldn't it be terrible if the threatening letter the attorney wrote mysteriously got forwarded to

Nicolas Martin said...

I beg to differ about ER wait times. Long wait times are a consequence of the near-abolition of a free market in medicine. Physician and nurse licensure drive up labor costs and reduce the supply. State and federal regulations place enormous costs and labor burdens on hospitals. In the end, medical providers are more accountable to governments and insurance companies (themselves awash in regulations and mandates) than to consumers; creating a classic instance of He Who Pays the Piper.

In a medical free market hospitals would have been the logical leaders in creating the minimal care clinics which are now burgeoning at places like Wal-Mart and the chain drugstores. These new clinics, which offer minimal care at low cost, are well situated to relieve the burden placed on ERs by people such as the attorney, but they face antagonism and opposition from physician organizations, which are more concerned with income and hegemony than with ER wait times. Long ER wait times are part of a "soft fascist" (to use Ron Paul's term) system which benefits everyone involved but consumers.

Now, if Wal-Mart could only offer low-cost paralegal services...

Hey, You said...

If I were the hospital, I would never settle on this case. He would look completely silly before a jury with his 1 cm laceration. I bet Dr. Whitecoat would be happy to testify that bringing that to the ER is a misuse of medical services. ;)

SnowLite said...
This comment has been removed by the author.
SeaSpray said...

Boy that's some shift!

Interestingly... or perhaps predictably... the city people that had to wait to be seen in our small city ED were usually very pleased with everything. I mean they would come in looking apprehensive about a facility they perceived to look like a post office vs a big city hospital but beyond that were pleased with how "quickly" they were seen, treated and released.

Conversely... the local people are the ones who tend to be the more obnoxious ones.

I guess because the locals are spoiled and the city people expect a lot worse.

Then there are people who see whats going on and will even offer to let someone go ahead of them.

A lot of people do get "pissy" (sorry..just describes it accurately)when they see people go ahead when they came in after them...especially if they have been waiting.

The ridiculous thing though is the people who threatened to leave to go to another hospital or just leave.

Well the ones that would just leave... must not have a real emergency... although some did but didn't care...they didn't really want to be there anyway.

They would tell me they are going to the other community hospital, about a half hour away. I usually talked them out of of but didn't always.

So they are about to be seen, they leave to drive a half hour away and will probably wait even longer.
often...someone would come out looking for them after they just left.

Before triage, we'd get the little elderly people who sit politely with chest pain because they didn't want to bother us when we're busy!

That lawsuit isn't worth the paper, time or energy. How lame!

SeaSpray said...

"our small city ED "

Correction: community ED