Tag Archives: triage

The New Norm In Our Little ER

Hey there, me again.

So I’ve just finished a fairly busy last few weeks, leaving me a bit tired.  I’m not the only one – seems many of my team mates at work are on the verge of burnout…if not that, getting somewhat beyond what I’d simply call annoyed.  Some are writing complaints, some are encouraging patients to write complaints and others are just leaving.

You see, there is an issue within this health region, and within staff management in our facility, of us being expected to do the work of everyone else.  More often than not, our ER is the only one covering and open in the region out of roughly 8 hospitals of various sizes and utility.  They very often are on some sort of diversion for their ER’s – not enough beds, no doctor or other care provider able to staff it, we even had someone go unilaterally on diversion because the XRay equipment in the hospital was down (far from everyone that walks/rolls in needs an XRay)…and accidentally (and likely accidentally on purpose) neglected to tell the ER doc on that day.  All this is resulting in a pile up of patients in our waiting room and also with pretty sick people in the treatment rooms…that can’t move or be admitted to the ward because they’re full…and the other places won’t take new patients for whatever excuse/reason…all this results in a full ER waiting room and nowhere to see anyone.

There was one point a couple of weeks ago that I was seeing patients that were basically ambulatory care issues in XRay waiting areas, blood draw chairs, etc (management  gets upset at us seeing  folks in hall ways).   This isn’t good – having to run about ensuring that the needed equipment is available, other care providers know they’re there in case something horrible/hideous occurs (these people were physically separated from the rest of the ER), confidentiality concerns, etc ad nauseum.  Nobody would get seen if we didn’t do that though.  I should add that I’m pretty sure that was the same day I came on and literally every paramedic unit in our region was in our hospital waiting room with someone to offload…and nowhere to put ANY of them.

Our ER wasn’t built and isn’t staffed to look after this sort of influx – the place was designed to see about 12-14000 patients a year.  We’re seeing somewhere along the lines of over double that now since I started there over a year and a half ago.  Yet the people just keep coming.  It doesn’t help that there are few primary care providers taking new patients, the “Doc in the Box” can only see so many people and the Quick Care Clinic only takes same day bookings, so many folks show up with primary care problems.  Unfortunately, the triage staff are contrained by not being allowed to send folks home for ailments that don’t require emergency medicine care.  One doc that I work with has a saying – “there is a lot of medicine to do to this patient, just no emergency medicine.”

There is also the insidious “Just wait until we move to the new facilityitis” that’s prevailing right now.  We’re being regaled of the new wonderful equipment and staff awaiting us when we move into the new hospital…in about a year or so.  So we’ve got stuff that’s older than Dirt’s great-grand parents, not enough of it, morale that’s lower than whale poop in the ocean, people dreaming up morale things like a dept newsletter instead of going to bat and doing something to offset what’s happening to us.

We’ve all pretty much decided that this will be our new normal to deal with.  We’re less than likely to ever clear out the waiting room, clear out a lot for our treatment bays because we’ll be holding patients awaiting admission in those same rooms.  I can foresee us losing staff in the near future as well…the ones that are really good aren’t putting up with this much longer and have essentially said they’re gone when something presents itself.

Unfortunately, what I see is people at various levels not being held accountable to the Region, the College(s), and to their patients for the actions that are leading up to this impending implosion.  People need to do what they were hired to do and if they won’t, then be dealt with the way any other employee of our own would be.  Patients need to take responsibility for their health care as well and stop using ER’s like their primary care offices.  A cold of 2 hours duration is not an emergency…no exaggeration, I’ve seen people that come in for that.  We need a system where either the triage nurse is empowered to tell people to leave with problems that have no business being there, have someone else at the triage desk to do that for them, or start billing people for frivolous visits.  I don’t want to see a New Normal 2 or 3.0.