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Sunday, September 14, 2014

DING! DING! DING!

There is a game we play in the ER. Its called the ER charge nurse bed game.

You are charge, the phone rings. There are 2 chest pains in the lobby and an ambulance on the way. You have 5 minutes to come up with 3 beds...GO!!!

Go directly to docs area, with a stern look on your face, ask docs who can go to the hall. Docs say nobody can move. You move their patients anyway! You come up with the beds! DING DING DING You score 25 points.

You are charge, the phone rings. There is a critical 3 minutes out. All the beds are full, including the stab rooms! GO!!! You do a 2 patient room switch and the ambulance rolls in just as a bed goes into the stab room! DING DING DING You score 25 points.

There are fifteen patients waiting in the lobby. The natives are restless. The triage staff is threatening mutiny. You are waiting for beds for 4 admits. GO!!! Y
ou quickly called the supervisor, threaten to go on divert to ambulances. She comes up with the beds. DING DING DING You score 50 points.

Final score: 100 points. You win: $16.00 extra ($2/hr) for being the charge nurse for 8 hours. You stop and pick up some cheap wine on the way home.

Thank you for playing the ER charge nurse bed game.

Friday, September 12, 2014

Joan Rivers, free standing ERs and that one in a million bad scenario

There is a free standing ER that is located in a nearby suburb which is connected with our hospital.  A free standing ER is an ER that has no hospital at the location.  Any patients admitted are transferred to our hospital or another hospital. These free standing ERs operate the same as any other ER.  They can do anything a normal ER can do.

I was thinking about the whole Joan Rivers thing and the news that she probably died of airway compromise related to vocal cord spasm.  I don't know anything about how something like this is dealt with.  I mean I don't know if you can do a cric or what.  Its obvious that an outpatient clinic isn't prepared for something like this.

Got me to thinking about free standing  how vulnerable free standing ERs are. Yes they have qualified highly trained ER doctors who can manage just about anything.  I wonder if there have been cases across the country where something has come in that can't be handled or a delay in transfer has caused a death?

I remember one time when a young girl came into our ER.  She was about 6 years old.  She was in anaphylactic shock.  It was very difficult to intubate her.  Fortunately there was a pediatrician who was in the special care nursery and helped with it.  What would they have done if he hadn't been there?

I guess thats the chance you take with outpatient settings.

Wednesday, September 10, 2014

why should we care?

I get dropped off on the days I work by my husband at our entrance.  So I have walked into our entrance probably thousands of times.

So I step out
of the car and the sidewalk to the door is all dirty.  There is a garbage can and typically there is a wet stain draining out of it down the sidewalk.  I walk in the automatic door.  The carpet looks like some remnant thing they got at Menards on sale.  It is dirty and worn.  The walls are scuffed.

You walk up to the triage window.  Over to the right is our waiting room.  Bolted to the ceiling are 2 TVs that were bought in the 1950's.  The lobby is dimly lit. The furniture is worn and dirty.

Welcome to our ER.  This is just the initial impression.  First impressions are  everything they say. Doesn't bode well for us.

The ER itself is old, very old, hasn't been remodeled in years.  It is run down, falling apart.  It is too small.  There is not enough seating for the staff.  It is noisy and congested. The walls are scuffed, the floors in the rooms are dirty.

Conclusion: Obviously the hospital doesn't care about what the ER looks like, what kind of condition it is in.  If thats the case, they obviously don't care about the patients.  Why not? My cynical old self says its because we are in the inner city, our patients don't have insurance, they don't demand new stuff.  Our patients are neighborhood people, old people, the chronically ill.  Middle class white folks ain't coming to our ER  

Why would I say this?   Every ER in the corporation I work in has been remodeled except ours. Only one other ER they own is in the city, the rest are in the suburbs where the people with insurance live. They just built a brand new free standing ER.

So the questions becomes: Why should the staff of my ER care if the hospital administration obviously does not?

Monday, September 08, 2014

oh by the way, the guy in the ambulance with the headache is a violent drunk

Sometimes I hate medic control.  Medic control is the county dispatching system in our area. They call us when an ambulance is coming to us.  They give us age, problem, ETA, triage level.

Here's the thing: THEY OFTEN  DON'T GIVE US ENOUGH INFO...  It is triage's job to decide where everybody goes, when they go.  The sickest go first.  As you can imagine, a lot of the times the rooms are all full.  So people go to the lobby. When we are full and an ambulance is coming in, sometimes we have to move people around or put them in the hall to accomodate it.  Sometimes we triage them and put them in the lobby if they called an ambulance for some numbskull reason like a sore throat, toothache, stubbed toe.  Or we might send the ambulance to urgent care.

Well here's what happens: We get the call, ambulance on its way in with headache or constipation. Okay, no rooms.  We'll triage them and put them in the lobby.  So here comes the ambulance. Oh what's this...that headache is sloppy drunk.  That UTI is a quadriplegic.  That sore throat has cerebal palsy.  In other words, they ain't going to the lobby.

So we now have medics with a patient on a cart with no place to put them.  GRRRRRR.....this pisses me off.  I have to tell the charge and either rooms are rearranged while the medics sit there or we triage them and stick that foul drunk or poor quadriplegic in back of triage while we mo ve rooms.

Why doesn't medic control tell us these LITTLE details?  I haven't got a clue....I know you work really hard. I know you have a really stressful job.  All I want is to add drunk to that headache, quadriplegic to that UTI...thats all.