Monday, October 24, 2011

If He Could Only Go Back in Time

It has been at least three months since I have had to work with Bobo and I can't say I've missed the little twerp in the slightest.  Since he is the antithesis of team player he is always such a pleasure to work with.  Especially annoying is that he is still like a rabid squirrel on the 20 minute or less door-to-doc time. 

Most of the time the patients see the physician within the allotted (and heavily marketed) time frame.  Mostly the delay lies in the minor detail of the registration process as it is unwieldy and takes a ton of time.  There used to be two registration clerks, but  the Brain Trust that is administration actually cut secretarial hours after 3 PM so now there is only one until 7 PM when outpatient services close.  Brilliant.  This has resulted in ridiculous waits for the appointment-making and insurance-having outpatients as well as walk-in routine blood draws.  On 3-11 it can get pretty busy since both the ER and outpatient department business picks up.  It doesn't help that a couple of the secretaries are deadly sloooooow.  Thorough, but slow.  There is apparently no way for the Suits to speed up this process although I know it is MUCH faster at Pseudocity Hospital.  Probably faster at any hospital  that has a vision of rapid registration as a simple but effective means of improving satisfaction scores. But that would just make sense, what do I know.

So to recap, patients are triaged promptly but often fall down the rabbit hole of registration.  That gets Bobo's tighty whities in a wad.  He used to say is was because the nurses were taking too long to triage.  WTF?  I wasn't taking that lying down, so  I began adding the time "triage competed" boldly next to the triage time.  In most cases it was less than 5 minutes.  He probably noticed that I only did this when he was working, and that I had instigated the other nurses to do the same.  Thus endeth the discussion of how long nurses take to triage.  But did it do anything to speed up registration?  Um, no.  I learned to make copies of complicated med lists for the above average patient who came equipped with such because we must HAND WRITE med lists or we get dinged, another stupid time waster.

Some of the other docs fail to write down the times of their first interaction with the patient and leave it to the nurses. It is usually a guess as we are also responsible for noting the following in addition to triage time:  time to room, time physician sees patient, time of labs, xrays, EKG's and discharges in addition to the obvious like meds given, IV starts, vital signs, pain scale, blah, blah, blah.   I've mentioned that Bobo obsessively writes his own times down, and gets testy if we fail to write down time to room.   I think he gets a prize for having the fastest door-to-doc times, even if it means going out to triage and seeing the patient first if the nurses are in the middle of something he can't drag us away from.  I have occasionally found him in triage if we are especially busy, so that his time-to-patient  is earlier than the triage time.  I don't think he has realized that this doesn't help his numbers at all as "door" time is calculated as "triage" time; the system won't calculate a minus.  It also doesn't take into consideration that there is sometimes as much as a 20 minute wait for triage.   

Last night I thought Bobo would have a stroke.  There were sick and complicated patients, multiple admissions and transfers, endless phone calls ("You have asked me to make 3 phone calls, start 2 IV's, and splint a kid; which would you like me to do first?"), the death of an end stage liver patient who's family was in denial which entailed even more calls and tied up a room for 3 hours (with the ER wake/viewing), and one nurse-accompanied transfer necessitating calling our boss in to cover for an hour. 

Notice to all the non-urgents in the waiting room who expected rapid service: due to circumstances and Actual Emergencies beyond our control, 20 minute door-to-doc is suspended for the evening.

1 comment:

hoodnurse said...

Whenever I see these advertised door to doctor times, it always blows my mind. How can anyone guarantee that in a place as unpredictable as the ER? With the volume of patients we see pretty much the only people who see the doctor that soon are dying or trying to die.