Friday, February 29, 2008

Dream Sign for Triage (well, it IS customer service, isn't it?)

Heh, heh. I had to chuckle at Girlvet's triage warfare.

Here is my dream sign for triage:

1. Please do not ask how long the wait is. We are doing our best to serve you.
2. Patients are seen in the order of severity of illness or injury, not "first come, first served"
3. Lack of planning on your part does not constitute an emergency. If you need a prescription refilled or have a chronic problem, please see your PCP.
4. Triage is not a popularity contest, nor does the person who wails the loudest automatically get in ahead of someone who is legitimately ill or just very quietly suffering.
5. Save the drama for your Mama. See #3.
6. If this is your third or more visit with the same non-urgent complaint this week and you have not followed any of your discharge instructions from your previous visits, we probably can't do anything more for you. Most of our advice is based on common sense, and there is no prescription for a congenital absence thereof.
7. If you are checking in with abdominal pain or vomiting, please do not avail yourself of the delicious snacks in the vending machine. For that matter, please do not eat the Big Mac you have brought with you.
8. Please be courteous to the staff and others who share the waiting area; screaming and using foul language only serves to piss us off, and Pseudocity Police station have way less comfy beds in their holding cells. And your bail will be more than your co-pay. Not that you'd pay it anyway.
9. Please do not inquire as to why someone has been brought in to be seen ahead of you. The triage nurse is very experienced, and if she thought you were as sick as you think you are, you would be in a bed too. Besides, it is none of your business and privacy laws exist to protect, well, privacy.
10. If your condition has changed or become worse, please do let us know and we will be happy to reassess you. Please be aware that the decision of the triage nurse is final, and faking a seizure is not cool.
11. Please watch your own children and be responsible for their needs. We cannot give everyone a turkey sandwich. Your medical care may be paid for by the government, but if you can afford cigarettes, a cell phone, and a videogame for each of your 5 children, you are expected to feed them.
12. "Pregnancy test" is really not a reason to come to the ER.

Thursday, February 28, 2008

Operators Are Standing By....

We get lots and lots of calls from people who are looking for advice, as I'm sure most ER's do. Here is today's top ten:

10. "How long is the wait?"

9. "If I took Tylenol at 2 hours ago, how soon can I take Motrin?"

8. "How long is the wait?"

7. "I cut my finger with an Exacto knife, do I need stitches?"

6. "I saw Dr. Dewshe Bagghe last week for my back, and my prescription for Percocet ran out, can he just call me in a script for more?"

5. "What are the symptoms of food poisoning?"

4. "Should I bring in my 2 year old for a high fever? It's 100 degrees"

3. "Can you talk to my husband and convince him to call an ambulance? He twisted his ankle yesterday and it's swollen and black and blue. Yes, I have a car, what does that have to do with it?"

2. "Can I make an appointment?"

1. "If I can't make an appointment, can I put my name on the list so I don't have to wait so long? Like at Chilli's?"

Wednesday, February 27, 2008

I Guess It Takes a Full Year For Some People to Feel Friendly

Wow, Hell has frozen over and I'm expecting the sun to rise in the west tomorrow. Dr. Dewshe Bagghe has condescended to make eye contact and engage me in actual human conversation. Will wonders never cease?

Aww, are you feeling all left out an lonely because I ignore you?
I'm sure.
Must be you are all impressed with what an AWESOME job I am doing as admissions coordinator. If not, see above image and follow these directions:
"First shalt thou take out the Holy Pin. Then, shalt thou count to three, no more, no less. Three shalt be the number thou shalt count, and the number of the counting shalt be three. Four shalt thou not count, neither count thou two, excepting that thou then proceed to three. Five is right out! Once the number three, being the third number be reached, then lobbest thou thy Holy Hand Grenade of Antioch towards thou foe, who, being naughty in my sight, shall snuff it." (Idea shamelessly stolen from Monkey Girl--I love Monty Python!)

Friday, February 22, 2008

Ear Enemas 'Til Clear

This could be the next big thing in ear lavage

I have never understood what compels people to come into a busy ER for a problem with earwax, never mind be willing to wait for a couple of hours to have them blown out. These are people who do this regularly. There is generally no infection, just diminished hearing. What?


Do PCP's not offer this service?

I really hate to irrigate ears, at my last job I simply refused to do it. Is squirting warm water into an ear with an 18 gauge IV catheter really a nursing task? Is there not the potential for perforating the ear drum? Hmmm?

You can soften up those big hunks of black gunk all day with mineral oil, the juice of two freshly squeezed ripe Colace gelcaps, or Debrox, whatever is lying around. You will still need a big honking squirt of warm water to make that puppy exit the orifice. Really, after more than 30 years there are few tasks I hate more than irrigating ears.

This guy has all the answers (and seems to enjoy it) so if you want to avoid a trip to the ER, check it out.

Sunday, February 10, 2008

We Have Met the Enemy...and We Don't Like Him (Part 2)

Noun 1. bean counter - an accountant or bureaucrat who is believed to place undue emphasis on the control of expenditures

Usually, the last thing in the world the bean counters want is for the ER to go on diversion- it's a money thing, or course. It always is. They will micromanage the hell out of what is going on in the ER to the point of silliness. The latest silly thing is "the Huddle". What is the Huddle, you ask? Simply stated, it is a meeting of the minds--the ER doc, charge nurse, admission nurse (reluctantly), and a couple of useless bean counters to "look at the board", or as I like to call it the ER scoreboard. How many patients, how many admissions, how many potential admits/transfers/discharges, where in the process are the docs/hospitalists on dispo's. Instead of asking "what can we do to help you", we get "what are YOU doing to get these 40 people out of here so we don't have to divert. It's all pretty senseless, because it's all just math; too many patients + not enough beds = diversion, a monkey could do it.
On Fridays, when the bean counters and managers go home, there seems to be an assumption that nothing happens in the hospital, that life goes smoothly on, and it is a happy little utopia for patients, nurses, docs and everyone. I humbly say this is complete bullshit, and Friday was business as usual. I am trying to get these people out of the ER, I really am. I have beds for everyone, including the suicidal 1:1. I am finding the charts for the hospitalist. I am communicating my ass off to the ER docs, admitting, and at the same time addressing the 5PM direct admit requests (you couldn't do this at 2PM when the patient saw you? Yes, I know about that). But I am only one person. The ER charge nurse is panicked and won't be talked out of the tree. We are on a help alert (does no good if you don't have orders). I get a call from the medical director who grills me on what the hospitalist is doing, how many admits he has (um, 6), why hasn't he called for a backup hospitalist--I simply hand to phone to the hospitalist who happens to be the only one in the whole hospital, not good. The medical director calls me back to let me know that she is flabbergasted that he is all alone, and it will be addressed on Monday, "in the meantime, there is nothing I can do about it", NO SHIT. And for the record, I didn't ask. It's Friday, inexperienced ER charge nurse, no techs, no volunteers, no paramedics, no LNA'a. Guess what? We are on diversion. Monday morning there will be an Ambush Debriefing: a surprise meeting, complete with white board, QM, and whoever was working on Friday to figure out how it all could have gone so wrong. Since everyone else worsk 3-11 and the meeting will probably be at 8:30AM, looks like I will be the only one there; I worked 4 hours past time to leave to try to straighten things out, but they don't care about that. Want to know how it could have been fixed?
1. More than one hospitalist. The floors were ready, willing and able to take their admissions, they just won't do it without orders. Can't blame them, why should they hang their butts out on a line?
2. Full nursing staff--it still is NOT OK to leave at 3 PM if you are a manager, without appropriate staffing levels. Come on, people, the same thing happens every week!
3. How about a little support for the nursing staff? LNA's, techs or paramedics to assist us in getting patients out of the ER and into their cozy floor beds. It's a no brainer- if the nurse is doing an EKG and mixing critical drugs, do you think she is going to transport the patient? Ridiculous!

Want to know what doesn't help? Constantly talking about the same damn thing over and over!!! I guess I can look forward to a heaping helping of bullshit tomorrow. Maybe I'll just call in sick.

Saturday, February 9, 2008

We Have Met the Enemy...and We Don't Like Him (Part 1)

It's been a looooong few weeks, having started school again (Comp/Lit, LOVE it, but it's a ton of work. Is there any call for an aging BSN with a minor in English?). I have also started a new job as an admissions coordinator. On the plus side, it is a lot more days, or at least until 8 PM some nights. No weekends or holidays. I have been orienting to this job for about a month now, and am getting the hang of it, at least the mechanics of where to put the admissions. For example, it has been 30 years since I have worked on a surgical floor. In those days, patients for an elective cholecystectomy were admitted the night before, had enemas until clear, were shaved from "nipples to knees", and stayed in the hospital for about a week. Now it's day surgery. Goes to show you what-all I don't know, but hey, I ask a lot of questions and generally trust that the floor nurses aren't going to 1).Make fun of me, 2)JAFE me on admissions (Just Another Fucking Excuse) 3). Throw me under the bus or 4). Try to lead me down the garden path. So far, everyone has been great, really helpful. And I'm reasonable; to use the SeaBee motto, "if it's difficult, we might do it; if it's impossible, fuck it".

It is also good to see how the other half lives. I am responsible, in part, for getting the ER admits out of the ER, in addition to floor to floor transfers and direct admissions. I have identified quite a few items which will impact my own practice when I work shifts in the ER. It puts a face on the nurses who get my faxed report. It puts more human in the interaction process, if you know what I mean. I have a better "global picture" of the hospital and it's workings, which is good since I've only been there for about a year. The only bad ("only" ha!) is the micromanageing bean counters and their Ambush Debriefings. Talk about being thrown under the bus. I will have to relate that tale in Part Two.