Thursday, August 14, 2008

Packing 'Em In, and Stacking 'Em High

Sigh. The beancounters are at it again. I truly believe that there must be some kind of...well, prize, or premium for winning whatever idiotic beancounter contests they are involved in.

During times of high volume Upper Level Management,who watches the ER board from a computer waaaaaaaay up above us, keeps a close eye on the Scoreboard. This Eye in the Sky so to speak really knows whats going on in the ER. Really. They know how to find it since they were there for the rededication after the renovation 2 years ago. Said Management, having read all of the People Magazines as well as "How to Manage a Hospital for Dummies" knows how long each and every patient has sat in the waiting room. My, they truly seem to have the Big Picture, don't they?

I'm thinking that there must be some kind of beancounter Sweeps Week, because the Eye in the Sky has been particularly vigilant this week. MANY calls to the ER to let us know that patients ARE IN THE WAITING ROOM FOR A LONG TIME.
Eye: Patient 1 has been in the waiting room for 2 hours. He needs to come to a treatment room NOW.
Me: Um. Well. That individual has been in the ER 4 times this week for Insincere Detox (translation: homeless, it's hot out, and the shelter is not airconditioned).

An hour later, the Eye in the Sky, omnipotent, omniscient, and omnipresent calls down again.
Eye: Patient 2 has been in the wating room for 2 hours and 20 minutes. He needs to get into a treatment room NOW.

Me: Well. Ahem. We have just had 7 ambulances roll in over the last 25 minutes, one is a v-tach arrest who is having the Big One, there is no cath lab available today, so the patient has to go down the highway. Oh, and we got an overdose, 2 more chest pains, a DKA, the police with a guy in shackles, and possible stroke. Scary Catholic Medical Center is on diversion and we are getting the overflow. We're a little busy. Stop calling me.

An hour later, the beancounter and entourage decide to make a Cameo appearance in the ER to Size Up the Situation, and Make a Plan. This is accomplished by the most insidious of all creations, the Ambush Huddle. Never has there been a more time-wasting activity than having the beancounters assess the situation, THEN tell you how to do your job.

Imagine the ER as a game of Monopoly. There you are, playing the game according to the rules; you are going on your merry way, buying up Utilities and Railroads, landing on Park Place and putting up houses and hotels. You are regularly passing Go and collecting $200.00. You have your strategy. It's cool.

Now imagine that in the middle of the game, sitting there with your hotels on Park Place and Boardwalk, you are told that the rules have changed. Now you are told that you will no longer be able to collect all of your $200.00; or only get it sometimes. And you have to put houses on the railroads and utilities too.

It is chaos. The halls are lined with people who have not yet been seen by a provider, as well as the really sick ones who are in rooms. The beancounters don't tarry long; obviously their place is directing the battle from a position of safety.

So, with Beancounter Sweeps week shaping up, the good news is that we have managed to shave a whopping 2 minutes off the average waiting time.


Yep. 2 minutes. And for what? The waiting room is empty, the ER halls are full, the nurses are overwhelmed, the docs are overwhelmed, it is crowded and unsafe; it is difficult to navigate around all of these hallway dwellers and their posses who want a warm blanket and a turkey sandwich. The most pitiful thing is that the patient's have been sold a bill of goods by being placed in a hallway bed. It's like Disney World; you wait 2 hours in the queue, and when you finally get to what seems like the entrance to the ride, what do you find?

Another queue; another 2 hour wait.


Anonymous said...

Everything you said is absolutely true. In my ER the nurses and docs are way overwhelmed.. I called in sick for my shift tomorrow... I can't take it.. I need a break.

Nurse K said...

Excellent post! I can picture the suits coming down to "help" right now. They really need to stop calling you though, that's just F'd up. You don't like it, YOU come down and take the patient. Our suits come down when we're on divert only. Sometimes they help, sometimes they make stuff worse.

When people wait in a bed for a couple hours to be seen, all they do is complain and whine. If it's not urgent, they need to be in the lobby where the TVs (and the front doors) are.

Julie said...

So true... and so FRUSTRATING!!! Yeah, let's just pile them all up so that nobody can get anything done without 10 pairs of eyes watching you and 8 mouths asking you for something else!!! AHHHHH!!!!

Anonymous said...

How refreshing to see that things are the same no matter where you go.

Love your writing, it is so entertaning and real.

Julie said...

Oh yeah, and BTW, I think 2 hours in the waiting room can be a GREAT wait time...that is compared for 4-8 hours. I mean seriously! I think it would be great if "they" made commercials to advertise for ED's so that people had more realistic expectations....

::two people sitting in a full waiting room:: switch frame to the nurses running their asses off, doing CPR, pushing meds, holding pressure on actively bleeding wounds, etc. Then back to the waiting room... "I'd rather wait a little longer to see a doctor so that I can have safe care." "Yeah, me too. There must be something really serious going on back there if we've had to wait this long."

This is more about safety than customer service...but too bad the beans don't get that. Since when did healthcare begin to agree with the saying "the customer is always right"? Isn't that what WE (and they) went to school for?