Is Triage Gone?

[NYEMMED]

I recently had to take a parent into the ED. As we all know if an EM doc is bringing somebody in, they are sick, it is bad.

Unfortunately it was a hospital I was not associated with, due to proximity of where they lived.

We check in, I mention I’m an EM doc and it’s bad. “Take a seat”

Met the triage nurse 45 mins later
I said I’m and EM doc, they are septic, heading towards shock.
“Take a seat, we will call you”
Doing my own vitals in the WR. Heart Rate 145, temp 104.5 on check in. Resp rate 28, BP 90/50 on check In.

I watch all the level 4/5 sniffles going back
“Sorry sir, we have no beds for sick people”

What is the point in triage anymore, I know all places are guilty of it while trying to move waiting rooms, but what are we doing? Why are the unsick moving and the sick waiting?

Opened my eyes, being on the other side


Conclusion: I called the EM doc on duty. Told them we are in the waiting room and they are getting less responsive, brought back to a trauma bay and Pressors started as BP dropped to 70/30

---

Members don't see this ad.

 

[bravotwozero]

The EM attending should mention that to his director, and the charge RN and triage nurse should get reamed.

 

[southerndoc]

The 4s and 5s that aren't sick can still walk and sit upright in a chair. Most of the time they don't get a "bed." In our rapid care unit, they're kept vertical in chairs. They are not resource intensive and rarely require anything more than a nurse to give them a pill. A nurse taking care of only 4s and 5s has more capability to treat 10+ patients simultaneously while a nurse treating 1s, 2s, and 3s may only be able to treat 4-5 at a time.

If we took 2 sick patients then we have to turn away 20 walking patients.

I agree it's a problem that we're seeing non-sick patients first, but it's just the reality that we're all in. It's like telling those with to go orders at a restaurant that they can't pick up their food because there aren't any available tables. I recognize more is at stake with people's lives than food getting cold, but you get the point.

 

[CoolDoc1729]

The 4s and 5s that aren't sick can still walk and sit upright in a chair. Most of the time they don't get a "bed." In our rapid care unit, they're kept vertical in chairs. They are not resource intensive and rarely require anything more than a nurse to give them a pill. A nurse taking care of only 4s and 5s has more capability to treat 10+ patients simultaneously while a nurse treating 1s, 2s, and 3s may only be able to treat 4-5 at a time.

If we took 2 sick patients then we have to turn away 20 walking patients.

I agree it's a problem that we're seeing non-sick patients first, but it's just the reality that we're all in. It's like telling those with to go orders at a restaurant that they can't pick up their food because there aren't any available tables. I recognize more is at stake with people's lives than food getting cold, but you get the point.

This is how my place is running as well. We have a side area staffed by an LPN where we can treat and street 4/5s. They aren’t allowed to do IV meds or anything as advanced as your family member needed.

I’m constantly scanning through vitals, labs, rads trickling in on my waiting room. Those vitals would have triggered me to beg, whine, plead until I get the nurse with a big heart to take an extra, critically sick patient OR threaten to call the ED director and the CNO until the charge nurse goes into assignment if I have a less sympathetic bunch that night.

I have to save doing that for when I really, really have to. I don’t get 6 of those a night.

Triage is more important now, if anything, since it’s their only medical staff interaction for 4-6-8+ hours.

 

[CoolDoc1729]

I recently had to take a parent into the ED. As we all know if an EM doc is bringing somebody in, they are sick, it is bad.

Unfortunately it was a hospital I was not associated with, due to proximity of where they lived.

We check in, I mention I’m an EM doc and it’s bad. “Take a seat”

Met the triage nurse 45 mins later
I said I’m and EM doc, they are septic, heading towards shock.
“Take a seat, we will call you”
Doing my own vitals in the WR. Heart Rate 145, temp 104.5 on check in. Resp rate 28, BP 90/50 on check In.

I watch all the level 4/5 sniffles going back
“Sorry sir, we have no beds for sick people”

What is the point in triage anymore, I know all places are guilty of it while trying to move waiting rooms, but what are we doing? Why are the unsick moving and the sick waiting?

Opened my eyes, being on the other side


Conclusion: I called the EM doc on duty. Told them we are in the waiting room and they are getting less responsive, brought back to a trauma bay and Pressors started as BP dropped to 70/30

Is your ED adequately staffed where this isn’t what happens? I’m not being snarky, truly asking. There’s nowhere by me that isn’t struggling.

 

[NYEMMED]

Is your ED adequately staffed where this isn’t what happens? I’m not being snarky, truly asking. There’s nowhere by me that isn’t struggling.

Of course it’s happening at my place as well. The flip side was truly eye opening.

I’ve always been the doc asking the charge nurse to pull sick patients back. They are the ones who appropriately came to an emergency room.

 

[chillaxbro]

Same thing happened when I brought my family member to a big name academic ER. I literally told them "he has esophageal varices and he is vomiting blood and his pressure is 70/30" and the nurse was like ok have a seat.

 

[Dr Mantis Toboggan]

Same thing happened when I brought my family member to a big name academic ER. I literally told them "he has esophageal varices and he is vomiting blood and his pressure is 70/30" and the nurse was like ok have a seat.

Just sucks we can’t put the hammer down on insolence anymore.

 

[maxxor]

My child had a bout of anaphylaxis this fall. I gave them epi, cleaned up, and drove 3 miles to the children's hospital. The line to get in the door to register was so long that they had a delayed second reaction while we were waiting. I had to cut the line and beg the secretary to have them seen as they were becoming unresponsive.

From reading this forum, I knew peds hospitals are in bad shape, but this was insane.

 

[emergentmd]

So when its true sepsis, they tell you to take a seat. When someone comes with the flu txting on their phone, some places call sepsis and a slew of stuff gets done

 

[PianoMedic]

 

[NYEMMED]

So when its true sepsis, they tell you to take a seat. When someone comes with the flu txting on their phone, some places call sepsis and a slew of stuff gets done

That's my point. Ive seen this in my place as well. The unsick get roomed by the nurses because "we can get them out" as opposed to taking care of the sick people that actually need our care. Troponin elevated? Fluid overloaded? Septic? Hypotensive? On oxygen? All those can wait, because these other ones "we can get them out"

 

[RustedFox]

That's my point. Ive seen this in my place as well. The unsick get roomed by the nurses because "we can get them out" as opposed to taking care of the sick people that actually need our care. Troponin elevated? Fluid overloaded? Septic? Hypotensive? On oxygen? All those can wait, because these other ones "we can get them out"

Don't get me started.

 

[RustedFox]

That's my point. Ive seen this in my place as well. The unsick get roomed by the nurses because "we can get them out" as opposed to taking care of the sick people that actually need our care. Troponin elevated? Fluid overloaded? Septic? Hypotensive? On oxygen? All those can wait, because these other ones "we can get them out"

Reason #12 why admins are evil.

We need a *separate* ER for dumb****.

Flu like symptoms?
Widget broken?
My doc sent me to get (x) done?

Leave this place. Go to the OTHER side of the ER with the rest of the misdirected.

 

[Arcan57]

That's my point. Ive seen this in my place as well. The unsick get roomed by the nurses because "we can get them out" as opposed to taking care of the sick people that actually need our care. Troponin elevated? Fluid overloaded? Septic? Hypotensive? On oxygen? All those can wait, because these other ones "we can get them out"

The "too sick to be seen" is a common phenomenon anyplace that prioritizes lowering LWOTs. The truly sick are much less likely to bounce from your ED while the BP check/knee pain x 6 months has maybe 30 minutes of waiting in a packed WR before they leave. FastTrack is often the only place there's forward patient flow, so 4s/5s come and go. Eventually some bright bulb decides to put less sick level 3s in FT and then pt flow halts entirely.

 

[GonnaBeADoc2222]

Sad.

I'm sorry this happened to your family member.

When a patient is SICK and I need something done NOW, and the nurse doesn't do it I document "Patient presents with xyz, I asked RN to do abc, and received this response: [insert quote of all the reasons why we can't do the thing]"

It's the doctor documenting "RN aware."

I'm sure as hell not going down with the ship.

 

[GassYous]

Sad.

I'm sorry this happened to your family member.

When a patient is SICK and I need something done NOW, and the nurse doesn't do it I document "Patient presents with xyz, I asked RN to do abc, and received this response: [insert quote of all the reasons why we can't do the thing]"

It's the doctor documenting "RN aware."

I'm sure as hell not going down with the ship.

As an icu intern I had a nurse refuse to take out a foley because ??? (lazy)
Patient self dc'ed and hemorrhaged because they were on ac
I documented the hell out of it and my senior knew
They ended up needing a blood transfusion
New York union nurses

 

[RustedFox]

Sad.

I'm sorry this happened to your family member.

When a patient is SICK and I need something done NOW, and the nurse doesn't do it I document "Patient presents with xyz, I asked RN to do abc, and received this response: [insert quote of all the reasons why we can't do the thing]"

It's the doctor documenting "RN aware."

I'm sure as hell not going down with the ship.

I take a hard tack with my crew at times; but my working relationship with them is one of trust in that when Doc Rusted says: "We either do this now, or we code him in :15-20 minutes", I generally get compliance.

It sounds like some of your shops are far, far more overburdened than mine.

 

[thegenius]

I recently had to take a parent into the ED. As we all know if an EM doc is bringing somebody in, they are sick, it is bad.

Unfortunately it was a hospital I was not associated with, due to proximity of where they lived.

We check in, I mention I’m an EM doc and it’s bad. “Take a seat”

Met the triage nurse 45 mins later
I said I’m and EM doc, they are septic, heading towards shock.
“Take a seat, we will call you”
Doing my own vitals in the WR. Heart Rate 145, temp 104.5 on check in. Resp rate 28, BP 90/50 on check In.

I watch all the level 4/5 sniffles going back
“Sorry sir, we have no beds for sick people”

What is the point in triage anymore, I know all places are guilty of it while trying to move waiting rooms, but what are we doing? Why are the unsick moving and the sick waiting?

Opened my eyes, being on the other side


Conclusion: I called the EM doc on duty. Told them we are in the waiting room and they are getting less responsive, brought back to a trauma bay and Pressors started as BP dropped to 70/30

I hope your family member is OK.

When the dust settles and your family member is on the mend, I would report that &@#$@ing triage nurse. Big TIME. I would levy an EMTALA charge and just let them investigate (whether it's EMTALA or not. Puts the scope on that hospital. It's easy to do follow the directions at this link ), and/or I would send a hand written note or email to the hospital CEO. Absolute shame and that hospital ER is a disgrace (at least triage is.)
This s^&T has to stop. Sorry you had to go through this.

 

[thegenius]

Same thing happened when I brought my family member to a big name academic ER. I literally told them "he has esophageal varices and he is vomiting blood and his pressure is 70/30" and the nurse was like ok have a seat.

Well I'm happy to say that at my dysfunctional ER these patients are brought back to resus, this one and the OP one. We are totally dysfunctional and have nursing shortages but at least we can take care of these sick people first.

 

[Tenk]

As an icu intern I had a nurse refuse to take out a foley because ??? (lazy)
Patient self dc'ed and hemorrhaged because they were on ac
I documented the hell out of it and my senior knew
They ended up needing a blood transfusion
New York union nurses

You know you can take a foley out in 5 seconds yourself right?

 

[RuralEDDoc]

Very frustrating. In the end, I wouldn’t blame the triage staff, good chance they are subject to a variety of overwhelming systems issues that drive their actions. The nonchalance of the triage nurse may be a defense mechanism necessary to survive in a broken system. Still sucks to be on the receiving end and hopefully your love one does well.

I hope your family member is OK.

When the dust settles and your family member is on the mend, I would report that &@#$@ing triage nurse. Big TIME. I would levy an EMTALA charge and just let them investigate (whether it's EMTALA or not. Puts the scope on that hospital. It's easy to do follow the directions at this link ), and/or I would send a hand written note or email to the hospital CEO. Absolute shame and that hospital ER is a disgrace (at least triage is.)
This s^&T has to stop. Sorry you had to go through this.

I agree with lodging a complaint. EMTALA report and letter to CEO might be a touch overkill.

 

[thegenius]

Very frustrating. In the end, I wouldn’t blame the triage staff, good chance they are subject to a variety of overwhelming systems issues that drive their actions. The nonchalance of the triage nurse may be a defense mechanism necessary to survive in a broken system. Still sucks to be on the receiving end and hopefully your love one does well.

I agree with lodging a complaint. EMTALA report and letter to CEO might be a touch overkill.

Yea it might be overkill. And yet a regular old complaint probably won't do anything. You have an ER doctor bringing their loved one in the ED and gives the triage nurse a set of current vital signs that demands immediate resuscitation. That pt is probably the sickest person in the ED, and they are asked to "Please take a seat"

The point of the EMTALA thing is to provoke change, not to have the hospital fined $50,000. It's completely reasonable to think that if someone was not advocating for that patient, the pt would have died in the waiting room.

Anyway I know we are all appalled at this behavior. If any ER cannot find space for a pt who is legit gonna die in the next 6 hours then they shouldn't be in business.

 

[Brigade4Radiant]

Yea it might be overkill. And yet a regular old complaint probably won't do anything. You have an ER doctor bringing their loved one in the ED and gives the triage nurse a set of current vital signs that demands immediate resuscitation. That pt is probably the sickest person in the ED, and they are asked to "Please take a seat"

The point of the EMTALA thing is to provoke change, not to have the hospital fined $50,000. It's completely reasonable to think that if someone was not advocating for that patient, the pt would have died in the waiting room.

Anyway I know we are all appalled at this behavior. If any ER cannot find space for a pt who is legit gonna die in the next 6 hours then they shouldn't be in business.

This is true if OP didn't call the ED doc himself then who knows what would have happened. This isn't the doctors fault but the hospital. The CEO doesn't want to pay for staffing.

 

[southerndoc]

This is true if OP didn't call the ED doc himself then who knows what would have happened. This isn't the doctors fault but the hospital. The CEO doesn't want to pay for staffing.

I think it's a little unfair to say the CEO doesn't want to pay for staffing. The market forces have been such that adequate staffing is not obtainable by many hospitals due to financial constraints. Sure, there are hospitals that are raking in money and able to pay for anything. However, there are many that are really struggling and you will soon see many of these hospitals closing without federal bailouts occurring. The next 2-3 years is going to be really bad for hospitals.

 

[NYEMMED]

I think it's a little unfair to say the CEO doesn't want to pay for staffing. The market forces have been such that adequate staffing is not obtainable by many hospitals due to financial constraints. Sure, there are hospitals that are raking in money and able to pay for anything. However, there are many that are really struggling and you will soon see many of these hospitals closing without federal bailouts occurring. The next 2-3 years is going to be really bad for hospitals.

We will see hospital systems merging into larger systems due to this

 

[NYEMMED]

This is true if OP didn't call the ED doc himself then who knows what would have happened. This isn't the doctors fault but the hospital. The CEO doesn't want to pay for staffing.

Update: doing well now, had a ICU stay for a few days, may have been avoided with more timely care, but today downgraded to step down.

I am concerned that if this was another patient without a physician for a child, would they have arrested in the waiting room?

I did speak with the CMO and CEO, and I expressed my concerns. I did tell them both that the EM doc was fantastic, and this was a pure Department and nursing issue. They told me they will do a root cause analysis.

 

[RustedFox]

I think it's a little unfair to say the CEO doesn't want to pay for staffing. The market forces have been such that adequate staffing is not obtainable by many hospitals due to financial constraints. Sure, there are hospitals that are raking in money and able to pay for anything. However, there are many that are really struggling and you will soon see many of these hospitals closing without federal bailouts occurring. The next 2-3 years is going to be really bad for hospitals.

Hard stop, bro.

"We can't afford staffing" yet the C-suite gets fat stacks in bonuses for years and years on end?!

Somehow, this doesn't pass the sniff test.

Maybe, just MAYBE they wouldn't face the insolvency vs bailout situation if there weren't 8 admins to 1 physician all hoovering up money.

Time for non clinical staff to feel some "austerity".

 

[ScepticSkeksis]

I think it's a little unfair to say the CEO doesn't want to pay for staffing. The market forces have been such that adequate staffing is not obtainable by many hospitals due to financial constraints. Sure, there are hospitals that are raking in money and able to pay for anything. However, there are many that are really struggling and you will soon see many of these hospitals closing without federal bailouts occurring. The next 2-3 years is going to be really bad for hospitals.

While CEOs are getting millions in bonuses, I don’t think we can blame “financial constraints”. Nurses are necessary. Most C-suite are not.

 

[forchinet121]

I recently had to take a parent into the ED. As we all know if an EM doc is bringing somebody in, they are sick, it is bad.

Unfortunately it was a hospital I was not associated with, due to proximity of where they lived.

We check in, I mention I’m an EM doc and it’s bad. “Take a seat”

Met the triage nurse 45 mins later
I said I’m and EM doc, they are septic, heading towards shock.
“Take a seat, we will call you”
Doing my own vitals in the WR. Heart Rate 145, temp 104.5 on check in. Resp rate 28, BP 90/50 on check In.

I watch all the level 4/5 sniffles going back
“Sorry sir, we have no beds for sick people”

What is the point in triage anymore, I know all places are guilty of it while trying to move waiting rooms, but what are we doing? Why are the unsick moving and the sick waiting?

Opened my eyes, being on the other side


Conclusion: I called the EM doc on duty. Told them we are in the waiting room and they are getting less responsive, brought back to a trauma bay and Pressors started as BP dropped to 70/30

I didn’t read the other posts but this is extremely unacceptable, you were way too nice!! IM AN EM DOC, LET ME TALK WITH YOUR BOSS! Your family could’ve died that’s nuts…

 

[NYEMMED]

While CEOs are getting millions in bonuses, I don’t think we can blame “financial constraints”. Nurses are necessary. Most C-suite are not.

Look at some hospitals
Chief provider Experience officer
Chief patient Experience officer
Chief customer Experience officer
Chief value officer
Chief wellness officer

Etc etc etc

Cut the fluff

You only need a handful of c suite spots.

CEO
COO
CMO
CNO
CHRO
VPMA
The rest are not necessary

 

[WilcoWorld]

You have an ER doctor bringing their loved one in the ED and gives the triage nurse a set of current vital signs that demands immediate resuscitation. That pt is probably the sickest person in the ED, and they are asked to "Please take a seat"

Should've introduced themselves as an ER Nurse.

 

[southerndoc]

Hard stop, bro.

"We can't afford staffing" yet the C-suite gets fat stacks in bonuses for years and years on end?!

Somehow, this doesn't pass the sniff test.

Maybe, just MAYBE they wouldn't face the insolvency vs bailout situation if there weren't 8 admins to 1 physician all hoovering up money.

Time for non clinical staff to feel some "austerity".

I'm in no way justifying those salaries, but a lot of their salaries are performance based and have been drastically reduced due to throughput issues. Some are even tied to patient experience and have been reduced because let's face it, doesn't matter how nice you are or how well you smile, if a patient waits 12 hours to be seen, they're going to rank the hospital very poorly.

I don't see how an extra mil is going to resolve a hospital's staffing shortages. It will help, but it won't resolve it.

I agree that there are too many administrators. People who know me IRL know my frequent politically incorrect saying regarding this. You can DM me if you want to know.

 

[RustedFox]

@southerndoc (Not directed at you as a personal attack, but challenging your argument)


I'm in no way justifying those salaries, but a lot of their salaries are performance based and have been drastically reduced due to throughput issues.

Oh, no! Cry me a river. They have no difficulty cutting clinical staff and clinical staff hours; but won't cut their staff or bonuses.



Some are even tied to patient experience and have been reduced because let's face it, doesn't matter how nice you are or how well you smile, if a patient waits 12 hours to be seen, they're going to rank the hospital very poorly.

Sounds like they're "not a team player", or "not up to the task", or "not doing what they came here to do", or insert any of those phrases that they throw at us. How's that gaslamp feel, admins?



I don't see how an extra mil is going to resolve a hospital's staffing shortages. It will help, but it won't resolve it.

The math is easy. You eliminate two useless deeekheads at 500k a year. Multiply that by 10 years, and that's 10 million dollars!
That will go a long way to hiring nursing and support staff. Even in the short term, one million and some more hours on the schedule will help in the short-term squeeze as things fluctuate. This achieves TWO goals simultaneously! Less deeekheads, and an improved patient experience! Note how those two things are related. But, admins gonna admin, and put profits above patients.


Bottom line: admins love to say "the patient comes first", but when the rubber hits the road... it's cronyism and bloat that comes first.

 

[RustedFox]

Look at some hospitals
Chief provider Experience officer
Chief patient Experience officer
Chief customer Experience officer
Chief value officer
Chief wellness officer

Etc etc etc

Cut the fluff

You only need a handful of c suite spots.

CEO
COO
CMO
CNO
CHRO
VPMA
The rest are not necessary

Yep. Why can't these guys "work harder and with less re$ources" like they make us do?

 

[thegenius]

I did speak with the CMO and CEO, and I expressed my concerns. I did tell them both that the EM doc was fantastic, and this was a pure Department and nursing issue. They told me they will do a root cause analysis.

Oh boy.
Happy your parent is doing better.

 

[RustedFox]

Update: doing well now, had a ICU stay for a few days, may have been avoided with more timely care, but today downgraded to step down.

I am concerned that if this was another patient without a physician for a child, would they have arrested in the waiting room?

I did speak with the CMO and CEO, and I expressed my concerns. I did tell them both that the EM doc was fantastic, and this was a pure Department and nursing issue. They told me they will do a root cause analysis.

Tell them I did the analysis for them and see my two posts above.

 

[Rekt]

I think it's a little unfair to say the CEO doesn't want to pay for staffing. The market forces have been such that adequate staffing is not obtainable by many hospitals due to financial constraints. Sure, there are hospitals that are raking in money and able to pay for anything. However, there are many that are really struggling and you will soon see many of these hospitals closing without federal bailouts occurring. The next 2-3 years is going to be really bad for hospitals.

I really don't understand how any doc can simp for an admin. Especially an emergency medicine physician. You could eliminate 75% of all admin/director/clipboard positions and not a single thing would change. They can reap what they sow.

 

[RustedFox]

I really don't understand how any doc can simp for an admin. Especially an emergency medicine physician. You could eliminate 75% of all admin/director/clipboard positions and not a single thing would change. They can reap what they sow.

What does "warrior eliminate" mean?
Like, do we kick them into a huge pit or something like in "300"?
'Cause that would be cool.
I like the way this is going.

EDIT: You edited your original post, so it edited my quote. Bro, edit it back.

 

[southerndoc]

@southerndoc (Not directed at you as a personal attack, but challenging your argument)


I'm in no way justifying those salaries, but a lot of their salaries are performance based and have been drastically reduced due to throughput issues.

Oh, no! Cry me a river. They have no difficulty cutting clinical staff and clinical staff hours; but won't cut their staff or bonuses.



Some are even tied to patient experience and have been reduced because let's face it, doesn't matter how nice you are or how well you smile, if a patient waits 12 hours to be seen, they're going to rank the hospital very poorly.

Sounds like they're "not a team player", or "not up to the task", or "not doing what they came here to do", or insert any of those phrases that they throw at us. How's that gaslamp feel, admins?



I don't see how an extra mil is going to resolve a hospital's staffing shortages. It will help, but it won't resolve it.

The math is easy. You eliminate two useless deeekheads at 500k a year. Multiply that by 10 years, and that's 10 million dollars!
That will go a long way to hiring nursing and support staff. Even in the short term, one million and some more hours on the schedule will help in the short-term squeeze as things fluctuate. This achieves TWO goals simultaneously! Less deeekheads, and an improved patient experience! Note how those two things are related. But, admins gonna admin, and put profits above patients.


Bottom line: admins love to say "the patient comes first", but when the rubber hits the road... it's cronyism and bloat that comes first.

I think you're trying to play money like the government does. 10-year savings.

A mil will get you 10 nurses max (not really counting the benefits; probably realistically more like 5/year). The problem is market forces have driven up their salaries exponentially thanks to travel agencies. Yes, hospitals can cave and pay the travel agencies (which take 30-50% of the cut). That's enabling the behavior though. What we need are dedicated staff that are invested in their hospitals. You don't get that investment with the vast majority of travel staff.

I'm not taking it personal. I'm not C-suite so I have no skin in the game. Just saying it's a lot more complicated than just eliminating their positions/bonuses to hire tons of new staff. It would help, but not as much as you think it would.

 

[RustedFox]

I think you're trying to play money like the government does. 10-year savings.

A mil will get you 10 nurses max (not really counting the benefits; probably realistically more like 5/year). The problem is market forces have driven up their salaries exponentially thanks to travel agencies. Yes, hospitals can cave and pay the travel agencies (which take 30-50% of the cut). That's enabling the behavior though. What we need are dedicated staff that are invested in their hospitals. You don't get that investment with the vast majority of travel staff.

I'm not taking it personal. I'm not C-suite so I have no skin in the game. Just saying it's a lot more complicated than just eliminating their positions/bonuses to hire tons of new staff. It would help, but not as much as you think it would.

Heard.
If it helps, then it helps.
What comes first again?

 

[inspirationmd]

I really don't understand how any doc can simp for an admin. Especially an emergency medicine physician. You could eliminate 75% of all admin/director/clipboard positions and not a single thing would change. They can reap what they sow.

See the initial 6 months when covid first hit and they all stayed home for an example. No clipboard nurses, no admin rounds, etc. It was hard work and a difficult time for sure but it was eye opening for me with respect to the glut that exists.

 

[Brigade4Radiant]

Also hospitals could just pay staff nursing a little bit more in benefits like maxing out the employee 401k/403b and getting a tax deduction. Also good health insurance and pay them an EBT like system for food like 500 a week and you can staff this place also you cam just pay an experienced EMTs the nursing salary.

Pay them 5 an hour to train some emts and nursing and you can staff a hospital sooner than you think.

 

[turkeyjerky]

What we need are dedicated staff that are invested in their hospitals. You don't get that investment with the vast majority of travel staff.

You want dedicated staff? Then support them. When was the last time an administrator responded to a complaint in anything remotely resembling a reasonable fashion? It'll never happen, but just once I want to hear "Hey Dr. T, I just wanted to let you know that patient you saw last Thursday, Mrs. T with the back pain, complained about you. I looked into it and it was obvious BS, so I told her that and asked her to stop coming to the ER with this nonsense. I just wanted to let you know, keep up the good work".

Or the situation with the OP. What should happen:
--Admin to triage RN, "Hey, we're really sorry for putting you in that situation. Staffing and throughput are my responsibility and I screwed the pooch on this one. We're starting a few new protocols in response and adding a few float nurses to help with flow, more details to follow. Let us know anything else you need".
--Admin to doctors, "After the recent near-miss, we've decided to reprioritize patient flow. We'll be adding a few new nursing positions, adjusting the triage process and are working on improving throughput throughout the hospital. However, these things take time. In the meantime, we'd like you to help out by forgoing non-emergent studies as much as possible and discharging patients with as minimal a workup as is necessary. Don't worry, any resultant patient complaints will be summarily dismissed. Also, after studying the issue, we've determined that low yield sepsis and trauma alerts likely harm throughput more than they help it, so we are scrapping these."

Instead, they'll issue a slap on the wrist to the triage nurse (or not, depending on how short they are). Or, worse yet, they'll determine that they need a provider in triage for more rapid assessments, leading to a bunch of unnecessary low yield tests done up front that will further compound the backup. They'll also remind all their 'providers' to "please remember to see patients in a timely fashion and use the sepsis order set".

 

[MechEDoc]

The EM attending should mention that to his director, and the charge RN and triage nurse should get reamed.

Or fired? There is virtually no accountability in this profession anymore.

I haven't seen an accurate set of vitals in years...

 

[CoolDoc1729]

Look at some hospitals
Chief provider Experience officer
Chief patient Experience officer
Chief customer Experience officer
Chief value officer
Chief wellness officer

Etc etc etc

Cut the fluff

You only need a handful of c suite spots.

CEO
COO
CMO
CNO
CHRO
VPMA
The rest are not necessary

Our VPMA quit in august.
Nothing has changed lol

 

[TooMuchResearch]

Or fired? There is virtually no accountability in this profession anymore.

I haven't seen an accurate set of vitals in years...

All respiratory rates converge on 18 eventually.

 

[NYEMMED]

Our VPMA quit in august.
Nothing has changed lol

I mean a good VPMA is the link between physicians and administration. A good one can make things much better for physicians

 

[Kryptocoin]

Packed triage is a symptom of a very old problem. I'm starting to think there won't be any nurses around to take care of me when I'm old. I'm still young but the trend is not looking good.

You only need to "invest" 500k to become a NZ citizen. I'll probably look into that when the time comes. Peaceful country with good healthcare. Sounds like a decent plan.

 

[TeddyBoomBoom]

You only need to "invest" 500k to become a NZ citizen. I'll probably look into that when the time comes. Peaceful country with good

Waitwut?

brb googling for more more info