It’s rush hour in a single coverage emergency department (ED) with one provider. Cold and flu season is upon us. People are getting out of work. Those that have been ill throughout the last few days decided it is time to come in and get checked out. Others are feeling unwell and want a work note for tomorrow. Phone calls to primary care offices are going unanswered or office hours are almost over. There is no late closing urgent care around without a long drive. The only option left is to go to the emergency department.
Meanwhile, the ED physician is currently dealing with several emergencies. There was a patient that just arrived with a heart attack and since there was no cardiologist available transfer was being arranged to a higher level of care. At the same time, a trauma patient in a high speed head-on collision by the interstate is getting a chest tube placed for a pneumothorax and undergoing stabilization. Nurses and staff are stretched thin dealing with the emergencies. Patients in the waiting room with uti symptoms are asking, “what is taking so long?” As 7 pm approaches, the line in the waiting room continues to expand for everything from runny noses and common colds to more urgent cases such as shortness of breath to chest pain. The ED provider and staff are trying their best to move as fast as possible to discharge patients from the ED and triage and room new patients. Unfortunately, several patients need transferred and are taking up 3 rooms while waiting for a bed at an appropriate facility. All facilities nearby are out of beds and patients are on a waiting list. That leaves 7 rooms left for the ever expanding waiting room of 15-20 people. The one hour wait becomes as three hour wait. Right when a patient is preparing to be roomed another EMS arrives with stroke symptoms. A patient that had mild cold symptoms and needed a work note is now angry and leaves without being seen. The ED staff can do nothing at this point but triage the sickest patients and eventually hope to get to the outpatient cases in the early am. It is now 4 o’clock in the morning and the last patients in the waiting room have now been discharged. The ED physician and staff now feel relieved and spend the next few hours before shift change finishing their charts and seeing an occasional patient. The last case of the shift ends up being a toothache a few hours before the dentist opens, and the shift is finally over. The tired ED staff members start their drives home. Eventually they make it to bed and alarms are set to get ready for the next night’s shift.
A month later administration notifies the ED physician and the nursing staff for a meeting. They have had several patient complaints about being rushed for their non-urgent cases or not being seen altogether. They are wondering why transfer times were taking so long. There was also a concern about patients leaving without being seen. There are several meetings thereafter on how to improve patient satisfaction scores. Over the next month, patient load improves and the satisfaction scores are much better. Administration praises the staff.
The cycle continues itself into the next cold and flu season. As 7 pm approaches, the line in the waiting room continues to expand for everything from runny noses and common colds to more urgent cases such as shortness of breath to chest pain. The the ED physician is currently dealing with several emergencies. A new staff member asks, “what happened here?” The nurse replies, “It’s rush hour in a single coverage ED.”
Disclaimer: This story is hypothetical in nature but re-created based on real life experiences and has no connection to any particular patient.
Administrator