| Anyone who has ever visited a hospital | | | | Is the triage nurse located in a place where he or |
| emergency room has experienced over crowding | | | | she can see what is going on in the waiting room? |
| and long waits to see a doctor. I have been on | | | | Did the triage nurse periodically monitor the |
| both sides of the fence as a patient and as an | | | | patients in the waiting room? |
| emergency nurse. It is a nasty situation that | | | | What is the average turn-over time for a bed on |
| brings out the worst in all of us. Some years ago, | | | | the floors (the time it takes for housekeepers to |
| the emergency department administrator in a | | | | clean a bed between patients)? |
| hospital that I was working in had the bright idea | | | | How many emergency room gurneys are there |
| to hire a magician to entertain the folks in the | | | | and are they routinely returned to the E.R.? |
| waiting room. This man was a clever entertainer, | | | | What is the average turn around time for blood |
| but he was playing to the wrong audience. While | | | | and urine tests (most take three minutes or less |
| he was doing his rope trick one patient told him to | | | | to perform while the doctors wait 3-4 hours for |
| hang himself. Another man told him where to | | | | the reports)? |
| shove his rabbit and a woman shouted, "Why | | | | Does the administrator notify the 911 EMS |
| don't you conjure me up a doctor so I can get | | | | dispatcher to divert ambulances to other hospitals |
| treated for this lousy migraine?" | | | | when the hospital in question has no empty beds? |
| That administrator's goal was to find a way to | | | | The Standards of Care and Corrective Action |
| get people to accept an unpleasant and dangerous | | | | In reviewing the literature for established |
| situation rather than finding the route causes and | | | | standards, Spaite, et al reported that |
| implementing changes. Therein lays the answer to | | | | administrative focus on correcting such problems |
| the mind boggling question, "Why does such a | | | | that cause slow downs and bottlenecks in patient |
| state of affairs that causes harm to the | | | | flow have reduced average waiting time by one |
| respective community and damages the | | | | half (7). Additionally, Lambe, et al reported that a |
| providers' reputations persist in virtually every | | | | survey of emergency department administrators |
| urban hospital in the country?" | | | | established that over crowding is defined as an |
| Root Causes and Potential Liability | | | | average waiting time of more than one hour and |
| The harmful effects of prolonged E.R. waiting time | | | | the waiting time is the time of initial entry to the |
| as well as root causes and solutions are well | | | | first physician contact (4). |
| documented in the medical literature (see | | | | 1) This provides sufficient evidence that a general |
| references). Therefore, when medical and nursing | | | | consensus exists as to what is good and proper: |
| errors occur in the emergency department the | | | | 2) That a hospital providing emergency care |
| existence of certain conditions that administrators | | | | services must keep track of ED waiting time; |
| could have identified and resolved can be an issue | | | | 3) That administration must make every effort |
| of hospital liability. For example, recent headlines in | | | | to keep average waiting time within one hour by |
| South Florida revealed that a young man in his | | | | eliminating correctable situations that cause delays |
| forties was found dead in a major hospital | | | | in moving current patients, which in turn cause |
| emergency waiting room. The initial investigation | | | | delays in treating new patients; |
| revealed that his body was stone cold when one | | | | 3) That there be enough nurses conducting triage |
| of the nurses found him still seated in a chair with | | | | and monitoring all patients who remain the waiting |
| his head leaning against a wall. Apparently, he had | | | | room for sudden changes in their condition. |
| been dead for several hours while his family was | | | | Summary and Conclusion: |
| frantically looking for him. | | | | We know from the many studies that have been |
| Investigating a Death Related to Overcrowding | | | | published that in most cases, prolonged waiting |
| The underlying reason why this man was literally | | | | times in emergency departments can be reduced. |
| forgotten to death is obviously over crowding. | | | | We also know that over crowding can be |
| There were so many people in the waiting room | | | | ameliorated a significant degree by conducting a |
| moaning, groaning, complaining, and making loud | | | | proper inquiry and making a few simple changes in |
| insulting comments that no one notice a quiet | | | | administrative policy. Therefore, it is incumbent |
| man in the back corner of the room who | | | | upon every hospital executive with command |
| appeared to be sleeping. The next logical step is | | | | responsibility over the emergency department to |
| to examine the factors that contributed to the | | | | take waiting time seriously and regard an average |
| overloading of people in the treatment and waiting | | | | of more than one hour as unacceptable. |
| areas. Therefore, in conducting a proper | | | | Moreover, the hospital's cadre of board room |
| investigation for corrective action the following | | | | denizens must take every reasonable action to |
| questions need answers: | | | | find and correct such contributory factors as |
| Does the hospital administration track waiting | | | | described above when emergency room over |
| time? | | | | crowding (with the staff operating in disaster |
| What is the average waiting time as per the | | | | mode) has become the normal condition. |
| tracking reports? | | | | |