This week has just been super crazy in the ER. When I walked in at 9 am yesterday, ALL of our beds were filled. Including our overflow beds, where we just stick beds randomly in the hallways and patients have no privacy whatsoever, but they need to be treated and we have no where to put them. When I walked in, at least half of our patients had been there 12 hours or more. The obvious question is, why does it take so long to be seen in the ER?

The easiest answer: we don't have the space/resources. Our visit times are completely determined by how many sick people decided to come before you. If you really are a true emergency (meaning, on the verge of dying or something serious happening), you will be seen right away. If not, who knows when you will be seen. Yesterday, we were backed up because we had many sick patients who were too sick to be sent home, meaning we had to admit them into the hospital. Except every single hospital bed was filled with sick people who couldn't be sent home yet, so we were holding onto the patients in the ER.They were taking up beds so we couldn't see new patients.

Why else does it take so long to be treated?
Each nurse usually has 4-5 patients to take care of, the docs 5-10. Our health care system is too broke to pay for enough doctors to make it so you have 1:1 attention.
If you need a CT scan/x ray, you sharing that resource with the entire hospital.If you need lab work done...so does most of the entire hospital as well. The lab techs will be working on processing other people's blood/urine/other bodily fluids besides yours.
If we need to consult another doctor for you, we have to wait until they are able to stop with their own schedule and patients until they have a moment to call...and if they need to come see you, well that just adds to the waiting time.

I'm not condoning this system, because it's not the greatest and there are flaws. It's what we have, and I feel like with a little more education the ED experience could be better for everyone. Knowing what is an emergency and what is not, to start. Also, knowing how to take care of one's self. So many things we see could be prevented if people just weren't so stupid/lazy.

We also have a triage system, which means we see the sickest patients first. I had an issue on Monday when I was working in our pediatric emergency department. The Peds ER is great because we see only peds patients, and we can get them in and out quicker than if they were going through the main ED. Most of the patients either have colds or strep throat, so we can discharge them fast. Monday, when things were crazy and the Peds ER was full, we had an 8 month old baby come in who was vomiting blood after a choking episode. That's a pretty serious situation for any person to be in, let along an 8 mo old. Shortly after, we had a 14 mo old come in who was having seizure after seizure after seizure and wasn't stopping despite all of our medications. The pediatrician working that night had to stop everything and spent an hour focusing on that one child who was trying to crump (die). Makes sense, right? I spent a better part of the evening trying to calm down one mother who was angry that she was here with her kid before the child with seizure arrived, and people were paying attention to the very sick children instead of her child. She honestly couldn't understand why we would make a child with seizures or who had choked a priority over a child with constipation, who was running around a hospital room filled with expensive technology and tearing it apart and obviously feeling fine. I think it was the first time I ever felt like being rude to a patient. It's not right, but all I wanted to say was "Ma'am, I understand that your child is constipated, but honestly you wouldn't even be here if you knew how to make your [unruly and completely and obviously undisciplined] 7 year old child into taking the tasteless and odorless powder that was prescribed to you a week ago when you were here last time. It's not our job to teach to you " She ended up getting mad and leaving and said "I'm just going to take him to another ED." I thought great, another waste of our country's resources (her ER visit probably cost at least $1500 to evaluate her son's constipation, and she wasn't paying for that out of pocket).

Gah. Anyways, that's a behind the scenes look at the ER.

PS, yesterday I was with my preceptor trying to dig some glass out of a patient's hand. He had punched a mirror and some glass got stuck in there. If we can't immediately see any glass and the patient isn't in any discomfort, we will sew him up and leave glass in there because it doesn't cause the body any harm. Well, this piece of glass decided it wanted to come out of the patient's hand. I was holding open the wound and the preceptor was trying to dig out the glass and accidentally sprayed me with blood over my face and coat. Ha! I was SO glad that no blood got in my eyes, because I would have had to check myself into the ER as a patient again, pay another $150 copay, and be labeled as a horrible student who obviously is reckless. Phew.