There’s some interesting stuff on how best to use physician time. When I see a patient who’s been waiting 6 hrs I always apologise for the delay and if I order an x-ray I tell them that it shouldn’t be too much longer as the major delay is usually to see me.
The other parts of the system, like triage and x-ray seem to work a lot more “efficiently” than the Dr part. We inevitably get called away to various important situations and the patient has to wait.
What I struggle with is that my time – in many ways the most important rate-limiting factor in patient flow is often used in desperately inefficient ways. Most of this comes from having inadequate nursing or ancillary staff.
Most hospitals (at least in US, Aus and Ireland) have patients admitted pts in ED corridors or cubicles. ED nurses time is then spent looking after admitted patients. Sometimes this is actually 2/3 of the patients in the department. As a result ED nurses are not available to do what ED nurses would like to do – look after ED patients and employ their full range of skills of assessment, interventions and procedures like IV lines and the like.
Instead, given that the nurses are so overwhelmed it falls to the Dr to do a lot of these tasks – everything from bringing patients to the toilet to get urine samples, testing urine, placing cannulas. moving patients to x-ray or even into a room where we can actually examine them.
I could easily double the number of patients seen an hour if:
- I could tick a box to request investigations as opposed to fill forms or take the blood myself.
- I could have a scribe or even dictate notes instead of hand writing.
- patients were in a gown, in a cubicle, ready to be seen when I come to see them.
Unsurprisingly, in an efficiency driven, for profit system like the US – they have already adopted most of these features that enable maximum throughput. They also have many, many more senior EM clinicians as opposed to essentially independently working trainees of varying experience.
This is very much NOT a slight on nursing staff. This is a criticism of short sighted planning that while the long wait in ED might be to see a doctor that’s actually because we have nowhere near enough nursing staff and we make poor use of their skills and training.
We get paid the big bucks to see patients, make decisions and spend time with patients. Anything that detracts from that is poor use of our time on on the floor.