ED Puzzle

This is a picture of an ambulance delivering patients to GVMH the day the hospital opened.  I added this picture because it relates to the topic of today’s blog which I saved until Friday for a reason – it’s difficult and it’s long.  Every week I ask for questions and all this week I have done “by request blogs” and today’s blog is a combination of both.

Last week, Kim Bybee, asked a question about responding to negative comments about the emergency department.  So let me first thank Kim for asking a sensitive question about a difficult topic.

Emergency departments in hospitals are a difficult beast.  Below I’ve copied and pasted some information about emergency departments released a couple of weeks ago by the American Hospital Association.

More than one-quarter of outpatient visits for new health problems or chronic condition flare-ups are made to emergency departments, according to a study published today in Health Affairs.  Two-thirds of these ED visits took place on weekends or after office hours. “Primary care doctors have packed schedules and their offices are typically closed in the evenings and on weekends,” said lead author Stephen Pitts, an associate professor at Emory University School of Medicine. “Too often, patients can’t get the care they need, when they need it, from their family doctor.”

Before I go any farther with this blog I want to make a couple of points.  1) Across the country, for better or worse, the emergency department has become a primary care clinic and the primary source of health care for millions of Americans.  2) More and more Americans are uninsured or underinsured and they are waiting longer to seek medical care which causes them to be sicker and more difficult to treat when they do seek care.  3) Bad news travels fast and good news isn’t shared.  4) An emergency physician is asked to evaluate and treat a person they’ve only known for 5 minutes.

Clinton is no different than any community in America and the emergency department at GVMH treats sore throats, broken bones, heart attacks, strokes, sprained ankles, stomach pain and viruses all in the same day and at times all in the same hour.  Emergency departments are expensive to operate, tend to lose money and at a facility like GVMH the emergency department is the entry gate to the hospital.  Emergency departments do great things every day and at GVMH, like all hospitals, there are times we can do better.

Two patients walk into an emergency department at the same time, patient one says “my chest hurts”, patient two says “my throat hurts”.  Who gets seen first? 

I’m sure most of you answered patient one.  Chest pain is serious business.  Hospitals are in the business of saving lives and someone with chest pain is much more likely to need his life saved than someone with a sore throat.  Emergency departments have limited resources and limited staff and every resource available will be devoted to saving a life. 

In the process of saving patient one’s life, patient two is asked to sit in the waiting room.  Two hours pass and it’s found that patient one is not having a heart attack but has a pulled muscle in his chest.  Patient one returns to the waiting room to share the good news with his family and says “we can go home now, it’s only a pulled muscle”.  Patient two hears patient one and says to her family “you mean we’ve been waiting for two hours because this guy has a pulled muscle!”. 

Who do you think’s happy with their care and who do you think is upset?  Do you think patient one goes to all his friends and says “I went to the emergency room, they got me right in and found that I had a pulled muscle in my chest” or do you think patient two says to all her friends “I went to the emergency room with a simple sore throat and it took more than two hours for them to get me in”.  My guess is patient two shares her story with more people than patient one.

Let’s look at another example.  A patient comes into the emergency department with swelling in his ankles and he tells the emergency department physician that the swelling has been going on for a couple of months but now he is having shortness of breath as well.  The physician diagnoses the patient with congestive heart failure and asks the patient if he has seen his primary care physician about the swelling and the patient tells the physician no – he couldn’t afford his co-pay. 

The patient has a condition, that if addressed earlier, could have been managed on an outpatient basis and never would have required a visit to the emergency department.

One last patient example.   A patient comes into the emergency department and tells the emergency physician “I just don’t feel good and I know something’s not right”.  What’s the emergency physician to do.  He has never met the patient before but he wants to be responsive to the patient and find out what’s wrong so he orders lab tests, x-rays and CT scans leading to a long stay in the emergency department, slowing care to other patients and racking up huge charges only to find out the patient is depressed because she recently lost a spouse.

I provide these examples only to say the situation is complicated.  For every bad story there are a hundred good ones.  Long waits are rare and short waits are the norm but no one complains about a short wait.

Every hospital in the country has the same difficult dynamic with their emergency department.  People go to the emergency department when they’re sick, the situations are emotionally charged for the patient, their family and staff.  If you think about it, many times we seek medical care just so we can be told “There’s nothing wrong” but until we hear those words, we are anxious and irritable. 

We are not going to change society and we are not going to change the health care climate in our country.  It’s important for emergency departments to provide the same level of compassion to the person with a sore throat as they do the person with chest pain.  It’s important that health care providers in every setting treat their patients with dignity and respect.  It’s important that we recognize as an organization and as individuals we can do a better job providing patient care and customer service. 

It’s also important that we respond to any negative comments about any of our services.

If you’re a GVMH staff member and you hear a negative comment about any of our services you should take that comment personally because it reflects upon you.  If you receive a negative comment, pass it on to someone who can respond, it needs to be addressed. 

If you are a community member and you’ve had a bad experience with any of our services, I want to know.  Not only do I want to know but others in administration want to know as well.  We can’t fix a problem we don’t know about.  We might not be able to fix the problem you had but we can fix it for your neighbor, spouse, friend, cousin, aunt, uncle, brother and so on when they need the service. 

So Kim, to answer your question about how to respond to negative comments the answer is simple.  Listen, share, and we will all learn.  We will learn and do better the next time.

Health care is an art and not a science.  We will never be perfect but that shouldn’t stop us from trying. 

So here’s what we are doing to help our emergency department be able to provide better service.  We have re-committed ourselves to customer service.  We will be developing a committee of community members to provide us feedback on our services and make suggestions for improvement.  Just this week we started a walk in clinic in Clinton and we already have one in Warsaw.  The walk in clinic should allow some of the more minor illnesses and injuries to be treated in our physician’s clinic and reduce the burden and wait time in our emergency department.  Hospital departments that provide service to the emergency department are re-examining practices to improve turnaround time.  We have re-designed the emergency waiting area to make it more comfortable. 

Finally, we care and we want to do a great job!

About Craig Thompson

I am a young professional with two great sons, and I work in the healthcare setting. I am employed in hospital administration and serve as Chief Executive Officer at Golden Valley Memorial Healthcare in Clinton, Missouri. At GVMH we care for our families, friends and neighbors. We're committed to providing the safest, friendliest and most compassionate care to all we serve.
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