March / April 2010 Issue |
Healthcare Journal of Baton Rouge
17
also serves a large primary care role because of a lack of
services in that community, said Freeman. “Seeing primary
care patients does impact us to a large degree. While the
majority of those are easy problems for us to handle and take
a short amount of time, it’s just the overwhelming numbers
that interfere with that.”
The factors that affect delays in the emergency department
can be different from day to day, explained Lane’s Conerly.
There are times when the hospital is full and they have a hard
time moving patients from the ED to a hospital bed because
there are no beds available. High acuity patients in the ED will
also take more time and increase waiting time for those who
are less acute. “We really don’t have an issue at this facility
where we have acute patients waiting in the waiting area to be
seen,” said Conerly. “Not to say we’ve never had that, but we
do a very good job of triaging our patients and following up on
triage and following up with patients when they are in the wait-
ing area.”
At OLOL, volume is the greatest challenge, followed by com-
plexity of illness, said Rhorer. “Very, very ill patients come to
OLOL because we have the most comprehensive healthcare
services in the city.” For those patients there are certain levels
of testing that are required before one accesses the consult-
ants. Some of these tests are automatic and immediate, fol-
lowing the national standards of excellence for chest pain and
stroke analysis. “You’ve got to get an EKG within ten minutes
if you come in with chest pain. That’s the standard, that’s
what’s going to happen,” said Rhorer. “The triage doctor is
there to make sure we are on the mark on all of these critical,
time-sensitive illnesses.” He also said that for every step that
is involved in a patient’s experience, one should expect a cer-
tain delay. How that delay may manifest, or to what signifi-
cance, is random and may have to do with how challenged the
consultants may be, said Rhorer. If it’s a high volume day and
a high illness acuity day, then everybody is challenged.
Despite built-in triggers to get extra staff into the emergency
department, some delays can’t be avoided. “If you need a sur-
geon, you need a surgeon. If that surgeon is just finishing
sewing up a case in the operating room you might have to wait
that extra 30 minutes.”
Dr. Cuba agreed that wait times are multi-factorial. “You can’t
quite hang it on any one particular thing. If you have fifteen
steps in a patient’s stay in your emergency room, each little
delay is amplified by another delay and a snowball effect
occurs,” said Cuba. “There’s a lot of literature out there that
does say, and I agree, that the waiting for the inpatient bed is
really the key part in ED wait times,” Cuba says that has to do
with staffing, but not necessarily just ED staffing. “You have
the average number of patients you expect, but if you have an
extra seven admits in the evening and you can’t get a nurse
on that floor, then those patients may have to wait in the ED.”
As for elective surgery backing up patients in the ED, Cuba
says it has not been much of a problem at Ochsner unless the
hospital is completely full. “Our nurse supervisors examine
that problem, but it still is sort of a predictable in-flow.”