Sunday, January 24, 2010

My Rant on ER Inefficiency in the Digital Age

My blog post is late this week, but I have a pretty great excuse. In the past 24 hours I fell skiing, felt a pretty horrible pain in my left foot, managed to make my way down the hill on just my right ski (only because I have been skiing for 26 out of my 29 years on this planet and I'm a decent skier), limped into the lodge to report my injury to my mom, iced/elevated/wrapped/ibuprofen..... and finally gave up and decided it wasn't going to get better. I had to go to the Emergency Room up here in North Conway, New Hampshire.

So here is my question.... why did my visit to the ER take so long? The process was inefficient and frustrating for me, and I was definitely NOT the patient in the most pain. I can't imagine how awful it must have been for the guy in his early 20s who had a separated shoulder, or the woman who was pale white and clearly nauseous.

Here is the process. First I went to the ER at 5pm last night.
1. Go to front desk.
2. Sit in waiting room to fill out paper work.
3. Turn in paper work at front desk with my ID and insurance card.
4. Wait for 1 hour to be seen by triage nurse.
5. Triage nurse asks all the usual questions -- Am I on any medication? How did it happen? Rate my pain on a scale of 1 to 10. Blood pressure. Temperature. Pulse.
6. Back in the waiting room.

At this point I decided that I was not going to wait another 3 hours (the estimated wait to see a doctor) so I went home to help my husband give our daughter a bath and get her to bed. I woke up this morning at 6am and went to the ER again since I still could not put any weight on my left foot. This time there was only one other person in the waiting room, and he had a migraine so severe that he was vomiting. I was OK with the fact that they took him in first.

1. Go to front desk.
2. Fill out paper work again because the lost my paper work from last night.
3. Turn in paper work at front desk with my ID and insurance card.
4. Wait for 15 minutes to be seen by triage nurse (ERs are significantly less crowded early in the morning).
5. Back to waiting room for 10 more minutes.
6. Go into registration room, which is on the opposite end of the waiting room and I have to walk... very painful for me... to help enter my information into the computer and receive my hospital bracelet.
7. Back in waiting room for 10 more minutes.
8. Limp, wincing, into an ER exam room with a nurse. Wait 5 minutes for a doctor.
9. Doctor examines my foot and leaves. Wait 15 minutes for X-Ray tech. (While I'm waiting I overhear nurses saying that they found my chart from last night and they don't know what to do with it!)
10. X-Ray Tech arrives and wants me to follow her. I had to ASK her to bring a wheel chair because I still couldn't put weight on my foot. (Apparently she had not looked at my chart to see what she was going to X-Ray before asking me to follow her out of the room!)
11. Get X-Rays.
12. Return to room and wait 20 minutes to see doctor after she has looked at the X-Ray.
13. Doctor says it is not broken (YAY!) but I probably have a bad sprain of the plantar fascia and I need to be on crutches for at least a week.
14. Wait 10 minutes for nurse to come in with discharge papers and give my the sexy boot brace and crutches.
15. Go to car and get in. Mom drives out of parking lot and onto main road just in time to remember that the woman at the registration desk still has my insurance card because I haven't paid the $50 co-pay yet. My mom drives back and goes in to pay with my credit card.

Why did I have to walk back and forth across the waiting room 4-5 times when I was clearly limping and wincing each time I had to put any weight on my left foot? Why did I have to ASK the X-Ray tech for a wheel chair so that I could get to radiology? Why wasn't I offered an ice pack? Why was the process so inefficient?

In schools we are able to submit grades online and post assignments to websites. In our day-to-day lives we communicate easily with email and text messages on our PDAs. My daughter's pediatricians' office is completely digitized. Why aren't ERs? They, by definition, should be more efficient than a regular doctor's office, right?

I just saw this commercial on TV while watching the NFL playoff pregame show on ESPN.
THIS is what I'm talking about. This is the efficiency I needed in the ER last night and today!