QEH: You have a problem
Emergency Department seems to have a problem with effective time management
Recently, I reluctantly spent over eight hours in the Emergency Department at the Queen Elizabeth Hospital, accompanied by an ever-changing and long-suffering cadre of fellow Islanders.
To say that my experience was frustrating would be putting it mildly.
Robert Preston, singing in The Music Man, once proclaimed: “Well, ya got trouble, my friend, right here, I say, trouble right here in River City.”
Minister Mitchell, we have trouble right here in Charlottetown.
I have had a lifetime worth’s experience in the ED, and I have never experienced a more perplexing Emergency Department than at the QEH. I have had both good and bad experiences over the years, but my recent visit was the most frustrating one ever, primarily because I was stuck in the waiting room for nearly six hours.
Upon arrival, I had to locate and help my wife into a wheelchair, wheel her into the department, take her to registration and park her in the triage area, unassisted. She was assessed promptly by a triage nurse, assigned a low priority triage designation (semi-urgent) and consigned to the waiting room to commiserate with 20 fellow sufferers.
Six hours later, my arthritic hip reminded me emphatically that I shouldn’t sit for that long. It was aching continuously. Getting up and hobbling around in the waiting room didn’t help. The waiting room had claimed another sufferer. From the treatment area doorway, a nurse called our name. She then waited in the doorway until I had gathered up our stuff and wheeled the chair into the treatment area. She walked alongside while I played porter and manoeuvred my wife into a treatment room, as directed.
How can they call it “fasttrack” when it is six hours before you are put in a room, only to wait another half an hour to be seen by a physician? When did non-staff become responsible for transporting patients inside the hospital? Who would be responsible if I got tangled in that wheelchair?
There is an electronic status board in the corner of the waiting room which is, in my opinion, a sop to the requirement that ED staff communicate with patients waiting for care. In reality, the subliminal message seems to be, “we are very busy saving lives but we may get around to seeing you sometime in the next 6-8 hours. Maybe you should reconsider why you are here, stop bothering us and go home.”
Unfortunately, as many as 10 per cent of registrants leave Emergency Departments without being seen by a physician; some of them are seriously ill. There are volunteers stationed in the waiting room but, if our visit was any example, they spend a great deal of time chatting with each other, and running back and forth to let people into the treatment area. Not once did I see them trying to engage people seated in the waiting area.
Back in the day, the patient waiting area was in clear view of the staff working area. Does our concern with patient privacy now preclude designing EDs that way? The beauty of the old design was that it allowed staff to keep an eye on patients who might otherwise get sicker unnoticed, and showed waiting patients that staff really were busy.
The Emergency Department at the QEH seems to have a problem with effective time management. The hospital seems incapable of moving patients who would be better managed on an inpatient unit, in an outpatient clinic or in a primary care office out of the Emergency Department.
Too many health-care professionals don’t seem to grasp the concept of customer service and our policy makers seem incapable of supporting significant change.
I wrote the minister of health and CEO of Health P.E.I. about my recent experience and the response was both patronizing and unhelpful. I was not surprised. The Emergency Department at the QEH is in serious need of an external review. It is time for leadership to be held accountable when the system fails to deliver on its promises.