Houston, TX – At DOA Hospital in Houston, a new “patient-centered triage” form has been made available to any patient or companion complaining about their or their loved one’s ED wait times. This option has elated some patient advocates who have championed the cause for years in the setting of increasing average ED wait times that they blame solely on lazy nurses and doctors. Hospital administrators have likewise been enthusiastic about the concept, as it has contributed to markedly improved patient satisfaction scores at DOA’s overburdened ED, even as it has led to worse clinical outcomes.
The current status of the ED is updated continuously in the electronic medical record (EMR) server and will automatically fill in pertinent data on the form when it is printed on-demand. This form contains a checklist of HIPPA-compliant one-phrase descriptions of the other patients’ conditions in the ED at the time of printing as well as their wait times prior to seeing a physician or mid-level practitioner. The complainant is then able to check off boxes next to the other patient(s) in the ED whom, in the opinion of the complainant, should be given deferred attention in order to deal with the complainant’s more important condition first.
After these forms are filled out, they are taken to a special administrative assistant who runs the form over to the charge nurse. All other active patient care is stopped as a team is mobilized to provide immediate care for the patient, bring them food and drink, and start them on IV pain meds, if needed.
A real-world application of this concept occurred this past Saturday evening involving the case of “RJ,” a 35 year old chronic back pain sufferer. After he arrived by EMS for his 7th visit in 3 days for his pain (with no interim changes in his symptoms), RJ was forced to wait for over an hour for care. His primary complaint was not receiving IV Dilaudid within his expected 30 minutes. He requested a complaint form, which was printed out, and the following “patient-centered-triage” checklist was then presented to him, listing the department’s other not-yet-seen patients’ chief complaints, with wait times in parentheses:
(1:05) Chest pain radiating to arm, sweating
(0:47) Arm amputation, exsanguinating, low blood pressure
(0:35) Sharp abdominal pain, knife in stomach
(0:05) Cardiac arrest, active CPR ongoing
When presented with this form, RJ thought over his situation and before checking any boxes, he responded:
“Prior to this form, I thought that wait times were too long for no reason and that I was being ignored for hours. Today I learned for a fact that this hospital feels my chronic back pain is truly less important than an active cardiac arrest or the patient with a bleeding, amputated arm in the next room. There is no doubt I learned an important lesson today: That DOA hospital, and its employees, are truly lazy pieces of S@#t and that I will seek care elsewhere in the future.”
RJ then proceeded to check every single box on the form before he eloped, without distress, out to the waiting room and then outside the hospital. At that point, he proceeded to call 911 for an ambulance to take him to the next hospital, as the care team, who had stopped CPR on the cardiac arrest, ran outside after him waving syringes of Dilaudid.