BLESSED ARE THE SQUEAKY WHEELS,
FOR THEY SHALL RECEIVE THE OIL. *
*Re-learned and confirmed by my recent 8AM – 4PM sojourn on a Monday in a community hospital ER helping a friend who had become unhinged and needed psychiatric help.
.1. Ask for and write down the name of any physician, physician assistant, or nurse practitioner who treats you in the Emergency Room..
These are the only ER staff who can write the orders for your tests or treatments. If later you ask a tech, a nurse, a social worker, or a care manager why something hasn’t been done yet, they may ask you “who said you were getting that?”. Answering with a specific name gets you past that particular speed bump.
These people often come and go in the ER repeatedly during their shift as they deal with multiple patients in multiple areas, so knowing their names can help you reconnect with them if they are not visible. Usually you can spot your ER nurse(s) and hail them directly or point to them if someone asks you “who told you that”. When desperate for info or action you can also ask the nurse to page the physician, physician assistant, or nurse practitioner by name.
2. If you don’t know why you are waiting for something, ask anybody who comes near you: “Why I am waiting, or what am I waiting for?”. Ask every half hour, but increase the rate to every 15 minutes if you have been waiting for more than three hours. If nobody comes near enough to you to ask, push the call button and ask whomever responds; same frequency.
Even if the person you ask doesn’t know the answer, he or she will find someone who does if you keep asking. ERs are busy and most of the staff are caring for multiple patients simultaneously, so sometimes you need to reclaim their attention to move along.
3. If you are waiting for a decision or a service of any kind and the time is close to 6:30 AM, 2:30 PM, or 10:30 PM start asking for clarification or expediting every 10 minutes until the next hour arrives.
Nurses change shift normally at 7 AM, 3 PM, and 11 PM and when the nurse that has been working with you for the past few hours leaves, that change can result in a reduction of a sense of direction or urgency that you have been working hard to establish. So, push for decisions and/or disposition before the shift change. Social workers and care managers usually work 9 to 5. Physicians work all kinds of shifts, so don’t be afraid to ask him or her when they go off, and push for decisions and/or disposition before they do.
4. If you are in the ER as a patient or as an advocate for a patient seeking behavioral or mental health services, do NOT be quiet, cooperative, and docile. The noisy, agitated “mental” patient gets faster treatment and disposition (or at least a quieter, more removed room to wait in)
One has to be moderate about using this last technique, but it is worth being more noticeable. If you are perceived as a very cooperative patient or as a polite, passive patient advocate you may be enabling a slower pace of action. This could be even more of a factor when several patients are awaiting psychiatric referral, evaluation, or placement. However, you don’t want to push this behavior to the point where they call Security or consider injectable medication.
For more details read on:
THE PROCESS: Inefficient, time-consuming, tiring and somewhat irritating to the patient and advocate, but probably “better than usual”.
8AM arrive in ER.
9:15 AM Social worker interviews patient for 10 minutes, and says she will ask the team intake person to evaluate
10:30 AM Team intake nurse interviews patient for 30 minutes. She says patient needs placement and someone will come to evaluate him.
11:30 AM Psychiatric Nurse Practitioner speaks to patient for 5 minutes. She says he needs to stay in the hospital, and they will start looking for a bed.
1:30 PM Patient’s advocate (me) goes to social worker desk to ask about progress in looking for bed. (See above for her response.) Discharge planner at the same desk seems to be hearing this news for the first time.
2:00 PM Patient’s advocate asks for update from discharge planner. Response: a possible bed at facility A 50 miles away.
2:30 PM Patient’s advocate asks for another update. (see above for critical timing). Response: No bed at facility A but possible bed at facility B 90 miles away.
3:00 PM Patient’s advocate reports to discharge planner that patient is getting restless and that the advocate has to leave. (More than a slight exaggeration for effect) Response: Let us know when you leave because “we will have to institute a one-on-one staff observation on him at that time”. (An expensive inconvenience for the nursing staff) Patient advocate requests a move of the patient to the quieter Psych holding area to get him out of the increasingly crowded and noisy ER before the advocate has to leave. Response: There is no room in the holding area.
3:30 PM ER nurse reports that a bed has been found in facility A, and that patient will be moved out of the ER into the Psych holding area awaiting transport. Patient is taken into the Psych holding area where 3 out of 4 beds are empty.
4:00 PM Local private ambulance company comes to the Psych holding area and packs patient up in 5 minutes to go to facility A.
THE OUTCOME: Excellent
The patient is placed in an appropriate Geriatric Psychiatry Unit with a good reputation in a community hospital 50 miles from home.