On the Job: A night in the emergency roomWritten by Brian Malkowski | | firstname.lastname@example.org
Editor’s Note: Reporter Brian Malkowski will spend shifts at various Toledo workplaces to offer insight into the people who work some of the area’s toughest jobs.
About a year ago, ProMedica’s Flower Hospital wanted to initiate a plan to reduce patient wait times in its emergency room and with just a few minor changes it has done so. When patients checked in they used to wait on average an hour before they were given a bed; now that wait is less than 30 minutes. Flower’s ER sees nearly 30,000 patients a year. With this much volume in a nonstop chaotic environment, in which areas did the hospital find room for improvement?
Before I started my day in the ER I sat down with Flower’s ER director, Sherry Watson. Wearing white pants, a white coat and a smile from ear to ear, she could not wait to talk about the changes made in the ER. She started by acknowledging that her team makes it happen every day whether she’s there or not. The first major change the ER made is that when patients checks in, they are immediately sent to one of 25 ER beds. In the past they were sent to triage, which basically prioritized the severity of the emergency. Getting a patient directly to a room and triaged is saving the patient at least 30 minutes. Second, the doctors used to take notes in each room and document each case themselves in between seeing other patients. Now a scribe has been added to follow each doctor, saving at least 90 to 120 minutes each eight-hour shift. This allows doctors another two hours of seeing more patients instead of punching computer keys.
I saw these changes in action as I was given the opportunity to follow Dr. Michael Mattin during his shift on the floor. Dr. Mattin’s shift might start at 2 p.m., but his day starts at home with his wife, raising their four boys. On his way to work, he usually finds himself on the cell phone talking to one of his EPNO (Emergency Physicians of Northwest Ohio) co-members about a case or a question another physician may have.
Once he arrives, it’s just like a scene out of the TV show “ER.” His day starts and ends in what is called a fish bowl, a glass-enclosed area filled with computers, monitors, ringing telephones and various colors of scrubs-wearing staff performing different objectives. He gets the rundown from the doctor he is relieving by looking at the tracking board, a monitor filled with all the patients in every room. It tells him the status of the patient: seen, needs to be seen, waiting on something, etc. The software looks something like a setup wizard. A patient can be diagnosed, admitted, prescribed a script, or discharged simply by a click of the mouse.
Wearing slacks and a button-down shirt, Dr. Mattin prefers to forgo the white coat worn by most doctors. He also prefers walking into a patient’s room shaking hands and having a seat next to the patient, creating a friendly encounter versus hovering over the patient.
Each of his colleagues are greeted the same, no matter how awkward the interruption. Dr. Mattin remains calm as he assists in numerous questions while moving from room to room. I counted, in a three-minute period, as seven different people asking him questions as he gets snack and talks on the phone with another doctor. No breaks and no lunch were taken during his shift, so sneaking in two pieces of pizza and a 20-ounce Mountain Dew took creativity.
The number of patients seen and the severity of their conditions in an eight-hour ER shift can never be predicted. From a simple cut on a finger to a heart attack, each case is treated as an emergency. People in the waiting room might think someone is wasting space in an ER for a simple cut on the hand, but what one needs to remember is that someone with a simple cut or someone having a heart attack have something serious in common: their anxiety level. The hospital respects this.
Elizabeth Solely, a 72-year-old woman, had been experiencing back pain and after X-rays are taken, Dr. Mattin discovered a compression fracture in one of her vertebra. Upset as she is admitted to the hospital and not going home to her cats that evening, Solely stays overnight for a kyphoplasty, a spinal procedure where bone cement is injected through a small hole in the skin after the vertebra is repositioned using a balloon. Now that the vertebra was restored to a more normal position and feeling pain relief almost instantly. After spending less than 32 hours in the hospital, she was discharged and sent home.
A male patient with a swollen neck due to cancer is in pain and refusing an IV. To make matters worse, he was there by himself and does not speak English. The hospital uses MARTTI, a mobile real-time interpreter. For around $2 a minute, the hospital has access to 150 languages, including sign language. Before, the hospital had to hope there was someone nearby to translate and has then trust what they were translating. Now they just wheel in MARTTI. Dr. Mattin dials in and has the interpreter explain to the patient that because of the severity of his condition he would be admitted to the hospital.
The ER is not where 8-year-old Raziah wants to be. She was sent by her doctor for X-rays. Raziah is all smiles while sitting upright in her ER room talking to the doctor, answering questions. After X-rays are taken by the doctor and a popsicle taken by Raziah, she is discharged.
The most interesting case of the day is the 40-year-old man experiencing chest problems. In the past two months the man has lost 40 pounds. With his immediate family by his side, he answers the doctor’s questions with slurred speech. After X-rays find an unexplainable chest mass, the man is admitted for nerve tests. Testing finds a very rare case of myasthenia gravis, a neuromuscular disorder caused by an abnormal immune response. The patient came in that day not able to swallow and fearing some sort of cancer. After a special treatment from the hospital known as plasmapheresis, the patient is back to baseline before being discharged.
An ER doctor must be swift, caring and very patient. Dealing with constant interruptions while moving from room to room is very difficult and time consuming. A doctor must use time management skills to see each patient while consulting with team members. Dr. Mattin did all of these things just before he turned his floor over to the next doctor. After a quick rundown on the tracking board, Dr. Mattin headed home to his family.