EMS - EC handoffs - ER Hallway patients.

[Krin135 at aol.com]

In a message dated 3/3/2007 11:09:30 AM Central Standard Time,  
KMATTOX at aol.com writes:

Hospitals all over this country are not doing a triage prior to  sending  
patients from an ambulance to the waiting room.  In the  case which  prompted 
my 
post, an EMT was left on an ambulance  stretcher in the waiting room  for 
several 
hours with a diagnosis of  appendicitis.    

k



Sorry, Ken...re read that story again...in the material YOU quoted, the  
young lady WAS triaged x2 and was left in the waiting room  for ONLY 2 hours 
before being seen by the doc and diagnosed with acute  appendicitis. And she was in 
the waiting room and not on the EMS stretcher. Part  of her complaint was 
that the EMS team did NOT stay with her, so there is  evidence that she may have 
not been that acute when she arrived, or I would have  hoped that the EMS team 
would have been more aggressive about getting the triage  nurse to pay 
attention to the patient.
 
Here's from the original quote again:
 
<block quote>
>From personal experience, I was left in the waiting room at  Newton-Wellsley 
Hospital in Boston after arriving by ambulance.  I was  triaged 2x and 
finally admitted to the ED with acute appendicitis after 2 hours  in the waiting 
room.  The EMS crew did not stay with me.  I guess I  didn't look or act sick 
enough.
</block quote>
 
You and I both know that even in a moderately busy ED, a low suspicion  belly 
pain could end up waiting for several hours before a doc laid hands on  her. 
I personally strive for 2 hours from triage to disposition, but then,  I can 
generally manage to avoid having multiple patients 'on floor hold'  tying my 
beds up...something that many big city hospitals cannot avoid.
 
I'll admit that a female of pregnancy age with belly pain should have a  
higher index of suspicion in the triage nurse's mind (because the chance of an  
impending rupture of an ectopic pg), but the facts as presented do not warrant a 
 listing as a sentinel event. Was she mis triaged? Was she one of those  
smoldering cases? 
 
Among other things, the patient does not mention how long she waited after  
being seen to go to the OR for her appendectomy...I'd agree that this MAY have  
been a sentinel event if she immediately went to the OR for an open lap with  
drainage of a leaking appendix in a patient who could not walk, had a WBC of  
19,000, and a fever of 101 with abdominal rigidity....I suspect that she was  
somewhat less acute than that.
 
As you have said in the past, the plural of anecdote is not  'data'....
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