ED Crowding

So as I was attending this conference on ED crowding an old thought reentered my head. What if crowding cannot be changed, what if all the efforts we put in making a system work more efficient then it has been for ages are in vain, what if human effort to improve what is already set in stone for decades proves to be futile. What if that idea, terrifying as it is, is only slightly worse then the concept that the system could very well be improved upon if only the ED docs would work harder.

Yet, there is one thing that can be done. What if we as patronising doctos let go if the idea of the patient on the bed. Why do we put people on beds? Do you want to lie on a bed when you are sick?  What do you do at home if you are sick. Right, there is sick and sick. Most of the times, you actually want to sit somewhere comfortable, watching old reruns of cheers while all you need to do for water or tea is reaching out for it. And! the cookiejar besides the teapot. Sure if you in septic shock, you might want to lie down for a bit.

Why do make our patients lie down for more then the two minutes it takes to ultrasound them or examine their bellies? Do we feel better when a patient is supine? It kind of controls stuff right? Patients that lie down don’t come to your desk to ask questions. I will tell you why we lie patients down on a bed; the waiting room is to uncomfortable. No way you are going to say to an elderely lady, please sit on that wooden chair in the waiting room again opposit from the blood spitting alcoholic, and next to the screaming todlers. We don’t. But what if….

What if the waiting room was cozy, there were televisions and ipads, there was coffee tea and biscuits. What if you had some privacy there, or could invite a visitor. How would you feel telling the 30 year old headache patient, thank you for examining you, The lab results will be back in 50 minutes, why dont you head to the lounge, grap a cup of tea and watch some old Cheers episodes. Wouldn’t that make you feel better? Wouldn’t that make us all feel better? Wouldn’t that dramatically increase the amounts of available beds.

So are we able to make a system, that has been set in stone for decades, more efficient? Maybe not. But we can build a new one. Lets build a new one.