It’s a crowded day in the emergency department . All the beds are full, the waiting room also a line has formed at the registration desk. It’s also the flu season when high fevers, stomach aches and sore throats which are prevalent at certain times of the year. Perhaps for every 1000 patients presenting with a triad of routine symptoms such as these only 1 may have a serious life threatening illness.
Mixed in with these routine sounding cases are trauma,overdoses, cardiac events, broken bones and other acute surgical illnesses. Physicians balance their time efficiently assessing severity of illness, complexity of diagnosis and care with the need to go through possibly a hundred patients/shift. Insurance companies frown upon ED visits since they are expensive as compared to office visits.
So physicians tread a narrow line between being overly cautious and moving briskly with their patients.
The story above has set into motion a call for standards in the ED where events can overtake process.
This should be included in the ‘never events’ algorithm…..no one leaves the ED without their laboratory results in hand…in addition to their presumptive diagnosis, referred to doctor, and instructions with warnings to watch for.