Make an Appointment in the ER
Here is an e-mail I received from Tyler Kiley, the founder of InQuickER. I am always amazed to see that people really do read our blogs! I have no financial interest in this company, and as usual I am never paid for any content I place on my blog. I post this because I am impressed with their innovative concept and because it refutes some of the false assumptions made on other blogs about this type of service. Adapt or fail, folks.
Hello!
My name is Tyler Kiley, and I'm the CEO and founder of InQuickER. We've maintained a low profile and quiet existence for the past two years, but I see our company has become the talk of the medical town in the past few days. Wow!
There is quite a bit of discussion on some of the nursing blogs about the risk that a service like InQuickER will increase use of the ED for inappropriate conditions. Two years ago when we started this service, I was very concerned about that issue; however, it appears this is not a problem right now. In our follow-up interviews and research with patients, we are finding that InQuickER is not causing patients to go to the ED when they would have otherwise gone to a PCP or an urgent care. We aren't causing patients to use the ER as a source of primary care; rather, much of our current volume comes from patients who would have ordinarily gone to another ED that doesn't offer the InQuickER service. Patients who have decided to go to the ER are willing to drive long distances to use our partner ERs because they would much rather drive 30 minutes than sit in the waiting room for two hours!
We do offer treatment appointments up to 12 hours in advance, but we've found that patients simply don't use this feature; over 96% of our treatment appointments are set less than four hours in advance. I think this is a relatively strong metric indicating that our service is being used by patients who do, indeed, need timely treatment.
I'm surprised that there is so much antagonism toward this service in the last few days; at our pilot hospitals, we have received a very positive response from the nursing staff. For the most part, InQuickER patients are more satisfied, more compliant, less stressed, and better prepared than other ER patients; I think this is partly because they haven't had the negative experience of sitting in the waiting room for hours, wondering when they will be seen by the doctor.
Ultimately, we give the nursing staff more flexibility in the waiting room; nurses have the opportunity to call patients in earlier than their automatically-generated appointment time if warranted, but InQuickER means that the nurses have more information, more control of the flow of incoming patients, and fewer people in the waiting room. Eventually, we would like to work with urgent care centers and open access PCPs as well, but we simply haven't had the right resources and partners to offer those services yet.
Thanks for taking an interest in our service!
Tyler Kiley
Founder and CEO
InQuickER, LLC
Hello!
My name is Tyler Kiley, and I'm the CEO and founder of InQuickER. We've maintained a low profile and quiet existence for the past two years, but I see our company has become the talk of the medical town in the past few days. Wow!
There is quite a bit of discussion on some of the nursing blogs about the risk that a service like InQuickER will increase use of the ED for inappropriate conditions. Two years ago when we started this service, I was very concerned about that issue; however, it appears this is not a problem right now. In our follow-up interviews and research with patients, we are finding that InQuickER is not causing patients to go to the ED when they would have otherwise gone to a PCP or an urgent care. We aren't causing patients to use the ER as a source of primary care; rather, much of our current volume comes from patients who would have ordinarily gone to another ED that doesn't offer the InQuickER service. Patients who have decided to go to the ER are willing to drive long distances to use our partner ERs because they would much rather drive 30 minutes than sit in the waiting room for two hours!
We do offer treatment appointments up to 12 hours in advance, but we've found that patients simply don't use this feature; over 96% of our treatment appointments are set less than four hours in advance. I think this is a relatively strong metric indicating that our service is being used by patients who do, indeed, need timely treatment.
I'm surprised that there is so much antagonism toward this service in the last few days; at our pilot hospitals, we have received a very positive response from the nursing staff. For the most part, InQuickER patients are more satisfied, more compliant, less stressed, and better prepared than other ER patients; I think this is partly because they haven't had the negative experience of sitting in the waiting room for hours, wondering when they will be seen by the doctor.
Ultimately, we give the nursing staff more flexibility in the waiting room; nurses have the opportunity to call patients in earlier than their automatically-generated appointment time if warranted, but InQuickER means that the nurses have more information, more control of the flow of incoming patients, and fewer people in the waiting room. Eventually, we would like to work with urgent care centers and open access PCPs as well, but we simply haven't had the right resources and partners to offer those services yet.
Thanks for taking an interest in our service!
Tyler Kiley
Founder and CEO
InQuickER, LLC
posted by scalpel at 5:37 PM
64 Comments:
Yeah right.
Allergy guy, the example patient, used your service because he was unwilling to wait for an appropriate appointment and heard about this from his neighbor. He never said anything near "I thought this was an emergency" or "I knew I needed the ER" in the article. If you don't think this is an example of encouraging ER abuse, I don't know what you'd consider ER abuse. It sounded to me like he wouldn't have used an ER if this service wasn't available.
It sounds to me like you are once again making assumptions with limited information. Super awesome!
Re-read the article, dood. If you get the impression that he thought the lack of an available appt (without calling the clinic?) meant that he was going to rush down to an ER no matter what, feel free to think that. I choose to avoid delusions when I form my opinions.
Besides, why would you want "real" ERs offering appointments anyway when they can go to Dox in Box, Inc. with the comfy couches and expresso machine? You should be opposed to real ERs offering appts. if you were tracking appropriately.
Before this hospital is slammed anymore, I would like to share my experience there as a patent. I contracted Bacterial Meningitis in 2007 and had the privilege of being admitted at this facility for over a week. I also had the privilege of meeting a know-it-all nurse that displayed the exact same attitude as Nurse K in triage at a nearby hospital who told me that I was not sick enough to be in the ED and that I should go home and try to make an appointment to see my PCP. Just to cover her ass, she did go on to say, "You don't seem sick enough to me to be in the ED, but if you feel like you need to be here, go ahead and sign in." Never mind that I had mentioned the worst headache of my life and being unable to touch my chin to my chest. Who in their right mind would have stayed and received treatment from this facility?
This is a smaller hospital and like I mentioned earlier has it's share of problems like every facility. It's not a major trauma center, but it does serve it's purpose to stabilize and treat patients with kindness, courtesy and most importantly, RESPECT.
I've been reading both blogs for the past couple of days and I must say that I feel sorry for you Nurse K. You've lost your compassion for your job and your fellow human beings. You can justify your blog by claiming it's a way to relieve the stress and pressure from your job and that you would never say aloud the snide and cruel remarks to a patient, but what you fail to realize is that your patients can see right through your phony friendliness and pretend-to-care facade. You're arguing blindly here with a physician who has 100 times your knowledge of medicine and patient care. That alone tells everyone you have absolutely no respect for the established medical hierarchy. Why should anyone respect your opinion?
Scalpel and I have a love/hate relationship. He calls me Dipstick, I call him Asshole, and we move on.
Thanks for projecting your disdain for one EMTALA-violating triage nurse onto me though. I certainly don't violate the law and tell people to leave. I'm also not an idiot; I make people turn their head side-to-side and touch their chin to their chest if they have a fever/headache. My job is to get useless JCAHO info, figure out how sick you are and either give you a room or show you the lobby. Not a lot of emotion involved one way or another. Other nurses might take 20 minutes to triage and they show you photos of their dog while I'm turning and burning through the slips. These 3 patients they triage each hour might be really happy with how nice the triage nurse was.
I choose to just do my job. I'm not there to be your friend. Definitely I crack jokes and stuff when I can, but I'm not going to delay anything to have unnecessarily-involved conversations with people.
Maybe I need to work in a lower acuity ER or something to see what it's like, but we have enough REAL sick people that we don't need to be catering to clinic patients. I'm busy enough with sick people, thanks. My priority is NOT making coffee, calibrating lab machines or whatever. My priority is efficiently and effectively saving your ass. That's why you should respect my opinion.
Congrats on surviving meningitis.
I agree with scalpel on this one.
Nurse K is a miserable existence.Has anyone ever told you to just shut up and LISTEN. Please go back to your blog. No one really gives a shit about you.
You only represent one person and you are only entitled to a single opinion you selfish, overweight miserable redneck.
Good quote for the sidebar, thanks.
There is nothing wrong with imagining you are important Nurse K- it is nothing that little Haldol & Ativan inj.can't fix.
From the patient's point of view....What do you do when you are in Florida for six months as a snow-bird and nobody wants to or has time to see you with a really bothersome complaint? I look fairly healthy and about sixty at first sight, but got the run around in a large Florida city. So, we went to a smaller town and an Urgent Care Facility. After hearing that I had fierce indigestion, a history of esophageal fundalplication, celiac stent, bil. carotid endarterectomies, small previous MI and am seventy three...they sent me to the local ED, because they had no way of dealing with that pile of stuff. The local hospital (on the second visit a week later) noted changes on the EKG and ambulanced me to the Regional Heart hospital, where I had a cardiac cath and two stents.
I'm back in Ohio and still have that rotten indigestion. My PCP is working on the problem... the heart was just an incidental finding, but it would not have been found without a visit to the ED for indigestion. Incidentally, I am an old retired nurse and even I am not always able to tell when I am in serious trouble.... that's what doctors are for. I love them!
Times change, whether we like it or not. We can rail about the way life (and the ER) should be or we can deal with it the way it is. People show up deservedly or not. Scalpel's right...adapt or fail.
All of that having been said...the first time I show up at the ED with Shark or Biscuit (usually bodily damage requiring casting or stitches, and respiratory issues, respectively) and I get blown off because Frank Q. Flyer has an 11:15 appt for his toe fungus, I'ma go nuclear on whoever is in my sights -- doctor or nurse alike.
People with medical needs, getting treatment right away. Oh noe! Must be a sign of the Apocalypse!
"selfish, overweight miserable redneck."
Wow, she sounds HOT! Where do you get this privy information? Is that whats is on her facebook profile?
Putting the anger and animosity aside - I think an alternative plan is to establish an "Urgent Care" area in addition to fast track and the main ED. This area could schedule people for minor problems. The area would be staffed by a nurse and a doctor (or PA/NP) who would NOT be periodically pulled to see pts in the main ED. The nurse would answer the phone and take down the info and schedule the patient - if the problem sounded more serious, they would tell the called to go to the main ER instead. The only issue would be that you would have to make these appointments only for patients with insurance - which might run into EMTALA issues if technically the ER staff is running the place. And that also might be bad for PR. Regardless, if people are allowed to make appointments for the main ER, they are going to come in all entitled and pissed off if their appointments get bumped for sicker patients, etc. Not to mention that people will come in for seasonal allergy nonsense - something I have about as much interest in seeing (given my EMERGENCY training, not primary care/allergist training)as putting a nail gun into my foot.
Basically, ERP, you're talking about creating a walk-in urgent care clinic in the ER.
Do you really think, in an atmosphere where dumbasses call 911 for lack of mcnuggets at McDonalds, use ambulances as glorified taxis, and go to the ER for jock itch, they are going to be satisfied with that?
ERP
I know Nurse K.Doesn't sound like you do.
Last Anon. I was being facecious about Nurse K being a selfish, overweight redneck.
Crackyliprof, I agree the people that call 911 for minor crap won't be the ones scheduling themselves for the urgent care area - unless they pay the scheduling fee upfront on the telephone. Then they can see my PA at their leisure.
In defense of Nurse K, I understand her job in triage, she has saved more lives working that box then most people could probably imagine. She has to burn through 10-20 slips an hour, sorting through the walk in patients and the EMS transports deemed not sick enough to need emergent care, trying NOT to miss the MI with subtle symptoms that might actually die or the leaking AAA that presents with back pain. Your Bacterial Meningitis is serious but you won't die in the waiting room. Kidney stones are one of the most painful patient complaints but you won't die from pain. She may be tough in that box but she's making sure there is no one out in the waiting room that may need immediate attention because she's socializing and making small talk for 20 minutes per patient while someones stroking out. I've seen it happen. I'd rather see a full waiting room of screened patients with reassessments being performed then triage being backed up. As a medic I personally don't mind wheeling a patient to a full waiting room because I know they have been screened, by me, and they don't go out unless I feel they are able to without jeopardy. I've had charge nurses say they want to put someone in the waiting room and if I disagree I'll get the attending as I work under their license not an RN's. If you think Nurse K doesn't care then you have never worked in Emergency Medicine. As far as these computer appointments in the ER, I think they are biased to the computer savvy boomer market that have a me, myself, and I personality inconvenienced with having a PCP with regular checkups and need to be seen by a doctor about their shoulder pain x1 month because they have time between the gym and dinner tonight and they had some time and dragging out the wait time for the 10 year old with a broken arm to get a proper splint and made some pain medication a little stronger then a Motrin. An ER is not a clinic period not matter how they get there. Emergencies happen fast and need to be treated faster everything else is just a trip to the ER clinic.
Nurse K, you seem to have an anonymous stalker. Honestly, folks, K may not be sugar coating her opinion, but she's right. If you or your loved one is facing a true emergency, do you want to risk waiting b/c seasonal allergy guy has an appointment? For that matter, do you want your BFF to be your nurse, or someone who can save your behind? As a floor nurse, I hear plenty of complaints about ER nurses. My response: relationships are my job - ER nurses need to focus on EMERGENCIES. Do you really want that line blurring any more than it already is?
ERP: Your solution is interesting. Since I don't work in the ER, I can't really judge how it would work, but it seems like it would serve a need.
If people think I'm an overweight redneck, I'll become more anonymous, so, yes, I'm an overweight redneck. Selfish too. YEEEEEEEEEEEEEEEEHAW!
PS I really hate it when my boss makes me herd cattle and clean her hunting rifles on my breaks. Total pain in the arse.
But, you still get to chew yur tobacky, so kwit yur moaning....
With a shotgun, rifle, and a 4 wheel drive, a redneck nurse can survive!
Some of you are so inured to the status quo that you're using its deficiencies as arguments in support of.
And so Nurse K has to triage 20 people an hour, meaning people with serious (but not life-threatening) problems have to languish in the waiting room.
Well, it's not Nurse K's fault, obviously. But let's stop defending or even glorifying the status-quo. And maybe stop and think what needs to change so that people can get their medical needs met expeditiously. Even those that won't kill them in the next hour.
I know most of you are ER people and are seriously put-upon. But take a step back once in awhile and see things from the patients' side.
Kidney stones are one of the most painful patient complaints but you won't die from pain.
If pain from a kidney stone does not constitute an emergency, heaven help us!
That is precisely the kind of "urgent" problem for which I would be extremely grateful to be able to make an appointment with the ER, so that I can at least lie down, scream, sit on the toilet, or whatever in the privacy of my own home rather than sitting for hours in the wait room, not knowing when I'll be seen.
By the way, not every city has urgent care clinics. The city of 100K in which I grew up does not have any. One of my relatives there chose not to go to the ER when she had a fever of 106 degrees (as low as she could get it at home), rather than go to the ER and wait in her misery. She would have been GLAD to have an appointment, so that she didn't have to sit in a chair for hours. It wouldn't have mattered to her if the wait time was the same, just being able to be in a bed turned out to be the deciding factor between going to the ER and not going with an urgent condition. She's lucky that it didn't become an emergent condition.
If you showed up to any ER in the world with a temp of 106 degrees after taking tylenol/ibuprofen, you'd hopefully be given a room almost immediately. See, you don't NEED an appointment to be seen quickly if you have a real emergency. You shouldn't wait at home for 3 or 4 hours; you'd get seen faster most places by just showing up. Let us decide how sick you are, hm?
Kidney stones, come on in! You might have to wait A LITTLE BIT though. Even if you have an obstruction/hydronephrosis, you won't DIE from it any time soon, and we know that, but we still feel badly for you.
If you showed up to any ER in the world with a temp of 106 degrees after taking tylenol/ibuprofen, you'd hopefully be given a room almost immediately. See, you don't NEED an appointment to be seen quickly if you have a real emergency.
So you are asserting that there aren't conditions more emergent than a temp of 106? Everyone else (GSW, MVA, MI, stabbing victim, etc.) gets to wait in the waiting room when the 106 person walks in with only one exam room open? Isn't is possible to have enough critical people that the 106 person would have to wait for a few hours?
She did live through it, BTW, so perhaps a high temp not really an emergency?
Kidney stones, come on in! You might have to wait A LITTLE BIT though.
Define "a little bit." You don't convince me that walking in for that with an undefined wait period is better than an appointment.
you won't DIE from it any time soon
Someone will be checking on me, right, and if I do get closer to dying, you'll move me up on the list, right?
we still feel badly for you.
I feel so much better about having to wait, knowing that you feel badly for me. The guaranteed appointment starts to lose ground in comparision, unless those nurses are also going to feel badly for me. Then I'm probably back to wanting the appointment.
I'm having trouble finding an example of something that I would want treated after hours for which I wouldn't prefer to make an appointment, unless I was not conscious. Then I wouldn't have any choice because I couldn't assert my will. But it is so much better to be in control than at the mercy of others to decide when I can be seen.
And there is something comforting about knowing that wait time WILL come to an end. You can't know that with an indefinite "wait until we decide you are the highest priority." An abulance could arrive every time you are 2nd on the list, bumping you down. There is no limit to how long that could go on. Psychologically, and especially when you are in pain or feeling very unwell, that is much harder to endure than knowing that the advance of time is bringing you closer to relief.
I realize my view is probably warped because I am not accounting for all of those people who go to the ER because they are bored, they need a pregnancy test, they sneezed, etc. I'm only thinking of my own situation. I try really hard not to need medical attention, but I can sure see the advantage of having an appointment for a genuine problem.
"Isn't is possible to have enough critical people that the 106 person would have to wait for a few hours?"
Ummmm NO!!!
"Someone will be checking on me, right, and if I do get closer to dying, you'll move me up on the list, right?"
CORRECT!!!
"I feel so much better about having to wait, knowing that you feel badly for me."
I dont "feel badly" for my PTs. Quite frankly its not my job to "feel badly" for anyone. Its my job to save your ass when you have a TRUE emergency. When you let feelings creep into your job in the ED you start to lose objectivity and that is always a bad thing.
Kidney stones will wait anywhere from 0-2.5 hours in my ER most days. It just depends. Not like continuous non-fake chest paineurs that wait 0-10 minutes no matter what's going on. A fever of 106 will probably get a bed in about the same time frame even if they're alert because, hey, don't want anyone seizing in my lobby, thanks.
This comment has been removed by the author.
“If pain from a kidney stone does not constitute an emergency, heaven help us!”
IT IS NOT AN EMERGENCY, An emergency is a situation which poses an immediate risk to health, life, Most emergencies require urgent intervention to prevent a worsening of the situation. There are very well defined criteria for emergency situations, they are even fast track courses that train health care providers to define the proper order of action, according to the CLINICAL CRITERIA of each patient, but an emergency can’t be the convenience of individuals, or can’t be defined by patients. Who will you see first someone with an airway obstruction (A) or someone with a pain from kidney stone (B)? If you choose B you will have one dead one alive if you choose (A) you will have two people alive, I guess its no difficult to understand is logic. It’s based on the ABCD triages what kill you first, if what get treated first, whether or not you like it, that’s based on science.
“I realize my view is probably warped because I am not accounting for all of those people who go to the ER because they are bored, they need a pregnancy test, they sneezed, etc. I'm only thinking of my own situation.”
Like every other patient around, you guys only think on their own situation, you are too selfish, yeah you want your kidney stone treated rather than hat guy nearly to die with the blockage in his airway, so what would think the guy with the sneeze think about your pain from kidney stone?. Patient definition of emergency: any medical condition that is mine is an urgent emergency SEEEEE MEEEEEE ASAP I don’t care if other dies, medical definition of emergency: see above.
Scapel under what grounds you encorauuge the use of an ER as an appointment place?
If you are suggeting making appointments in the ER you are overloading the hospital with more patients, and you are contracdicting the very purporse of it.
For those patients with minor symptons, discharge and send them to the PCP, if ED work like this we would decrease wait rates from 3 to 5 hours to just 30 min.
A kidney stone is an emergency. You don't get to decide what is or is not an emergency, fortunately, because you obviously have no clue.
This system is not "overloading the ER with patients." It is allowing patients with lesser emergencies to wait at home. They aren't cutting in line. If sicker patients come in at the same time as their "appointment" then the sicker patients will still be seen first.
If you don't like the service, then write an angry e-mail to your hospital's CEO and tell him you think it's a bad idea. Good luck with that.
A kidney stone isn’t an emergency in the strict meaning of the definition. Its given priority because of the pain it causes, but it is not a life treating situation, at least it includes renal failure. i would consider a biliar stone more priority on treatment than a kidney stone, cause treatment avoid the progress to an acute colecistitis.
Do people with acute pain should go to ER? Of course yes, but they should wait if something worse is treated. I have experienced kidney stones myself.
"You don't get to decide what is or is not an emergency, fortunately, because you obviously have no clue.
If health care providers can’t define what is an emergency or not, who else can? how do you do you to establish priorities then, I don’t reject patients on my ER, but I do a good physical examination and actually talk with them, to conclude whether or not is an emergency, but there are thing that obviously wont be emergencies just by a look, sometimes appearances might be misleading, I’m well aware of that.
At this point, Scalpel, given that my linked example of a satisfied customer was someone with "seasonal allergies" and a stuffy head and no time to be bothered with a clinic appointment, you're just making yourself look bad.
The last 3 shifts that I worked, not a single nurse in the ER even got a break. The boss had to order us pizza just to keep us from passing out on the job. This is no joke, either. No one was being a break martyr (defined as not taking a break just because they want to be able to complain about not taking a break)...we were saving life after life, tubing person after person. I was holding original and repeat EKGs up to the doc who was tubing someone going: Cath lab, right?
It's hard to convince me that someone with seasonal allergies has a "lesser emergency". They just have no patience for trivial discomfort, and lack of patience doth not an emergency make. If he wants to sit in the lobby (no TV, no magazines despite Happy's wife not being anywhere in sight) for 4-5 hours while we tube everyone in the entire F'in city to get his seasonal allergies looked at, great. Most insured, employed people who have responsibilities will not do this, however.
I would call a kidney stone an "impending emergency" since they could become septic if the urine is infected, or if there is a big calyceal rupture. I think they should be brought back before people with an appointment for seasonal allergies.
I think hiding behind an "anonymous" ID is being cowardly. If you're not man or woman enough to put your real ID, then your "opinions" degenerate to "rant" status. What are you afraid of? I don't respect anonymous comments, especially when they are abusive, insultive, and hinge on hysterical.
Party on, Nurse K---I hope I get you the next time I'm a patient in an ER.
Scalpel--you're a piece of work, heh...
I really think Nurse K should write for Grey's Anatomy or ER (if it were still on). She knows how to create, propagate, and exaggerate drama. For an ED that sees 45K a year, Nurse K's place must be one heck of a place because having worked for the last 15 years in a place that sees 80-90K a year, I don't think I've had as many intense days as she has.
Nurse K, you are burnt out. You belittle, dismiss, and disrespect not just patients, but everyone as anyone of us could end up as a patient. I appreciate skilled nurses who can tell a true emergency from an urgent, or even non-urgent, issue but I do NOT appreciate a nurse who believes that he/she has knowledge and skills superior to that of a board-certified, experience EM physician.
Nurse K, I am sure you will use this as fodder for further drivel but I must implore: Take a vacation. You sure as hell need it and maybe you can take a spelling course as well.
I noticed Nurse K screens her comments. I guess I can surmise that it is a result of self-selection that most of the comments on her blog support her.
"I would call a kidney stone an "impending emergency" since they could become septic if the urine is infected"
WOW!!! Well by that logic an infected toenail is an emergency too. It could cause pain and sepsis too. RIIIGHT
Anon
I guess you have never seen a 30 yo die due to overwhelming sepsis from a stone. Good for you. I wish I could say the same thing.
"I guess you have never seen a 30 yo die due to overwhelming sepsis from a stone. Good for you. I wish I could say the same thing."
No but saying a kidney stone constitutes an emergency because they could be in septic shock is ignorant. Last I checked things like, oh I dont know VITAL SIGNS/HISTORY/INITIAL ASSESSMENT, are done at triage. If you have a competent triage nurse the septic shocky PT will be brought straight back. So you can take your "kidney stone PT could be shocky" argument and shove it up your a$$.
From what I see most of these comments are from Nurse K in which case i found out that the K stands for Kabooki. The word Kabooki not only suits her as a name but also explains her state of being. If anyone needs a reminder or explanation on what Kabooki is please read my definition:
A Kabooki is a painful sore typically found in the groin during the advanced stages of Bubonic Plague, which will burst from slight pressure to discharge white or yellow pus with an extremely foul odor. Kabookis should only be lanced by medical professionals in special cases, because the vulnerable site will usually fall prey to parasitic infestation.
Example: Nursezilla wanted to popp Nurse K kabooki with a help of a scalpel but didn't- she would have been covered in squishy yellow shit that smelled like bleu cheese.
Nurse K a.k.a. Nurse Kabooki
Wow -- the anonymous hostility toward Nurse K is very interesting. My favorite is the anon poster who suggests that she should write for Grey's Anatomy. Seriously, people, if you can't outwit someone intellectually, start slinging mud. It's the only way to go.
And people wonder why I don't allow anonymous comments...
PS everyone knows that a symptomatic kidney stone is, absent any vital sign issues, an impending emergency or an urgent problem because there is no particular way to know if there is a blockage (that can cause a kidney infection or even kidney failure on the affected side) in need of a stent or lithotripsy.
And really, Nursezilla, "Kabooki?" Was that really your definition? Seriously?
http://www.urbandictionary.com/define.php?term=kabooki
I'm learning more about human nature here than I did studying psychology textbooks.
I stand by my comment that Nurse K should write for Grey's Anatomy.
And if she really does triage 20 patients per hour, then she is the only triage RN at her place and her place is only open 8-12 hours a day if they really have only 45K visits.
20 patients/hour x 12 hour shift x 200 days/year = 48000 patients triaged per year
OR
10 patients/hour x 12 hour shift x 300 days/year (more likely) = 36000 patients per year triaged by Nurse Kranky.
Gee whiz, no wonder why she has a God complex! The ED couldn't possibly function without her. I bet the whole hospital would shut down.
Please note the dripping sarcasm.
Re: "So you can take your "kidney stone PT could be shocky" argument and shove it up your a$$."
Good Lord I agree with Nurse K on something. You see genius that patient I alluded to DID SEE a urologist in clinic. No CT. Vitals signs stable. 6 hours later, septic then dead. Please don't tell me you actually practice ER medicine.
Dreamtree -there is only one "proper" definition of Kabooki.
You didn't possibly think i invented it did you?!(retorical question)
Laughing my ass off that you had to google it to see if its a real word.HAHAHAha!
Keep learning there is a lots of information outside of your little nursing JOB!
Nope, didn't think you invented it, but do think you copied the definition & example. And, I was right -- from urban dictionary.
I'll be the first to admit that I never heard of a kabooki and googled it. Hell, if you think that is funny, come to work with me (at my little nursing job) and watch me look up crap on my pda. Laugh a minute.
I like your username.
Dreamingtree-i think like you. You are honest and i find you amusing. I may just read your blog!
BTW Urban Dictionary rocks!Glad you found it
oh give me a home where the buffalo roam...
Scalpel, what a wacky bunch you got here. This is turning out to be almost as fun to read as Happy's cataract/magazine thread. But to your credit you have a real live stalker on yours...
"Anon: board-certified, experience (d) EM physician, I think you are a female, (sigh, unfortunately) which is extra creepy for Nurse K! You just are chasing her tail, aren't ya. If I am wrong and you are male, well then, I'd work on that tricky/bitchy affect.
-SCNS
Nothing beats the HH magazine thread, I'm sorry.
SCNS,
Why yes, I am a board-certifieD (dropped the 'd' in my earlier anonymous post) FEMALE EM doc but no, I am not Nurse K's stalker. Happily married with a couple of kids and surely far away from her (gladly). And why the "sigh, unfortunately" remark? If it's insinuating what I think it is, you need to re-evaluate what world you are living in.
So. Ms. EM, are you excited about the prospect of selling out your desire to treat emergency patients by encouraging insured patients with minor problems to make appointments for the ER? With your disdain for me and my logic, surely you are interested in practicing primary care medicine from the ER for not only the uninsured but the insured now too, right? The idea of already-overcrowded and understaffed ERs allowing for non-urgent clinic patients to bribe their way into immediate care over those with more serious conditions is your thing too?
Highly doubt you're an ER doc, but feel free to tell me why you think those who bribe should have access to emergency care in 15 minutes or their visit is free.
How easily you are rattled and angered. You find the need to throw your education down, like it's a weapon. Pretty sad weapon these days. If you spent more time coming into your own, you would be a great asset. 15 years out you should be hitting that calm that comes of knowing. I should not ever hear, "I do NOT appreciate a nurse who believes that he/she has knowledge and skills superior to that of a board-certified, experience EM physician." The respect you so want, ain't never gonna come your way.
-SCNS
Nurse K- that magazine needs it's own blog
Nursezilla- no posts on your blog yet?
dear fools: nursezilla doesn't really exist
It's funny when absolute beginners scold their future co-workers.
Anon 2:33-Nursezilla doesn't exist? Major buzzkill.(shuffling off dejectedly to look for reruns of House on the USA channel. . .)
That is funny isn't it. Just the RN part will be new for me... Oh and the co-worker part, hmmm that too.
-SCNS
I'm having difficulty with the part where the folks who signed up on-line are getting in ahead of those with more pressing conditions. Can someone point out where an article said this?
SCNS- Oh, I hadn't realized you were a doctor. Never mind, then.
No matter how beautiful or how trained the committed medical staff may be, the CEO who plans his cuts in order to survive the long wait for this concept to be solid, called the shots.
So marketing and the pretty building pull in a patient. He arrives in the dead of night clutching the chest and gasping for air. Thinking the doctor is just inside the door, he is greeted with less. Instead of the Board Certified ER Doc, he gets a nurse practitioner or an ER nurse.
Some of these care givers are awesome but this is not the BEST standard, this is the financial standard and it is not enough. WHO will and when will the 24 "ER" be held to the standards of staffing and quality of staffing. The patient has lost 20 minutes and though a physician has been called in from a few miles away, this man has now arrested.. dying. Someone call the Code Team...nope..not one..someone..call the Rapid Response Team with a Respiratory Tech..nope not one. Yes, now an ambulance is on the way and so is the physician-owner.
This patient has seen the marketing materials and the beautiful building with Red
Crosses on it. He and his family
were convinced that this was help..
this was survival in his desperate hour. Nope..business decisions, cut backs and thinning of the staffing herd due to poor reimbursements came home to roost.
The State did not step in and say..CLOSE YOUR DOORS..you failed the standard...you failed the patient..you failed his family, you have failed the profession.
These settings will NEVER have hospital financial depth for the hard times. The settings will never have the staffing depth to fall back on when times or tough.
There in a room is an infectious patient who has just started breathing the same air as visitors and other sick patients. There in the next room is a nursing home pt bristling with a colonized MRSA.
There in the next room is a child who is choking to death on a toy..who needs to be in an OR in minutes. Someone has had the audacity and the fear to walk in with a gunshot wound..thinking it might save his life. Maybe. but there is not a physician in the house.
Now who will pay for this ambulance that will take him to a real ER...if he makes it that far.
Come on friends..we are talking about money here. This has nothing to do with medicine. It has to do with bad overburden services in hospitals. The next discussion will be just how many children must die in these places before the who concept craters to hell!
Frank, Texas
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