Our emergency department was very busy recently. The hospital was full and we were holding patients. Three had been in the ER many hours; one waiting for a bed for six hours, another eight hours, and still one more for eleven hours. Of course, ambulance traffic hadn’t stopped and the waiting room was full, with patients waiting too long to be seen. (And we all know that the media loves to highlight bad outcomes from the ER waiting room!)

Administration set up a ‘command post’ to try to arrange beds, discharges and moves. At one point I asked one of our administrators to move those waiting the longest to hallway beds up on the patient floors. He told me that he couldn’t because each of the two floors in question already had one patient in the hall. And besides, it would violate the patients’ privacy and make it too difficult for the nurses to do their admissions assessments.

I pointed out, ‘our nurses do assessments in the hall, our patients don’t have privacy and sometimes we have to work with seven or eight patients in the hallway!’

He replied, ‘yes Dr. Leap, I know, but I won’t move anyone else to the hall upstairs. I just won’t.’ I asked why. With a slight sense of obvious discomfort he replied, ‘because there is a different standard. When patients leave the ER, they expect to go to a better place.’

I was honestly dumbfounded.  He’s a nice man, a good man, who is generally on our side.  I like him, so I can only assume that he has to repeat a kind of administrative party line.  Still, it’s a sad admission and reflective of a dangerous underlying mentality.

The ER staff can work in crowded conditions, the ER patients can be treated in overwhelming conditions. The ER waiting room can just stagnate. Because that’s just how it’s expected to be.

But let someone die from delay of care, let an adverse outcome occur, let a psychiatric patient escape, and all the hand-wringing begins over new policies, new programs, new checklists for safety.

Policies aside, however, nothing can change if nothing is expected to change.


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