First in line doesn’t always mean first, at least when it comes to hospitals, where emergency rooms average nearly 180 patients per day.
“People think it’s a first come first serve basis here,” said Veronica Hopster, manager of West Georgia Health’s Emergency Department.
Instead of being seen by a doctor or nurse in the order patients are checked in, they are seen based on the level of severity and of their condition, which may cause those with less life-threatening emergencies to wait for a period of time.
Patient check-in or registration is the first and quickest process for patients in the Emergency Department, and takes approximately 90 seconds. Patients only give their name, date of birth and complaint to the patient access representative, then sign a paper to consent for treatment and a photo is taken for verification, a fairly new process at the Emergency Department to prevent fraudulent services. No insurance information is requested at registration.
“We want to make sure the public knows that because some people feel like “they didn’t treat me like they should have because I didn’t have insurance,’” Hopster said. “We used to ask for that up front but we want to do what’s beneficial to you. What you want is to be back here for doctors to take care of you.”
After registration, the Emergency Department staff strives to have patients seen by the “triage nurse” within 20 minutes. From there, the nurse then uses a Triage ESI (Emergency Service Index) and an assessment of the patient’s vital signs, medical history, age and risk factors to determine if the patient is in immediate need for care or if they can wait a bit longer.
“Sometimes it’s almost like being in a battlefield, when you’ve got 30 victims that come at you at one time, and you’ve got to decide which ones can wait 15 minutes and which ones can’t wait at all,” said Hopster.
The Triage ESI shows that level one patients have an urgent condition that can’t wait at all on down to level four and five patients who could range anywhere from someone wanting a STD test to someone needing a prescription for pain medicines or antibiotics, said Hopster.
“Level one means need treatment now, five means ‘I’m sorry but you’re going to have to wait until everyone else is seen before you come back,” she said.
The Emergency Department set a goal to have lower level patients from the nurse triage to a rooms called the “Fast Track” to be tested and treated by a nurse practitioner within 45 minutes. The practitioner then performs testing and X-Rays, but a doctor can see these patients upon doctor or patient request. The most time consuming aspect of the Emergency Department process is awaiting results from lab specimens and X-Rays, which usually takes about 45 minutes.
Those with higher level factors are taken to rooms immediately upon availability to be seen by one of the two Emergency Department doctors. If the ER is overflowing with higher level patients, the goal wait time for a patient in a room waiting to see the doctor could surpass the goal time of 30 minutes. Wait times to see the doctor after being assessed by a nurse on Sunday and Monday this week showed that patients waited an average of 39 minutes in a room to be seen.
“Another thing people don’t understand is that if that ER doctor is tied up with someone, maybe having a heart attack, he may be in the room for 30-45 minutes, which means if he’s by himself no one can be seen until that patient is stabilized,” said Hopster.
After the ER doctor and nurses have treated their patients, registration representatives then gets the insurance information from the patient.
In addition to the general walk-in ER entrance, a separate entrance for those transported by AMR is handled in a somewhat similar process.
Though those being emergency transported to the hospital, Hopster said those with non-level 1 conditions will still be escorted to the front registration desk.
Though WGH does not have a trauma center for extreme emergencies such as a severe car crash or shooting victim, the Emergency Department doctors are board certified in emergency medicine and have all trained at a major trauma center. The nursing staff trains in trauma as well.
“Even though we’re not a trauma center, we still get trauma,” said Hopster “If the weather is to bad to fly patients to a (Columbus or Atlanta) hospital, they’re coming here. If they’re too unstable to transport or to make it to those hospitals, they’re gonna make it here.”
Those patients are taken to WGH to be stabilized until they can be taken another hospital.
“LaGrange is such convenient location,” said Rogers. “We’re right here with the best of the best. The staff that’s here keeping them stable is just as important as getting them to the trauma center.”
Rogers and Hopster agreed that the teamwork among the nurse team and doctor helps them to reach their goals of getting patients in and out of the Emergency Department as quickly as possible.
Emergency medicine Dr. Rao Subhod also said the nursing team at WGH is a major help and factor of the timeliness of patient care in the Emergency Department compared to other hospitals he has worked in.
“This is a well run ER and the nursing staff is amazing,” he said. “We’re always looking to get them in and out. The patients are spoiled here. Typical wait time in other Emergency Departments is sometimes four hours. Here after 90 minutes to two hours patients are either admitted to a bed upstairs or are discharged from the hospital. Of course there are some days we have bad days when the hospitals are full and we can’t get everyone in and out, but 25 out of 30 days it’s fast.”
Like most of the staff in the Emergency Department, Subhod said his job gratifying.
“I like the fast pace and action,” he said. “The ER is like instant gratification. The patient can come in with anything, but right away you have everything at your disposal and in a couple of hours, you know what’s wrong with the patient and you can admit them or send them home.”
Hopster referred to the staff as “adrenaline junkies.”
“They like not knowing whats coming next,” she said. “It’s a controlled chaos and we like not knowing what’s coming in next. When you save that one life and you look back on it, it makes it all worth it. Anything even something small, the one life that you saved is worth it. Or even those in severe pain and you help them and relieve their pain. It’s definitely worth it.”