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Horror in the ED

My exuberant five-year-old son and I are no strangers to an emergency room. One night Max developed a cough and was having trouble breathing. So I bundled him up and headed off to the nearest hospital. I assumed it was the croup it’s a chronic problem for him, but I wanted to be sure, and was hoping the doctors would be able to do something to help him catch his breath. To my relief, there was no one else waiting and we were led back into an examination room almost immediately. The nurse was pleasant as she took Max’s vitals and then we sat behind a curtain to wait. On the other side, I heard a brief exchange between the nurse and the person I presumed to be a doctor. He rushed in with no introduction; ripped up the back of Max’s shirt; listened to Max’s breathing and then rushed out. He handled Max roughly and never made eye contact with me. My kid is a rough and tumble sort of guy and not much phases him, but I was appalled. I wanted to comment and ask for feedback on Max’s condition. But instead, we listened to the nurse’s personal telephone conversation on the other side of the curtain. Every time I tried to get her attention, she averted her eyes.

After an hour with no communication of Max’s status, with his breathing getting significantly worse, I was forced to interrupt her and ask for assistance. A ventilator was placed over Max’s mouth by a person I had not noticed earlier. She seemed like she could have been an EMT, fresh off an ambulance based on her appearance and dress, but she did not introduce herself either. She just rushed in and made a comment about getting his breathing a little more regular and rushed off again. I wanted to know what kind of medication was being administered through the mask, but when I peeked my head out, I saw no one.

We sat there for another hour with no further communication, while Max’s breathing improved and he got more and more hyper from all the sitting and waiting. Finally at 2am the doctor reappeared and said, “Well it’s just the croup and his breathing is much better so I am going to discharge him”. I asked if he should have some steroids or a nebulizer – two items frequently prescribed in the past – and he told me no. The nurse, who had also finally reappeared at this time, asked the doctor if he was sure. Then I chimed in with a comment that Max is a chronic sufferer and those two items have helped him in the past. He told us both to stop overreacting and to get Max home.

So I left. Frustrated and exhausted and angry, four hours after we had arrived.

I wish my personal story was the exception to the rule, but I hear ED horror stories all the time. Many are much worse than the one I just described. Could this have been prevented? Definitely.

It starts with compassion. And if you don’t have it in ALL of your clinical staff, then you may need to find it elsewhere. Check out this study about the amazingly significant impact compassionate non-clinical workers can make on your ED satisfaction scores. Let me know if you have any questions or would like some more information.

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