The Overcrowded Trauma Center
A few years ago, a community hospital in a New York suburb had completed construction of a new state-of-the-art emergency suite that the city had awarded a Level I Trauma Center designation. This coveted assignment meant that the 911-system ambulances would bring all trauma cases within a certain catchment area. This would translate to nice increases in hospital revenue. The opening day ceremony went off with the usual fanfare, starting with an array of speeches by politicians, followed by the mayor's ribbon cutting. The CEO gave his usual recitation about human service and saving lives.
Soon thereafter, it became obvious that this new emergency department was defective in its design in that it was too small to meet the needs of the community. The area became so overcrowded that the management decided to "double-bunk" the patient cubicles. That meant putting two stretchers in a space the architects had designed for one. At times, the patients remained on the ambulance gurneys lined up in the corridor with the paramedics waiting more than an hour for an available emergency room bed. It was like watching the landed airplanes at LaGuardia Airport waiting on the tarmac for an open terminal. The walk-in patients had to wait ninety minutes just to see the triage nurse and nine hours for a doctor unless the nurse thought the patient might die in the waiting room. In those cases, the triage nurse would walk the patient into the main treatment area to be seated in a chair in front of the nurses' station. These poor souls usually waited two to three hours for a stretcher, and that was because the nurse considered them a high priority. One such patient, a seventy-three-year-old man, collapsed from his chair and had to be treated while lying on the floor for a few minutes because there was no place to put him until a stretcher appeared from the x-ray corridor (the patient in x-ray was probably wondering what happened to her stretcher).
This situation continued for about fourteen months, until there were so many complaints to the mayor's office that the mayor gave the CEO an ultimatum to fix the situation. The nursing director hired me to survey the emergency department and come up with some recommendations. I joined a committee of doctors, nurses, paramedics, and community leaders. We resolved most of the problems within two months. It was simply a matter of changing the mind-set of the professional staff, speeding up the process of making beds available on the floors, and decreasing the four-hour turnaround time for emergency room laboratory tests. We also stopped the practice of keeping admitted patients in the emergency department for diagnostic tests that doctors could perform in other areas and made a few other adjustments in handling the patient flow. The emergency department continued to have crowding problems, but it became tolerable. The point of this scenario is that these changes would not have taken place without community activism causing a barrage of complaints that triggered off a political backlash.
In brief, this story embodies the theory that the public's blind trust in the current corporate culture of hospital management is unjustifiable. How many people would be willing to fly if the airline industry reported 100,000 passenger deaths and 300,000 catastrophic injuries each year due to negligence or structural design defects? How long would you tolerate such performance?