Waiting to Be Seen2017-02-03T11:37:52+00:00

Waiting to Be Seen: Where EM Policy Meets Practice is an EM Cases blog series, authored by Dr. Howard Ovens, a veteran Emergency Department Director, whose main purpose is to share ideas and generate discussion on the role that public policy and administrative practices play in creating the conditions that help front line emergency providers achieve better patient outcomes. You can contact Dr. Ovens at [email protected] and follow him on Twitter at @HowardOvens.

WTBS 15 Planning to Fail: Why Warning Patients to Stay Away from the ED Will Never Work

It’s been another trying flu season in the northern hemisphere—for patients and for emergency department (ED) providers. EDs that are crowded at the best of times come close to a tipping point, waits to be seen and for beds climb, and hospitals struggle to handle the load, sometimes coping by putting patients in hallways or lounges. Even well-written surge plans fall apart in the face of staff illness or unit outbreaks. Too often when trying to help the system cope, a hospital, health region, or government puts out a call for the public to stay away from crowded EDs unless absolutely necessary—but are such warnings ethical or effective?

WTBS 14 Improving Patient Flow in the ED: 7 Strategies for Nurses

It is both an evidence-based truth and almost a mantra of emergency department (ED) providers and leaders that the major cause of ED overcrowding is boarded patients. Yet 10 years of experience in more than 70 EDs has shown that impressive flow gains can be achieved despite a poor flow of admitted patients out of the ED. While I have always been and continue to be an advocate for improved admission processes and better ED resources, these issues should never excuse us from exploring our own role in improving flow in our departments. Fostering a culture in which all staff are committed to improving care through better flow will trump petty concerns about hierarchies and role descriptions—and it will improve morale.

WTBS 13 Transgender Patients: How to Foster a Safer Emergency Department Environment

In this EM cases Waiting to Be Seen blog we discuss how to make Emergency Departments safe places for transgender patients to access care that is informed and non-judgmental. A big part of our job is to advocate for our patients. Dr. Nadia Primiani helps us understand where some of our most vulnerable populations are coming from and aims to improve our familiarity and comfort with issues around gender to improve care...

WTBS 12 – Introducing EM Cases Conflict of Interest Policy

Whenever discussions about conflict of interest (COI) come up, one of the first questions that’s inevitably raised is why are we focusing only on financial conflicts and ignoring all the other kinds. That’s a fair question. What about intellectual conflicts or ones based on political leanings? Why are we implementing a COI policy? Is it really necessary? I thought it best to answer that question by having COI expert Joel Lexchin express his thoughts on this subject for us in this month’s guest post to Waiting to be Seen...

WTBS 11 – Keeping Score: Providing Physician Feedback

What does the evidence say about the true utility of physician performance feedback and scorecards? Do they meet a real need for information to guide self-improvement or just scratch our competitive itches? What do we know about the best way to provide feedback? In this month’s guest blog Dr. Amy Cheng, the Emergency Department Director of Quality Improvement at St. Michael’s Hospital in Toronto with an interest in physician performance feedback, reviews what’s known and comments on her own experiences...

WTBS 10 – EM Quality Assurance Part 2: Individual Responsibilities

Last month in introducing part one of our guest blog on quality assurance I told a story about a missed opportunity with follow-up care. This month I’d like to share a story with a happier ending. Recently, a patient presented at our emergency department (ED) with a non-specific fever. After discharge the patient’s blood cultures were reported positive, but attempts to reach this person over the ensuing 36 hours at the contact numbers provided were unsuccessful. An enterprising colleague googled the patient and found contact information online that eventually led to a call to the patient in a hotel room in another city, but when reached the patient was ill and confused...