The Trouble With ER

6:58 AM

I refer to the following article in The Star.

Waiting for 12 hours at the ER
It is most unfortunate for his mother to have waited for 12 hours at the emergency department. During my stint at ED, I had a few patients who had to wait at the ED for more than two shifts...slightly more than 14 hours. I guess at Hospital Serdang, it is seldom as busy as on the night the columnist brought his mother to the hospital. In the place I used to work, it was ALWAYS a mad house. Sometimes, there aren't even enough seats to sit on....katil apatah lagi!

Being an ED MO can be tough mentally, physically and emotionally. Others may say

"You only work for 7 to 10 hours a day mah, where got tired like work in ward"

"You don't have to go into OT, see patients at clinic etc...that one also tired ah?!"

By the time patient are referred to them DIAGNOSIS has been made. ED MO have ruled out most of the stuff for them. But not all MOs are this cocky.
I have seen two MOs that have changed from being a cocky MO and being more humble after they were pushed to become ED MO. From...

" Come on la, that one also cannot manage and want to refer to me"

" Eh MOFrust, need your opinion la. Fracture like this need to refer ah? "

When patients complain of sloppy service, the first name tag they will see and quote will be the staff at ED.

When patients have to wait in ED before admission, the staff at ED will be the ones that will be scolded even though the ones arranging the beds are upstairs in the ward.

Blood results not ready in 1 hour, it's ED staff fault even though the machine in the lab broke down.

What has all this got to do with waiting 12 hours in ER?
Despite all the efforts of attending to the needs of patients and their relatives in ER, there will ALWAYS be room for improvement. It is true we should strive to achieve the same level of care as private hospitals. But most of the time, resources are scarce. The place I used to work at was one of busiest hospitals in Malaysia but we had only TWO functional ECG machines which had to be divided among 3 zones. There are a few other machines but it usually breaks down. MOs, nurses and MAs worked to the max but every time a request is made for additional staff, we are always declined.
In this case of 12 hours in ER, I think the staff that day were stretching their resources. What might have happened is relatively stable cases were not referred as quickly as priority was given to more critical ones.

To my colleagues at HOSPITAL FRUST (you know who you are) I salute you. I feel your pain. You have given your best...and MOFrust supports you. I dedicate this song to you....

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  1. To the frontliners, kudos to you guys. Keep up the good work.

  2. In ED, MO most of the time have to be humble. My senior ED MO had once said that being an ED MO is like a salesman, where you have to "sell" your patient's story so that the respective dept MO "buy" your story and pt and admits them. There are many possible reasons for the delay, and it is not entirely ED's fault but as you say, the first name tag seen is the first casualty. Most of the time, the patients are attended almsot immediately esp in yellow and red zone, but it is usually the subsequent follow up where everything could screw up:

    1. Blood samples not sent to lab quickly. Some PPK's are great, but there are also some who would rather hide around playing their iPad/tablets/iPhone5 or smoke around, making very few PPK available to help send blood. True, emergency blood are sent immediately by HO's, but on a busy day, everyone is forgiven as we have more urgent matters to tend to.

    2. Slow turnaround time in lab. Forget those non emergency blood. Some lab technicians esp the males tend to slack off and ignore you even if you go asking for help in front of them for emergency cases' blood samples. You can hear the keyboard typing or listening to radio but they would just ignore you esp at night when they are alone with God or perhaps a whispering demon beside them. The delay can be up to 2-3 hours before they move their ass to run the test which can take another 1-2 hours (When some good technicians can do it under 20 minutes). Whats best is some hospitals who had to run ABG in labs and they allow it to sit til its clotted before rejecting them. What's best are those computerised system when they reject a plain tube blood sample as "Sampel beku" or a EDTA tube with 3 cc blood as "sampel tidak mencukupi" and you;'r back to square one to retake the blood.

    3. Stupid dept MO's who refused blood investiagtions from other hospitals even if its fresh barely an hour or two ago. Repeat all blood samples and inform them again after that so that they could get another 2-3 hours of sleep. Or the surgical MO who refuses to see a case of clear cut acute pancreatitis because the serum amylase was 3000+ compared to 3 days ago prior to discharge from surgical ward for acute cholelithiasis, claiming that the serum level was not significant acting ala pseudoconsultant with an empty brain. Or the medical MO who refuses to accept a case of young male with AEBA 2' bronchial asthma with poor oxygenation SPO2 93% and aBG showed the same SPo2 with PaO2 55 despite started on oxygen therapy and nebulization. She even refuses to see the case and asked ED to repeat abg 3 times because the results were still showing low PaO2! Such irritating prick MO should be sent back to medical school to learn their clinical skills or fired from their the medical fraternity. Of course, there are also cases where ED in certain hospital in Klang Valley who sends pt with DKA up to ward without IV drip or sliding scale insulin because it is their "policy" and doing lots of funky business, so it is up to individual actually.

    4. And then for admission. Nurses in ward have to arrange beds. It may take ages. Esp during passover period. The golden period where nobody can touch them when they are pasisng over patients' They won't even attend to patient's needs or even send a female pt with an almost flat CTG to OT for EMLSCS, what else patient admission. "dr, takde katil lagi la, tunggulah. This can wait on average 1 -2 hours and the worst was 8-10 ward on a packed day. Of course, not to include the PPK again to send patient which will take some time again.

    Overall, a hitch in all factors can really bring it past the 12 hour mark easily. Been there done that.

  3. waited for more than 7 hours, earlier diagnose with this 'kencing tikus', went to hospital and wait and wait and wait...

    then, doc confirm dengue (with cirit birit, stomach pain, demam), admit to class 3 ward, treated like a human, young doc cucuk 2-3 times nk amik darah tp x kuar2 darah...



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