Waiting Room Medicine

In response to a recent conversation with @Prof_Elemental regarding an engagement to perform at the upcoming Utopian Conference of Waiting Room Medicine, the Council executive have urged us to re-post the UCEM concept of Waiting Room Medicine to enhance global understanding…

With exponential Emergency Department over-crowding and spiraling waiting times, the Utopian College has produced a series of guidelines to assist fondling members. Ultimately, these Waiting Room guidelines will improve patient comfort and safety; facilitate early diagnosis and treatment (four minute rule) and expedite the global acceptance of Waiting Room Medicine.

Currently, non-Utopian waiting rooms often feel like cold ante-chambers to Hell with reefs of cigarette butts drifting under the non-smoking sign; agonizingly uncomfortable plastic chairs and strange clanking machines that intermittently spit out volcanic black fluid described as coffee, but tasting more like dilute tar.

The Utopian College Council Executive have delegated a task force implementation group sub-committee on Utopian Waiting Room Design. This sub-committee will report to the chief working party liaison group of the Utopian Medicine WorkFlow, which in turn reports to the steering committee of the UberGroups. This should create enough bureaucracy and red-tape to ensure that no suggested implementations in Waiting Room design will ever pass through the bowels of the financial re-design working group or cross the threshold of the ‘almost there‘ implementation committee.

Utopian College Letterhead

The first draft of the Utopian Waiting Room redesign for the Waiting Room Medicine working party has been published online as a 3D walk-through at and is now available for discussion.

Five discrete areas have been incorporated in the first draft of the Utopian design and are outlined below. Additional areas will include Waiting Room Gynecology, Patients without discernible pathology and an area to asses patients for signs of imminent admission

Feedback in the form of comments, and additional acronyms to be included will be taken into consideration and duly ignored for the second stage of the planning and implementation process. This second stage will co-incide with the inaugural Utopian Medicine Conference scheduled to be held on February 29th 2011 in Molvania (details to be announced later this year). The final Waiting Room design will be published in the Journal of Irreproducible Results.

Strategic Areas for Waiting Room Redesign

Utopian Waiting Room

Coronary Chair Unit (CCU)

  • Monitored chairs are placed in close approximation to, and in sight of, the Triage desk.
  • All patients are fitted with defibrillation paddles on arrival and sat around the central defibrillation station.
  • Patients then hold hands to create a ‘series‘ electrical circuit between the group.
  • If a patient develops a shockable rhythm, the circuit is broken and a series of ILCOR derived shocks will be generated to all patients in the circuit.
  • Patients deemed to be at risk of imminent collapse should be transferred to the ICU

Our organized approach to triage and waiting room evaluation for stable chest pain patients was safe and efficient. Although waiting room evaluation is not ideal, it may be a feasible contingency strategy for periods when ED crowding compromises access to the main department and the use of monitored chairs is required [Reference]

Imminent Collapse Unit (ICU)

  • Situated immediately adjacent to the CCU and directly in front of the Triage window
  • A central clearing of 4m x 4m is covered with strategically placed pillows, blankets and carpeted tiles
  • Triage will be alerted to ICU patients by observing the high-stepping gait of patrons within the queuing community
  • ICU patient management options are outlined in the UCEM Resuscitation Guidelines V1.07

Geriatric Observation, Mobility and Early Rehabilitation Unit (GOMER)

  • The GOMER area includes three discrete units
  • The first area comprises exercise bikes, treadmills and a selection of ambulatory devices.
    • Gerontologically challenged patients physically capable of moving towards the light are encouraged to choose an appropriate walking aid, and then directed towards the soft-fall area.
  • A second area comprising a ‘Hamster wheel’ of doors is used to contain wandering patients without compromising already diluted staff time.
    • The Wanderer Containment Unit (WCU) comprises 8-10 doors which open onto each other in a circular arrangement.
    • This allows any wanderers to happily amble in circles for hours without the risk of getting out in to the road or becoming lost in the building.
    • The door in and out of the hamster wheel should be lockable and occasionally observed by the triage staff.
  • The Happy Knitter Distraction Unit.

Time-distraction therapy can be employed to usefully disengage patients from their environment, disorientate them with respect to time (length of stay) AND afford the opportunity to increase the GDP of the department (Granny Dumping Productivity) by selling the beautiful creations at the TRIAGE shop

Patient Subduement area (PSA)

  • The high walled, sound-proofed section of the waiting room – situated well away from the triage area
  • Padded chairs, diodotic turnstile entry, soft-tiles, ambient music and lighting are the mainstay of this area
  • For subsequent assessment after subduement please refer to the Psychiatric admission guidelines

Rarely Assessed or Monitored Patients (RAMP)

  • Expandable area (depending upon local policy)
  • Comfy seating and refreshments provided for attending ambulance officers; uncomfortable, inappropriately elevated trolleys provided for attending patients

TRIAGE

  • The TRIAGE area is divided into sections determined largely by the general patient demographic and ability of staff to make up nonsensical acronyms
  • In this prototype the College have defined consecutive streams of TRIAGE
    • Tearful Relatives Inquiring About Getting Examined
    • Totally Random Investigation And Granny Emporium

This area provides the ability to

Waiting Room Medicine References:

  • Scheuermeyer FX, Christenson J, Innes G, Boychuk B, Yu E, Grafstein E. Safety of Assessment of Patients With Potential Ischemic Chest Pain in an Emergency Department Waiting Room: A Prospective Comparative Cohort Study.
  • Ann Emerg Med. 2010 May 23. [Reference]
  • Pines JM, Pollack CV Jr, Diercks DB, Chang AM, Shofer FS, Hollander JE. The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Acad Emerg Med. 2009 Jul;16(7):617-25. Epub 2009 Jun 22. [Reference]
  • Handel DA, Fu R, Daya M, York J, Larson E, John McConnell K. The use of scripting at triage and its impact on elopements. Acad Emerg Med. 2010 May;17(5):495-500. [Reference]
  • Pines JM, Shofer FS, Isserman JA, Abbuhl SB, Mills AM. The effect of emergency department crowding on analgesia in patients with back pain in two hospitals. Acad Emerg Med. 2010 Mar;17(3):276-83. [Reference]
  • Russ S, Jones I, Aronsky D, Dittus RS, Slovis CM. Placing physician orders at triage: the effect on length of stay. Ann Emerg Med. 2010 Jul;56(1):27-33. Epub 2010 Mar 16. [Reference]

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Comments

  1. says

    What is TRIAGE? (Terribly sorry about this, folks. Couldn’t help myself.)

    Timely Refusal of Inappropriate Admissions Gracefully Executed
    Terrible Rants of Inebriated A**holes Gleefully Ended
    Tough Relatives’ Irritations Allayed by Glycerine Enema
    Trying Religiously to Ignore Amorous Geriatric Eve-teasers
    Tension Released In Appropriately Grandiose Expletives
    Trauma? Rest, Ice And Gin. Exit!

    bb

  2. Paul Jones says

    So funny.
    Recently was noticed that discharged patient would linger on our minor assessment area because it had a TV playing live coverage of the recent Royal visit for Will and Kate to Canada.
    Strategy to improve ED wait times and overcrowding…turn off the TV or play something really terrible to make people want to leave.

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