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October 2015
How to be 'people-centred' in the emergency department
Oct 22, 2015 2:00 PM

My husband was experiencing a painful sore throat though only on one side, and he did not have a fever. He gargled with salt water, yet 2 days later it was worse, causing much pain when he swallowed. We headed to a walk-in clinic as our family doctor is a 35-40 minute drive each way. From experience we know he cannot see us the same day. We arrived at the walk-in clinic around 9:30 am. Our wait was approximately one hour, the waiting area was very clean and staff was courteous. The doctor saw my husband, discussed his symptoms and took a swab of his throat for testing. He said it would take 24 hours for the results to come back. The doctor said the clinic would call him if they discovered something that needed treatment. He also advised us that recently some of his patients had been diagnosed with strep throat, and there was a virus circulating that caused symptoms that mirrored those of my husband.

July 1st, my husband woke at 5:30 am saying that his pain was even worse and asked if I could take him to the local hospital emergency department (ED). We arrived at the hospital parking lot around 6:30 am. It was our first visit to this hospital, as we recently moved to the area. We parked and headed to the ED entry at which time we began hearing from a loud speaker a voice welcoming us to the department. It then went on to advise us that staff were entitled to respect, and to use a mask provided just inside the revolving door; the message was on an endless loop.
 
Here's my suggestion: A live person’s voice recording would lend a “human” dimension to this communication.
 
The outside glass on either side of the revolving door as well as the revolving door, was dirty, finger marked and had a number of hand-made posters, poorly written/scrawled, hanging lop-sided, so one had to bend one’s neck to read them.
 
Here's my suggestion: Where are the environmental/maintenance folks? Cleanliness from the entry way to everywhere inside inspires confidence in patients, not to mention more respect. With computers and all types of materials to make signs and posters, the way in which patients are greeted with upon entry makes an impression.
 
Immediately inside, we took and put on the masks provided. There were a collection of wheelchairs scattered about this area, around which we had to navigate in search of the Triage Desk.
 
Here's my suggestion: having wheelchairs organized in a space away from patient traffic would pose less of a navigation hazard. A poorly hand-made sign pointed to the right, which we followed, then came upon a room on the right side which was the waiting room for Triage. No one was in the waiting room nor was anyone sitting at the Triage desk. If triage staff must be away from desk, please leave a sign advising walk-ins where to find a staff member; what if I could not have left my husband to look for someone? I told my husband to sit in the waiting room and I would go and find someone to help us. A minute or so later I saw a hospital staff member and advised her that we had just arrived and no one was at Triage. She said “go and wait in the waiting area and someone will come.”
 
Here's my suggestion: An apology, or saying something comforting like, “let me get the Triage staff for you right away" would have been appreciated. We sat. A couple of minutes later the Triage person arrived and took a seat behind the desk without looking at us. She then looked up, saw us and called out “next” for my husband to come to her desk.
 
Here's my suggestion: An acknowledgement by the Triage member was called for here; instead I perceived we interrupted something she was doing and we were an interference in her job. My husband and I both approached the Triage person sitting behind the desk, which was behind a glass panel that had a small circular opening in it. There was one dirty looking, black plastic chair in front of the Triage area for the patient.
 
Here are my suggestions: Wouldn’t it be nice to have a clean chair in a hospital. and nicer still, if the person accompanying the patient had a chair to sit on? This would make it easier for caregivers to converse with Triage if the patient needed help answering questions or providing information. Instead, that person, the patient’s wife in this case, had to bend down to speak through the opening and stay that way to hear the questions and provide information to assist the patient. My back and knees hurt after a while in a stooped position. The Triage person was expressionless and took my husband’s medical information without looking up from her computer.
 
I’m sure there was no malicious intent on the part of the Triage person; her behaviour however, loudly communicated she was unaware of the fact that two human beings were in front of her: a patient in much pain, unable to concentrate on providing her information she required to complete her job, and another person who was worried about her husband and also experiencing pain as a result of bending down to talk with Triage. Her people skills were nonexistent.
 
With the information taken and without looking up at us, she told us to “go down the hall to another waiting area, give this (materials) to the nurse at the station, and your husband’s name will be called.” Again, she could have used people skills saying something to the effect of, “thank you for your information, I’m giving you this paperwork which you will give to the nurse at the station in a seating area, just down the hall to your left. There you’ll wait for the doctor to see you."
 
Three people were waiting in this second area. Signs were posted all around us, advising that patients would be seen in order of priority, and to be respectful of staff or one could be asked to leave.
 
Here's my suggestion: Perhaps the signs could have been more people-oriented, instead of intimidating.
 
After an hour and a half my husband’s name was called and someone directed us by pointing the general direction to another wait area, there a doctor would see him. We waited there about one hour. The doctor was a welcomed relief - pleasant, the first staff member we’d met since arriving that seemed human, and he was the fourth staff person with whom we interacted. After interviewing my husband, the doctor advised they would do blood work and accompanied us to where to wait for a technician. (Great people skills.) We waited another hour, then the technician called my husband’s name. Blood taken, I asked the technician “approximately” about the wait time for results and was advised approximately one hour.
 
Here's my suggestion: The technician did not advise us how long the results would take, I had to ask him. He could have been more people-oriented as he's a medical professional and knows roughly how long these procedures typically take. We were sent back to the second waiting room to wait until my husband’s name was called over the loud speaker.
 
After about two hours, I approached a desk where three people were seated behind glass. As I approached, a young man stood up, not because he saw me coming, but to stand while he talked on the phone.
 
Here's my suggestion: His appearance was intimidating, as he was quite dishevelled – I didn’t want to talk to him but we were exhausted waiting. Once his phone call ended he looked at me expressionless and wordless. Intimidated by his appearance, eye contact and demeanor, I said as gently as I could “excuse me, my husband had blood work two hours ago and the technician said that it would take approximately one hour for the results. We’ve been here two hours and we haven’t heard his named called."
 
Assuming I was a terrific burden in his day, I adopted a more submissive, hesitant approach and said “excuse me, we were advised to wait but I’m wondering if we have been sitting in the wrong wait area and maybe missed hearing my husband’s name. The young man, expressionless, hardly looking at me, asked “what’s the name?” He entered my husband’s name into his computer from a standing position, muttered something, without looking at me, about results being back. He made a call and said to whomever picked up that my husband's results are back, and he’s waiting for results. The young man was in the middle of telling me to sit down and wait when my husband’s name was called over the PA.
 
In conclusion, we are never coming back to this ED, I don’t care how far we have to go. We headed back to the same area where we had seen the nicest person we encountered, the doctor, and sat to wait. Approximately 40 minutes later the doctor arrived to speak to us where we were seated. He said the blood results were fine, and if the sore throat persisted that he should gargle with salt water. We thanked him and left.
 
Checking the time expended in this visit to ED, it was 1:00 pm.- it had been six and a half hours since we first arrived. We paid the exorbitant parking fee and left. We should have called Telehealth Ontario and asked them to call all ED's to inquire to the shortest ED wait time. I have called Telehealth four times in the past and they have always told me to go to ED.
 
Here's my suggestion: Maybe patients and family caregivers should call the ED (or check on-line) to see what the average wait is before going to any ED, or perhaps walk-in clinics could remain open 24 hours a day.
 
I once burned my leg inside my thigh with a cup of boiling water. I was wearing corduroy slacks at the time and the burn was painful and severe; however, I refused to go to ED because of long wait times. Instead I treated myself at home and went to a walk-in clinic two days later when a blister had formed.... the wait time was an hour.
 
Follow-up from visiting our family doctor
This happened on July 3rd. Our family doctor can rarely see us the same day. We like him a lot and never will move or give him up for anything. He’s younger than we are, so we're hopeful he will see us to the grave. Plus, he’s hip to technology, great to talk with, demonstrates compassion, is knowledgeable, he answers our questions and always referred us to great specialists when needed. He referred my husband to an ENT (Ear, Nose, Throat) specialist. His office had to make the appointment with this ENT for us, and informed us that they'd call us with a date. My husband’s sore throat started to subside somewhat, but we were both anxious to discover the problem. Our family doctor’s office called a week later, advising my husband can see him in mid-September! Our ED experiences have been lengthy waits, though not so 'people-unfriendly' for years. We’ve used ED services maybe five times in the last 15 years. Hopefully, things will improve.
 

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