Girish Venkatesh

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08/19/08 Class notes

My views about ER before presentation (this is based on what ppl have told me. I have never been in an ER)

  • Quick treatment for major/ sudden injuries
  • Comparatively longer waiting time for others even though they need immediate care
  • Generally referred to other doctors/departments for treatment
  • Only one/two family members can accompany the patient
  • Doctors don't spend a lot of time with the patient because they have other cases to attend to.

My views after the presentation

Thanks to Dr.Ackerman's presentation, I now have a better understanding about how things function in an ER. I came to know the other side of the story from a doctor's perspective. I cannot agree more as to how processes need to be streamlined for better functioning of an ER. I have come to appreciate how designing an ER the right way can help in doing that.

08/26/08 Site Visit notes

Facts/ Interesting details during the tour:

  • Parking space is limited and gets overcrowded during busy days.
  • Emory Crawford Long ED has 50 beds.
  • Morning times are not typically busy.
  • The busiest times start after 10:00 a.m. and thereafter it is a "mountain climb" according to the nurse.
  • The day after any holiday sees a rise in the number of patients.
  • ER sees more patients during Fall and Winter seasons when compared to other seasons.
  • Capable of handling 150 - 155 patients one day.
  • The patient movement is as follows:

Waiting room -> Triage -> X rays, ECG and every other test conducted -> waiting room -> test results -> physician.

  • Door to Doc time is 76 mins.
  • National waiting time average for ER -> 6 hrs
  • Waiting time average at Emory Crawford Long ER -> 6.5
  • The triage process takes around 5-7 mins.
  • 5 level triage rating: 5 being lowest acuity and 1 being the highest.
  • Staffing 4:1
  • Divided into express care and acute care.

Issues/Design problems that I noticed:

  • The nurse pointed out that the automatic doors in the entrance do not make sense to a lot of people. That is they try pushing the door. The doors also open outward and so being near the door when it opens can be dangerous.
  • As Ellen and Craig pointed out the direction arrows were misleading.
  • A clear site map or a floor plan will help people to get around, at least for the new hire nurses. I felt lost and had no idea of my orientation with respect to the building from the mid way of the tour and thanks to the knowledge our awesome nurse/guide, we just kept following her.
  • The patients who were waiting have no idea as to how long they will keep waiting. The reason given was that the calls are made based on the acuity level of the patient and so no one can be given a particular time. However, as I thought ( and as someone suggested) we could have a waiting list for each acuity level perhaps in an electronic board in the waiting area. This will maintain the priority for the high acuity level and also give the others an idea of how long it is going to take. This will also reduce the anxiousness of the patients and they will no longer keeping asking the nurse for how long it will take.
  • Nurses call out patient's names from the registration counter. I felt that this could be handled with a more efficient method. ( I noticed this when a nurse was shouting out the name of one person multiple times but it turned out that the patient had dozed off. There was a confusion for sometime but then they figured it out.)
  • The Nurse pointed out the the storage room was very far off from the nurse station and that if some thing ran out of stock they had to come all the way to the storage to get it which is a considerable wastage of time.

09/4/08 Class notes

The brainstorming process went on well and the experts' opinion was the key. Thanks to Marvina, Jamie, Ellen and Christine, we were able to get an idea of the problems faced in the ERs with respect to issues we were asked to address. Bao did a very good job summarizing and presenting the ideas discussed. and.. the Jalapeno pizza was yum!!! :)