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Sunday, August 31, 2014

16 hours in the ER; 16 hours well spent

Long wait times in hospital emergency departments are a persistent problem around the world. The American College of Emergency Physicians in a paper on ER overcrowding reported:

"The news media have given great attention to the crowding “crisis” in emergency departments as if this were a recent development. However, as far back as 1987, after sustained and unsolvable problems with crowding, the first statewide conference on crowding was held in New York City. . ."

Recently, The London Free Press ran a story reporting that ER wait times at London Health Sciences Centre (LHSC) University Hospital (UH) have been as long as 19 hours. The newspaper went on to bemoan the fact that patients with serious conditions were "spending hours in the ER." Although this is all true, this is not the whole story.

Less than two weeks ago I spent 16 hours in emergency at UH. Those 16 hours may well have been the most import block of time in my entire life. Those 16 hours led directly to my undergoing emergency surgery for a life-threatening bowel obstruction.

Two mornings earlier I had awakened with a severe pain in my gut. By mid-afternoon I was at the St. Joseph Urgent Care Centre. The service was fast but that is all I can say for it. When nothing could be found to explain my pain before the centre closed at six p.m., an unnamed virus was blamed and after a shot of morphine for pain I was sent home. I asked to stay overnight for observation but was told that St. Joe's does not have any rooms for that purpose.

An interesting aside: This lack of rooms is a main reason St. Joe's fared so well in the CBC Rate Your Hospital report. Patients appearing on St. Joe's doorstep who are exceedingly ill, possibly dying, are often shipped off to University Hospital. UH takes the patients, the responsibility and the risks. St. Joe's accepts the accolades for its lower than usual mortality rates.

Now, back to my story. As soon as the morphine wore off, the pain returned. I suffered all night. My difficulty with keeping stuff down, a problem dismissed by the doctor at St. Joe's, was now a constant. As I take meds for my heart and other meds to prevent stroke, I feared I was losing these all-important pills when I got violently ill. By late afternoon I called the doctor at UH who monitors my meds. I was instructed to get to the UH emergency department immediately. This was serious.

I arrived by ambulance at the ER shortly before five in the afternoon. I was parked in a hallway but I was not parked and forgotten. An EKG was done and I believe blood was taken for testing. I'm not sure how long I was in the hallway. I really didn't care. The pain had been so severe that I was just grateful to be in the hospital where I was receiving something for the pain.

At some point in the early evening an ER cubicle became free and I was moved to a small bed in the ER. I met with an ER doctor who immediately ordered x-rays. He was concerned I might have a bowel obstruction. I did.

It seems a tight band had formed around part of my small intestine. Why it formed was not clear but what was clear was that it had to be removed and soon. The tight band was shutting off blood flow to a section of my intestine and if not removed soon would irreparably damage the trapped intestine. Surgical removal of the damaged section of intestine would be necessary.

But the doctors in ER faced another complication. I take Pradaxa. This is an anti-coagulant or a blood-thinner in common parlance. Unlike coumadin, there is no easy way to reverse the effect Pradaxa has on blood's ability to clot. Major surgery can result in life-threatening bleeding in patients taking Pradaxa. Discontinuing Pradaxa a day or two before surgery is the usual answer but my doctors did not have that luxury.

A CT scan was ordered. A couple of hours before the procedure I was given a litre of a contrast-enhancing fluid to drink. The surgeons needed to know exactly what it was that they were up against. A CT scan was the answer. An MRI might have been another option but not in my case. I have an ICD/pacemaker in my chest. For me, MRIs are not an option.

Served cold the contrast liquid was not all that difficult to drink. The nurse divided my dose into two 500ml portions. I slowly consumed the first 500ml during the first hour. The nurse thoughtfully put my second dose on ice.

Normally, I was told, I would have been given close to two litres of the contrast-enhancing fluid but as I was slated for surgery first thing in the morning the volume of the dose was kept to a minimum. One never has anything by mouth before surgery and here I was drinking a full litre of liquid. As soon as the CT scan was complete, a young doctor threaded a tube through my nose and down my throat into my stomach. He pumped what he could of the contrast-enhancing fluid out of my stomach.

At 9 a.m. I was in the operating room. Thanks to the CT scan the surgical team had determined the exact location of the offending intestinal band. The lead surgeon, an expert in laparoscopic surgery, a minimally invasive surgical approach that does not require splitting the abdomen open, led the team down a surgical path that would skirt the Pradaxa bleeding risk. Brilliant.

After about three and a half hours I was wheeled into the recovery room. When I was asked if I needed another shot of painkiller, I said, "No. The pain is gone."

I had spent 16 hours in emergency. A reporter searching ER records would learn a patient at LHSC University Hospital spent 16 hours in the ER but would not learn that those 16 hours saved the patient's life.

I send my heartfelt thanks to the young doctors, the team-leading surgeon and to the nurses in the ER, the nurses in the recovery room and the nurses on the eighth floor where I eventually found a room. What a fine team! They saved my life.

Thank you!

Understanding ER Wait Times Information

What does “ER Wait Times” mean?

ER Wait Times means the total time that someone who visits an ER looking for immediate, unscheduled care spends in the ER. The measurement of wait time :
  • Starts when a patient registers or is triaged (“triage” is the process for deciding which ER patients need or are likely to benefit from immediate treatment).
  • Ends when the patient is discharged from the ER or is admitted to a hospital bed.
During the time that a patient is in the ER, doctors and nurses may be treating the patient's condition or ordering tests and waiting for test results so they can decide on  the best course of treatment/

Some months after I wrote the above post, I had another event. This time I had a severe chest pain that left me doubled up. The pain then moved from my chest to my back and eventually settled in my chest. I spend all day in emergency. I was given another CAT scan and when nothing was found I was pushed to the side but not forgotten. It took a full day but before I was released I was given a three page document detailing the findings of the CAT scan.

Again, the wait times information looks bad. Eight or more hours in emergency seems unbelievable on the surface. A reporter might roast the hospital for this. Me? The patient who spent the time in ER? I'd give the staff in ER a big thumbs up. They went above and beyond what they needed to do. They discovered a lot of important stuff and the doctors who care for me will make good use of their findings. It was eight hours well spent.

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