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Life in Emergistan: Ban on Food and Water in the ED a Cruel Policy

Leap, Edwin, MD

doi: 10.1097/01.EEM.0000547197.78525.8a
Life in Emergistan

Dr. Leap practices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at www.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available at www.booklocker.com, and of a blog, http://edwinleap.com/. Follow him on Twitter @edwinleap, and read his past columns at http://bit.ly/EMN-Emergistan.

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It's difficult to explain what we do, so maybe it's difficult for others to sympathize with our situation. Physicians, midlevels, and nurses in emergency departments are tied to computers in cramped workspaces even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.

This lack of understanding is what leads hospital administrations to do one of the stupidest things imaginable: Ban food and drink from our workspace. This rule is usually justified with some unholy combination of infection control, Joint Commission regulations, and public health claptrap, coalesced and refined, then circulated as a cruel policy.

When it's enacted, clinical staff have their water bottles taken away. Nobody is allowed to eat where they work. Dedicated, compassionate staff members grow tired and dehydrated and hungry. (Maybe it's a good thing. We don't have time to go to the bathroom anyway, and water just makes that necessary more often.)

Mind you, the water bottles are sometimes kept in a nearby room or on a nearby shelf. It's an act of kindness, I guess. And the food? All you have to do is take your break and go to the cafeteria or to the break room, right?

Those who come up with these rules don't understand that a scheduled break is a great idea ... that never happens. It's an emergency department. It isn't (technically) a production line, however we try to impose time restrictions and throughput metrics. It isn't “raw material in/product out.”

It's “sick, suffering, dying, crazy human in,” and if all goes well, “somewhat better (at least no worse) human evaluated, stabilized, saved, calmed, admitted, transferred, and sometimes pronounced dead” out.

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MRSA, Meth, HIV, Hep C

Those Herculean efforts can take anywhere from 20 minutes to 12 hours, during which time it's pretty hard to leave the critical patient in the understaffed department with the five-minute-to-doctor guarantee and the limitless capacity for new tragedy rolling through the door.

That setting makes it remarkably hard for breaks, or even meals, at all. It is nothing short of cruel and unusual for anyone to say to the staff of a modern emergency department, “You can't have food or drink,” especially when it's typically uttered by people who have food and drink at their desks, people who have lunch meetings with nice meals, or who have time to walk to the cafeteria or drive off campus and feel good about protecting the staff from their deadly water bottles.

The argument, of course, is that the clinical staff work in a patient care area, even when they aren't at the bedside but are, for instance, behind a glass wall at a desk. If this is the case, then one could argue that the entire hospital (including the administrative suites) is a patient care area.

They are afraid we'll catch something, that it's unsafe for us to eat or drink where we work. Of course, this is while we roll around in MRSA and breathe in the particulate sputum of septic pneumonia patients. This is while staff clean up infectious diarrhea and wear the same scrubs all day. This is after we intubate patients who may have tuberculosis and start central lines on HIV patients, after we wrestle with meth addicts who have hepatitis C.

And this concern for our safety occurs in places where physical security—actual security against potential violent attack—is a joke often tabled until the next budget cycle.

As for our patients? Our food and drink are no danger to them. They and their families fill the exam rooms with fried chicken, burgers, and fries, eating at the bedside (often by the patient with abdominal pain). Their infants drag pacifiers across floors that would make an infectious disease specialist wake from bacterial nightmares in a sweat-soaked panic. In short, our food and drink are no threat to them and no threat to us.

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Just Mean

But the absence of food and drink? That's a problem. Because the ED is an endless maelstrom of uncontrollable events and tragedies, of things beyond our control for which we are responsible. It is a place of physical, emotional, and spiritual exhaustion where we rise to the challenge and manage (against the odds) to do so much remarkable good by virtue of our knowledge, our training, our courage, and our compassion.

In the midst of all that, a bottle of water, a cup of coffee, a glass of Diet Coke is an oasis. And that sandwich, slice of pizza, cupcake, or salad is the fuel that helps make it happen. More than that, food and drink are among the few pleasures we have time for each shift. They serve as bridges to the end of the day, small reminders of normalcy in a place where so little is normal.

Doubtless, one day someone will take away our music so that it doesn't hurt our ears or offend our patients. We'll fight that battle when it comes. Until then, depriving staff of food and drink where they work is of no health value and strikes me as just one more way of exerting control over the people actually engaged in the hard, grinding work of saving lives. Worse, it's just mean.

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