Letter to the Editor
I couldn't disagree with Dr. Edwin Leap's position more than anything I have read in EMN for some time. (“‘Pull Till Full’ Pits Nurses against Physicians,” EMN 2018;40:1; http://bit.ly/2PMJMw5.)
The idea of letting people wait because they can is so antiquated that I have a hard time believing that someone of his status in emergency medicine would write something like this. This was the standard back in the late '90s. Those who are doing cutting-edge process change realized that getting people seen quickly is not only good for your reimbursement and patient experience scores and time metrics, but is the right thing to do.
This is the way we would like to be treated if we happened into an ED where we were unknown to the staff. I was told a long time ago that the sickest patient in your ED is the one you haven't seen yet. I still believe that to this day. Our nursing staff makes mistakes in triage, and we catch seriously sick people in the waiting room from time to time. Getting these people roomed sooner than later lets another nurse and set of eyes see them before I can. I don't know about Dr. Leap's department, but I don't have enough staff to be rounding in my waiting room, so I don't really know if they are getting sicker. Having patients in a room gets them closer to me.
Triage should be a process, not a place, and should take place in a room whenever possible. We should be getting back to the patient-centric focus that makes us the safety net and arguably the most valuable cog in the health care wheel. Reimbursement is more closely tied to metrics and scores, so this type of practice will fade away. But we should be doing it not for the metrics, but for the way it makes people feel to be seen in a quick and efficient manner regardless of the complaint. Patients come to us for caring as much as they do for our medical care, and I would hope our specialty can move away from the practice that Dr. Leap espouses and get back to why we all entered health care in the first place.
Robert T. Adams, DO