There's military time, daylight savings time, and springtime, so I think it's only fair that we have our own kind of time—ED time.
Sports have their own seasons. A New York minute is a flash, an instant in time. Johnny Carson defined it as the interval between a Manhattan traffic light turning green and the guy behind you honking his horn.
The ED is just like that: You are in a different time zone.
Our calendar is simple. We speak in terms of days and weeks and months so we can get along in the real world, but there are really only two days on our calendar: on and off, shift or no shift. It's just too daunting to say, “I'm on shift 2838 of the 4500 I plan to do in my career.” It's easier to say, “I have three in a row or 12 this month.”
If a New York minute is an instant, then a lab minute is an eternity. Lab minutes come in multiples of 10. If you call the lab about a missing result, multiply their estimated time by 10. It is possible to get your results sooner after such a call, but multiplying the estimate by 10 will help avoid undue frustration and workplace unrest, both of which you will experience if you encounter downtime.
Downtime in the ED takes several forms. If you are still on the phone with the lab and hear downtime mentioned, this is the most troublesome—your lab minute has become a lab hour. The analyzer is down for maintenance or, worse, broken. This secret information is only available after sufficient time has passed and you have become curious why your results are delayed. The regular maintenance does not occur at 2 a.m. It happens when the ED is the busiest. You are also the last to know.
Don't forget CT downtime, which is measured in six-hour blocks, and MRI downtime, which is measured in days.
A paramedic minute is a funny thing. It seems to change constantly. Ten minutes become one. Three become 15. Fifteen become at your back door. Downtime takes on another meaning as well. Unresponsive downtime. On-the-floor downtime. Witnessed downtime.
Codes become a race against time. Someone has to keep track of time because our brains tend to compress it. How long did that take? Was there apneic time? Hypoxic time? Please, not anoxic time.
There's door-to-doctor time, balloon time, thrombolytic time, holding time, boarding time, throughput time. We're told to sit down so that patients perceive that we spent more time with them. Maybe FaceTime will replace mask-to-mask time during COVID-19 time.
I can remember summertime when I was a kid seeming like I had all the time in the world. Sadly, in the ED, even kids can be living on borrowed time. With them, it's especially hard to understand the appointed time that all of us face someday.
They say a black hole can stretch time. That would come in handy during the golden hour of trauma time, especially when dealing with transfer time, and at the end of a shift when trying to get out on time to get home for our own downtime. Family time, personal time, sleep time, me time.
I can't bring myself to talk about meeting time. But waste of time comes to mind. There's QI time that can be painful at times but hopefully helps us avoid deposition time.
An ED Minute
Spending extra time in the ED doesn't get you double time, time and a half, or overtime. It just ensures you won't get out on time.
We can try to manage our ED time. But time is rarely on our side when we see a patient. More often, we encounter a time bomb with us trying to diffuse the situation before time runs out. It's not really even our own time. You would think you could occasionally get a little private time, but call a consultant and go to the bathroom and see who calls back in record time.
Patients need to know about ED time. Seems like everyone knows that if you go to another time zone, you have to reset your watch. You might even get jet lag trying to adjust to the new time. If you call to ask about wait times, you probably don't need to take up any ED time. I can queue up for a haircut online. Never understood how advertising that made sense for the ED. Isn't scheduling your emergency an oxymoron?
Don't get me wrong; I'm always going to do the right thing and take care of anyone anytime. But not being able to get PCP time is usually not going to get you to the front of the line. You know how when you land in a different time zone, the flight attendant says. “Welcome, the local time is...”? Maybe we should have that piped into triage. You are now in the ED; the local time is not yours. You will be seen as soon as possible. Reset your watch, and enjoy the fact that you are not being rushed back. Set the background music to Don Henley's “New York Minute.”
In an ED minute, everything can change.
In an ED minute, things can get pretty strange.
Well, I'm out of time and need to get on the road for commuting time. Hopefully I can help my partner get through sign-out time and home to downtime. Until next time. It's ED time!
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Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, CA.