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I think waiting room medicine, if you do it efficiently, shows our partners that we’re here doing our best. And when I say partners, I mean our partners in hospital medicine, our partners in social work, our partners in the ICU, our partners in EMS, and our partners, obviously, in administration at the hospital level. But, I think playing nice makes it so that having finesse in waiting room medicine helps the overall problem. A lot of time that I spent was working on, how do you make waiting room medicine better? What is good patient selection? Obviously, you want to do probably lower acuity patients. You want emergency physicians that can be a little bit minimalist, that can churn patients. You might want to have dynamic staffing for both physicians and nurses so that you can handle day-to-day surges. You want to come with processes where there’s a nurse, tech, or phlebotomist resources or physical access resources, i.e., nearby Pyxis’s, having internal waiting rooms, having a process for doing “waiting room medicine,” but in a way that is … ensuring privacy for patients. Also what do you do with these patients if they need a consult or admission? How do you facilitate that?
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ACEP Now: Vol 42 – No 04 – April 2023Dr. Luke LeBas: You seem to be very lucky in that you’re working at a facility that has such strong physician leadership and physicians who are in the C-suite and who are being listened to. Unfortunately, some of the jobs that I’ve had in the past, people that have been removed from the bedside from decades or people with an MBA that have no clinical background whatsoever are trying to dictate to me best practices. And you can clearly see that they don’t know what they’re talking about. And that gets to be a little frustrating whenever Blue Cottage comes in or McKenzie comes in or different organizations like that and they don’t understand the world that I’m living in. You’re lucky that is you, you’re on both sides of that fence. You’re able to talk to both sides of that equation. And that is a plus for the practicing pit doctor to have somebody like you that’s on their side.
Dr. Amy Ho: I think I certainly was welcomed to have walked into a facility where physicians were already very well liked and very well listened to by administration.
Dr. Luke LeBas: The planning that you’ve discussed, the internal waiting rooms, the throughput issues and all of this, I like all of that. And whenever it’s instituted as a new change within a hospital setting, I think that you would get more buy-in from the practicing doctors based off of how you sell it to them. Have a practicing doctor pitch it to them. Don’t have an MBA pitch it to them, don’t have somebody from the C-suite that you’ve never met before. Have somebody that you’ve worked hand in hand with to sit down with you and explain how this new process is going to work. Also, give explanations to the ED doctors what the rest of the hospital is doing. Acknowledge the difficulties that are going on in the ED and show me that the hospitalist and the surgeons and the other folks that are upstream and upstairs understand what we’re dealing with. Show me what sacrifices they’re making to try to help the situation as well.
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5 Responses to “Pros and Cons: Waiting Room Medicine”
April 16, 2023
John Patrick MD FACEPI was disappointed that there was very little said in the discussion about what is best for our patients
April 16, 2023
Mark Melrose, DO, FACEPDear Dr. Ho-
I come from a similar background as you- EM trained, spent most of my 35 year career in ED Director roles- academic, urban community, suburban community, public hospital, and founder/owner/operator of urgent care practices. I am now back in a purely clinical practice in an urban academic, tertiary care, well resourced specialty hospital. The issues you describe are indeed real world EM concerns, however there is one thing you stated as the basis for your value proposition on WR medicine that is so off base that I had to write this reply. “…But we also know that holding patients as collateral as a way to ransom the hospital into trying to come up with solutions isn’t part of the narrative we want to put out there.” FALSE!!! Patients are indeed held ransom daily by our ED’s, because they have nowhere else to go. In my urgent care practice, people would walk in, and turn right around and go somewhere else if the wait time was too long. It was money out of my pocket, so we made sure people didn’t wait. Our ED’s and ED patients will always be hostages as long as inpatient capacity is a slave to surgical revenue stream, and boarding is an ED problem, not a hospital-wide problem. If WR medicine was “best practice”, inpatient hallway medicine would be a thing, and private rooms would be doubled up, everywhere, everyday.
Yours truly,
Mark Melrose, DO, FACEP
April 16, 2023
GW MDLet’s be honest. This conversation is like the choice of only eating fast food and people arguing whether McDonalds or Burger King is better. Sure, you don’t want to starve. But how about not eating fast food at all.
What are the current interests and motivations of hospital leadership?
Let’s take an auto factory. Imagine one part of the factory has workers and processes with set hours.
In another part of the factory, you can run the workers into the ground, force them to build extra cars at all hours of the night, and they can’t say no.
Would you overwork that other part of the factory? Of course you would.
Want to fix this problem overnight?
1. Claw back the past 5 years of bonuses for the CEO, CNO, CFO, COO if there are more than 5 boarders 30 days of the year.
2. Not allow the CEO, CNO, CFO, COO to leave the hospital if there are any boarders in the ED.
3. Forced firing of all 4 of the above if there are more than 5 boarders 60 days of the year.
I guarantee you, the boarding problem would get fixed very very quickly.
But currently, the financial incentives are to maximize boarding. It’s a win-win for admin whatever they may say.
Elon Musk and Spacex are building self landing rockets. Boarding is just not that difficult. It hasn’t been fixed because the motivations are not to fix it.
And then it’s left to us to have these discussions of whether we should be taking care of patients with +trop’s, appendicitis, and sub arachnoids in the waiting room (yes, we had a SAH we were managing in the waiting room in the recent past).
April 23, 2023
Kevin C Meyer, MD, FACEPYou’re both saying the same thing, one glass half full and the other half empty.
I’ve done both clinical and admin over the years within different systems. Some systems are definitely more metric focused and do a better job than others.
Bottom line is that waiting room medicine (hallways too) is terrible for us and the patients. Fundamentally, hospital CEOs are convinced that a shift from inpatient to outpatient care is the future. I would argue that patients don’t know that. We are the center of the medical universe. Physicians in the outpatient setting cannot keep increasingly complicated patients from the ED, but actually encourage them to go if they are concerned.
We need to focus more staff and money on EDs, observation/respite units, and social workers. Make specialty ED in person consultations normal. Let telehealth and AI be the main stays of outpatient care.
We’re doing it wrong and those in charge are thinking about the future of medicine wrong.
January 12, 2024
N. Newman, MD“I think waiting room medicine, if you do it efficiently, shows our partners that we’re here doing our best.”
The fact that “waiting room medicine” is necessary demonstrates that the ED is not efficient and they system as a whole is functions poorly.