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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  14 call “frequent flyers.” This can make triage more difficult, as parents seeking routine pediatric care for their uninsured children (for example) invent more dramatic symptoms (e.g., abdominal or chest pain) in the hopes of being seen more quickly. Others who try to “game” the situation are people who come by ambulance, having learned that ambulance patients go “straight back” and get to skip triage and the waiting room. But this hospital, and an increasing number of hospitals nationally, have begun sending these people back to triage as these non-urgent ambulance arrivals have been identified as another significant contributor to rising health care costs (Bindman, 1995). Another group of ED patients are former hospital in-patients who have come to see CHC as “their hospital. While they may have been satisfied with the quality of in-patient or specialty care they received in the Women’s Center or Heart Institute, for example, it quickly becomes apparent that a different level of service is offered by the ED. Amidst all of this are critically ill patients who traditionally have a more legitimate claim to ED services but sometimes have to shout to be heard above the crowd. And patients with primary care physicians are routinely sent to the ED for evaluation and treatment on weekends, holidays, and after hours during the week, further adding to the patient load. Security is another major concern in triage. Everyone who works in triage is aware of the potential for violence (which is one of the reasons triage nurses are wary of people randomly interrupting their work). They try to control

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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call “frequent flyers.” This can make triage more difficult, as parents seeking
routine pediatric care for their uninsured children (for example) invent more
dramatic symptoms (e.g., abdominal or chest pain) in the hopes of being seen
more quickly. Others who try to “game” the situation are people who come by
ambulance, having learned that ambulance patients go “straight back” and get
to skip triage and the waiting room. But this hospital, and an increasing
number of hospitals nationally, have begun sending these people back to triage
as these non-urgent ambulance arrivals have been identified as another
significant contributor to rising health care costs (Bindman, 1995).
Another group of ED patients are former hospital in-patients who have
come to see CHC as “their hospital. While they may have been satisfied with the
quality of in-patient or specialty care they received in the Women’s Center or
Heart Institute, for example, it quickly becomes apparent that a different level of
service is offered by the ED.
Amidst all of this are critically ill patients who traditionally have a more
legitimate claim to ED services but sometimes have to shout to be heard above
the crowd. And patients with primary care physicians are routinely sent to the
ED for evaluation and treatment on weekends, holidays, and after hours during
the week, further adding to the patient load.
Security is another major concern in triage. Everyone who works in triage
is aware of the potential for violence (which is one of the reasons triage nurses
are wary of people randomly interrupting their work). They try to control


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