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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  17 registration staff resisted this change, however, and after a while one of the laptops was removed from the area due to lack of use. Overall, though, it seemed that registration was a relatively smooth and timely process at CHC; at the very least, it kept people occupied and out of the waiting room for a few minutes. The failure to adopt bedside registration, however, is but one manifestation of a more pervasive problem at this ER—the lack of consistent leadership over time. The department has employed VHYHQ nurse managers the past four years, and employees have become accustomed to doing as they please and treating change efforts as optional. :DLWLQJ $UHD The chart listing the cycle of events moves directly from registration to a treatment area, where a doctor, LPN, or registered nurse performs a physical evaluation. This happens quickly mid-morning on a weekday, but is a very long wait most other times. Once triaged and registered, people are sent to the waiting room where they can languish for hours with no obvious contact person to answer to any questions they might have. The ED waiting room is designed to keep visitors out of the treatment area unless they are escorted back. One possible change to current practices would be to add the waiting room to the flow chart, positioning it between registration and treatment. The waiting room is where patient expectations are consistently violated and where bottlenecks begin for the organization.

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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17
registration staff resisted this change, however, and after a while one of the
laptops was removed from the area due to lack of use. Overall, though, it
seemed that registration was a relatively smooth and timely process at CHC; at
the very least, it kept people occupied and out of the waiting room for a few
minutes.
The failure to adopt bedside registration, however, is but one manifestation
of a more pervasive problem at this ER—the lack of consistent leadership over
time. The department has employed
VHYHQ nurse managers the past four years,
and employees have become accustomed to doing as they please and treating
change efforts as optional.
:DLWLQJ $UHD The chart listing the cycle of events moves directly from
registration to a treatment area, where a doctor, LPN, or registered nurse
performs a physical evaluation. This happens quickly mid-morning on a
weekday, but is a very long wait most other times. Once triaged and registered,
people are sent to the waiting room where they can languish for hours with no
obvious contact person to answer to any questions they might have. The ED
waiting room is designed to keep visitors out of the treatment area unless they
are escorted back. One possible change to current practices would be to add the
waiting room to the flow chart, positioning it between registration and
treatment. The waiting room is where patient expectations are consistently
violated and where bottlenecks begin for the organization.


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