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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  18 As one might imagine, the ER waiting room is an emotional place, and consequently most ER staff and hospital employees avoid it at all costs. The waiting room is also subject to mob psychology; people take their cues from each other. If one person “loses it” emotionally with the wait time and the non- specific answers s/he receives from the staff, others will follow suit, creating a chaotic environment that may be disruptive. To deal with this and related issues, the ER has hired three specially trained Patient Advocates. These individuals serve as communication liaisons between the waiting room and the ED staff, delivering information and providing on the spot counseling where needed. The likelihood of an emotional outburst by visitors in the waiting room is increased significantly by a common practice called “jumping the line.” One phone call from the right local celebrity or hospital Board member can dramatically reduce wait time for that individual (and incite anger in those he or she passed on the way). ED leaders resent line jumpers for three reasons: they usurp the supervisor’s power and authority; it’s unfair to patients; and it leads those who exploit it to have an atypical experience of the ER, on which they will base later opinions and conclusions (e.g., “I don’t understand all this talk about overcrowding and a nursing shortage. I was in the ER at CHC and was treated immediately!”). In addition to emotions running high, another result of this overcrowding is a rise in patient elopements, which occur when someone leaves after triage, but

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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18
As one might imagine, the ER waiting room is an emotional place, and
consequently most ER staff and hospital employees avoid it at all costs. The
waiting room is also subject to mob psychology; people take their cues from each
other. If one person “loses it” emotionally with the wait time and the non-
specific answers s/he receives from the staff, others will follow suit, creating a
chaotic environment that may be disruptive. To deal with this and related
issues, the ER has hired three specially trained Patient Advocates. These
individuals serve as communication liaisons between the waiting room and the
ED staff, delivering information and providing on the spot counseling where
needed.
The likelihood of an emotional outburst by visitors in the waiting room is
increased significantly by a common practice called “jumping the line.” One
phone call from the right local celebrity or hospital Board member can
dramatically reduce wait time for that individual (and incite anger in those he or
she passed on the way). ED leaders resent line jumpers for three reasons: they
usurp the supervisor’s power and authority; it’s unfair to patients; and it leads
those who exploit it to have an atypical experience of the ER, on which they will
base later opinions and conclusions (e.g., “I don’t understand all this talk about
overcrowding and a nursing shortage. I was in the ER at CHC and was treated
immediately!”).
In addition to emotions running high, another result of this overcrowding is
a rise in patient elopements, which occur when someone leaves after triage, but


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