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before being evaluated. Elopements are, of course, unbillable. Consequently, a
primary challenge of any emergency room is to reduce elopements by identifying
and addressing their root causes. At CHC, the number of monthly elopements is
tracked and a nurse is assigned to make follow-up calls to these individuals to
determine the reason why they left before being seen. The process mostly seems
to work, although the staff is slow in making these calls, creating a significant
backlog. With rare exception, elopements are the result of prolonged wait time
that leads patients to decide that the service they are about to receive is not
worth the wait.
3K\VLFDO HYDOXDWLRQ. Some of the physical evaluation that takes place in
the ED—notably for cases that are truly life threatening—takes place quickly.
On many occasions, we witnessed how well the ED team pulled together in a
crisis. All staff, regardless of status or role, seemed to “just know” when they
were needed to pitch in. This is when these employees are at their best,
responding to real emergencies using their considerable skill. It was in the more
routine evaluations that things sometimes slipped. Nurses in particular feel
that their jobs have become increasingly routine, and both nurses and physicians
struggle to use good communication skills when first greeting a patient who is
likely upset (and often hungry) after having waited for hours.
The nursing shortage affecting all health care facilities in the United States
is also affecting CHC. CHC is confronting a nursing shortage in all units but
especially in the ED. Not all nurses are trained to work in emergency medicine,
Convention