GUGloria Underwood
We need to talk about your numbers.
GloriaMetrics.
Our door-to-balloon times beat federal standards.
Gloria
I'm talking about Press Ganey scores. Patient satisfaction.
If they're still alive, they should be satisfied.
Gloria
Our goal is 36% very satisfied with their care. Your department is at 8%. Do you know how likely patients are to recommend this hospital?
This is an emergency department, not a Taco Bell.
Gloria
11%.
Well, if you want people to be happier, don't make 'em wait for 12 hours.
Gloria
There's a nursing shortage across the country.
Most of our patients are boarders who are waiting for a bed upstairs.
Gloria
We don't have the beds.
That's bullshit. The beds are up there. You just don't want to hire the staff you need to care for them.
Gloria
Like I said, there's a nursing shortage.
Well, if you paid them a living wage, they'd be lining up to work here.
Gloria
Our budget can't support that.
[laughs] Here's a dirty little secret. The hospital saves money keeping patients down here in the Pitt. It's way cheaper than staffing upstairs.
Gloria
I have asked you repeatedly to stop referring to the emergency department as the Pitt. It is derogatory and incompatible to the institution's image.
You know what's incompatible with the institution's image? Me speaking to the media about people who code in our waiting rooms and people who get shitty care in our hallways waiting for an ICU bed for days.
Gloria
I've heard about doctors who have tried that and find themselves out of work.
Gloria
I know today is difficult for you.
Every day is difficult down here.
Gloria
Boarding is a nationwide problem. Your predecessor, Adamson, sure as hell knew that. Or wasn't that something he taught you?
Gloria
Yes, really. Other hospitals are managing this crisis much more effectively. So, you can either step up your game, or you can step aside.
Gloria
Is it true? ...
You have to be more specific.
Gloria
Are there rats in the ED?
Apparently, if somebody already snitched!
Gloria
Do you know how bad this looks? One more reason to shutter this place. Only the emergency department admits rats.
Emergency department would never admit rats, unless they had the right insurance.
Gloria
Did you catch any of them?
One, and I charged him for a full visit.
Gloria
I'm glad you think this is funny.
I'm sorry that you don't.
Gloria
Did you call an exterminator?
He's waiting on a second opinion.
Gloria
[chuckles] You're pushing your luck today.
Don't worry. Last I heard, they were headed for the cafeteria, so they should be dead within the hour.
Gloria
OK.
Gloria
Or maybe not.
Gloria
Dr. Robinavitch.
Gloria
This is Dr. Tracy Morris, regional manager of ECQ America.
The contract management group.
MMorris
It's a pleasure to meet you.
Likewise. But if you'll excuse me, I'm a little slammed, as per usual.
Gloria
We were upstairs with the executive team going over a proposal.
Gloria
Mm-hmm.
MMorris
We're interested in having your emergency department join us.
The 500 or so ERs you have aren't enough?
MMorris
What can I say? Business is good.
MMorris
Everyone benefits.
Do they, though? Your contract management's corporate mandate is profits for shareholders above everything else, yes?
Gloria
Robby.
MMorris
Your hospital's board was very impressed with ECQ's metrics on patient satisfaction, throughput time, and billing collections.
Does your proposal include the part where you cut the pay for all my doctors?
MMorris
Maybe I can find an incentive for you. How does regional medical director sound? Lighter workload, better benefits, stock options.
Did you go to business school or medical school?
MMorris
Both. We look forward to your decision.
Gloria
Of course.
MMorris
Hopefully we'll get a chance to work together soon, Dr. Robinavitch.
[Dr. Morris leaves]
I can't believe you're seriously considering this.
Gloria
Bottom line is, our current numbers aren't good, and theirs are.
Just because their dashboard is pretty doesn't mean it's good for patients.
Gloria
If you want to keep this ED, improve metrics. There's a lot of OFI. Opportunities for improvement.
Well, you could have just said that.
Gloria
I need you to care about patient-satisfaction scores.
I would love nothing more. But right now, the average wait time is six hours, and that's before you see a doctor. You need to hire more staff so we can open more inpatient beds. Are you prepared to do that?
Gloria
I need you to improve scores with the resources we have, or we will explore what ECQ has to offer.
This is bullshit. You know this is bullshit. And if you don't, then we are all in trouble.
Gloria
Maybe you need some time off.
Patients come in already in distress, and waiting only makes it worse.
Gloria
Wait time has nothing to do with this.
Which is why we're seeing hospital workers like Dr. Collins get assaulted.
Gloria
Assaulted?
Which we're gonna take seriously. We risk our lives coming to work here every day. What if that mother had brought a weapon?
Gloria
We have metal detectors.
This is what happens when you keep all the hospital admissions stuck down here instead of properly staffing upstairs. I've got four patients waiting on ICU that have been here since before I got here, and it's already 1:00.
Gloria
I can see that you're...
We've got four more waiting on psych. One of them's been here for a fucking week. So please, for the love of God, hire more nurses.
Gloria
I'll come back later.
That's not gonna help anything.
Gloria
[after Dana was attacked by a patient] Did you fill out an incident report?
I don't know, I was more concerned with her having a skull fracture than with your liability.
Gloria
How'd a guy from the waiting room get back here without anyone noticing?
Wow, Gloria! What a great question. Our hard-working nurses were just asking me what steps the hospital plans to take to ensure their safety in the future. Maybe you would like to explain to them why you've denied my request for additional security measures three times in the last four months? If nurses don't feel safe, they're not gonna come to work.
Gloria
First off, the safety of all our employees is paramount.
["Code Triage, Emergency Department now." over Public Address system]
Gloria
We're locking down the hospital and setting up a command center in Administration. We'll coordinate logistics, supplies, communication.
Unclear, but initial reports are not good.
The night shift is gonna be here soon, but we are gonna need more help, especially from Surgery and Anesthesiology.
Gloria
MCI group text and email went out to everyone, including Transport and Environmental Services.
OK, good. [to Dana] Hey, everyone's gonna want to come in to help. Keep enough in reserve. Tell them to come in eight hours later to give us a break. And can you try and reach Jake?
Surgery's got to call in the cavalry. We're gonna need all 25 ORs.
Gloria
Ahead of you. Four ORs are prepped and staffed, and we're working on getting the rest up and running.
What about disaster supplies?
Gloria
On their way.
Every patient in the ER needs to go up. Beds or no beds, they'll get better care in an upstairs hallway than ignored down here.
Gloria
Agreed.
There's a whole wing that's empty on the eighth floor. I don't know if that's...
Gloria
But no nurses to staff it.
No comment on that one. Waiting room and Triage can go to Family Medicine Urgent Care. And we should turn off the TVs. We don't need to cause any extra panic.
Gloria
Will do.
The cafeteria will handle the family members and survivors.
Gloria
What else do you need?
Gloria
Amen to that.
Keep the press out of here.
Gloria
Gladly. Call me directly if you need anything else.
The Pitt · 77 quotes
