[Robby introduces his newest group of medical students and interns to the key players of his emergency department day shift]
MRDr. Michael "Robby" Robinavitch
Actually, this is the most important person that you're gonna meet today. This is Dana. She's our charge nurse. She is the ringleader of our circus. Do what she says, when she says it. As you can see, our house is always packed, and our department is mostly clogged up with boarders. Those are admitted patients waiting for a room upstairs, sometimes for days. Beds are a very precious commodity around here, so please be quick and efficient with your workups. What else? We treat the sicker patients back here, but please keep your eye on that waiting room. Make sure nobody's gonna die out there. Your senior residents are Dr. Collins and Dr. Langdon. You report to them, and they report to me. Senior residents, you got your sign-outs?
Patients, they check in for registration here. A nurse eyeballs them, makes sure they're not dying. If not, they're moved to one of two triage rooms for vitals and a quick chair exam where you can order your labs and your X-rays. And then they come back to Waiting room, until a bed opens up.
MVMS3 Victoria Javadi
For how long?
Eight hours, if they're lucky. A lot of times, 12.
MDMS4 Dennis Whitaker
Uh, is it always this busy?
Uh, no. It gets a lot busier.
GUGloria Underwood
We need to talk about your numbers.
Our door-to-balloon times beat federal standards.
I'm talking about Press Ganey scores. Patient satisfaction.
If they're still alive, they should be satisfied.
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.
Well, if you want people to be happier, don't make 'em wait for 12 hours.
There's a nursing shortage across the country.
Most of our patients are boarders who are waiting for a bed upstairs.
That's bullshit. The beds are up there. You just don't want to hire the staff you need to care for them.
Like I said, there's a nursing shortage.
Well, if you paid them a living wage, they'd be lining up to work here.
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.
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.
I've heard about doctors who have tried that and find themselves out of work.
I know today is difficult for you.
Every day is difficult down here.
Boarding is a nationwide problem. Your predecessor, Adamson, sure as hell knew that. Or wasn't that something he taught you?
Yes, really. Other hospitals are managing this crisis much more effectively. So, you can either step up your game, or you can step aside.
OWOtis Williams
Am I gonna be OK?
Yeah. You just need to take it easy on yourself. Muscle breakdown and myoglobin damaged your kidneys.
OWOtis Williams
Why'd you shock my heart?
When your kidneys don't work, potassium builds up and messes with the electrical activity in your heart.
OWOtis Williams
Can it happen again?
We gave you medicine to lower your potassium, and you'll need dialysis to clear it all out.
OWOtis Williams
Then I'll be OK?
Yeah. You might need a week or two for your kidneys to recover, but yeah. You really need to hydrate like crazy before and after a triathlon.
OWOtis Williams
Trust me, I won't let this happen again.
Good. Be kind to yourself.
