How To Fix Any ER In 3 Easy Steps

Suspecting a fractured foot in December 2023, I drove myself to our local public Emergency Room, hobbled in and spent 7 hours* observing the grinding system struggling to serve our community, and the unsustainable toll it takes on Healthcare Providers. The front-facing walk-in ER is a small part of the machine of the public hospital, but requires an outsized amount of resources.

8 OPP Officers in 5 squad cars, 3 Security Guards and 2 Social Workers talked down and removed belligerent patients. Busy Cleaners mopped up blood and vomit. A distressed patient yelled into his speakerphone, sharing personal details with everyone within earshot. A severely disoriented fellow sloped by and crashed into my sore foot, before bursting into a bathroom to throw up for the third time. Ill and frightened children and people with severe headaches suffered through this melee, sitting on plastic bucket chairs under bright fluorescent lighting in a stale, windowless room. I waited 4.5 hours for an X-ray, and a further 2.5 hours to see an overworked Doctor…for 45 seconds. Afterward, someone pointed me to the non-obvious exit arrow, and I traversed the maze of hallways to eventually show myself out.

This breakdown requires a compassionate solution, borrowed from efficient systems already in use:

Step 1 ‘Airport Security’ screening (estimated time: 1-2 minutes)

Upon arrival at the ER, the ambulatory patient passes through the full-body x-ray scanner in the vestibule, while being observed by a calm witness in scrubs or a white coat who gives the visual impression of professional medical care while welcoming and assisting patients’ in ‘Wash your hands, Wear a mask’ protocol.

(If you don’t want to go through the scanner, you are free to enter the other end of the hospital and camp out in the waiting room for days! *7 hours' wait is so 'last year'; the average wait time crested 21 hours today.)

***additional time required for the following: If found to be carrying weapons or concealed contraband, Police Officers on standby will process the person before they try again to go through screening. If found to have traumatic injury (broken bones, bleeding, obstructed airway) the patient will be whisked by a Porter directly to Imaging/Surgery. If giving birth, Mother is wheeled directly to Labour and Delivery. *** If they have neither weapons nor any immediately discernible issue, the patient enters the ER foyer.

Step 2 ‘Disney’ Registration kiosks (estimated time: 1-5minutes)

Upon entering the clean, pastel-coloured ER foyer, the scanned patient proceeds to one of at least three unobstructed Registration desks, staffed by a Nurse Practitioner and a Scribe. The NP interacts with the patient while the Scribe observes and records. The patient supplies their OHIP card, has a photo taken, submits a finger print, and has a blood pressure reading with a cuff or hand scan. All of the IDs match—the patient’s previous history and ongoing concerns appear. The photo is analyzed for medical signs of decompensation, including pupil size and pallor, the finger print is checking pulse ox, and palm/wrist scan/cuff provides blood pressure reading. If blood work is required, it can be taken now and processed before seeing the Doctor.

***additional time required for the following: If the patient appears to be primarily in need of emotional support or psychiatric services, a Social Worker will bring the patient through to the Quiet Room for further testing and treatment options. If the patient needs an ECG or hands-on exam (heart attack/stroke) from a Doctor, is decompensating or having a ‘bad trip’, they will be seen immediately in the Triage area. If the patient needs further X-rays or a CT scan, they will taken directly to Imaging before returning to Triage. Every unsteady patient will be offered a Porter-assisted wheelchair ride to other locations, which reduces liability and provides a sense of caring and teamwork. *** Step 3 Hunters and Anglers’ Catch and Release (est. time 3-5 minutes)

Upon discharge from the ER, the patient will be offered a drink of fresh filtered water and a small snack of fresh fruit, vegetables, or flax crackers, to ameliorate the stress of the illness and reason for the ER visit. The food and water will be offered from hand to hand, effectively normalizing the stress response to ensure safe travel, while also giving the patient a tangible sense of well-being. The patient will be accompanied to the exit, after first ensuring that any follow-up appointments or tasks are understood.

*** None of this is possible without Step 0: Build and Staff more Long-Term Care ('Nursing Home') facilities to free up hospital beds. Congested beds are why the rest of the system is constipated.

Step 0.5: (RE)build dedicated homes for the chronically mentally ill, severely addicted, and for those with special needs who can never live independently (see L'Arche and Summerhill) so they have in-house support.

***

This setup makes better use of existing buildings, equipment, and personnel. This plan expects the best but prepares for the worst—days in which the system is overwhelmed and nothing goes right. We’re already losing good people and failing to provide—why not try something half-baked?!