There was no storm, no earthquake, not even a major car pileup in the mix, but the Utah Valley Hospital Emergency Department had so many people coming in for help one day earlier this year that they had to put out a red status, drawing people from other areas of the hospital to help.
On one day earlier this year they had their rooms in the ED filled and still had 24 people waiting in the waiting room, says Kevin Butler, RN, nurse manager.
“We don’t reach that number very often at all,” he says, “On this day there wasn’t a good explanation for it. We just had a really busy day.”
Rachelle Rhodes, RN, executive director of Emergency Departments and Trauma Operations in the Canyons and Desert regions, says this is just one example of ED caregivers dealing with the challenges a busy day can bring.
“These caregivers were recognized in a Tier 6 huddle earlier this year after this particularly busy day and I think it’s a good reminder of the type of challenges EDs routinely face,” Rachelle says. “Our ED caregivers always rise to the challenge and get people the help they so desperately need.”
When patients back up in the waiting room the ED relies on triage nurses who work with each person as they come in.
“These caregivers aren’t physicians, but they are highly-trained, experienced nurses and we know we can rely on them to make the difficult decisions about who needs care first,” Kevin says. “That’s a big weight to put on their shoulders but our triage nurses rise to the challenge every time they are needed.”
Chandra Eldredge, RN, was the charge nurse that day and she says the triage nurses have one of the toughest jobs. Chandra says when patients back up into the ED waiting room it can be stressful determining who will be seen first, especially when people are in pain.
Krishelle Magee, RN, was a triage nurse that day.
“There’s a good amount of training before you become a triage nurse because there’re very specific protocols to follow and things that you’re watching out for,” Krishelle says. “Some people don’t appear to be as sick as they actually are, so you use a little bit of your critical thinking skills and draw on your experience as well.”
Kevin says such situations are especially difficult because caregivers don’t want to see people suffering.
“I can tell you from experience these caregivers in the ED care deeply about their patients and often struggle with their own emotional responses to the situations they’re dealing with,” he says. “Even on a day like this, if there was a patient who was really struggling or a homeless patient who was very dirty and needed a shower, somebody’s going to pause for just long enough to hold that person’s hand to reassure them or maybe even offer them a shower.”
Chandra says when days are busy she doesn’t hear caregivers complain or ask to go home early. Some, in fact, volunteer to stay later to help.
“We’d never specifically go up and ask someone to stay past their 12-hour shift,” she says. “But more often than not, they’re offering to do that without being asked.”
Chandra says that day when she came on shift at 5 a.m. it was already busy and it never slowed down. Some of the patients who came in were there for serious things like stroke and head trauma. She says they were using every possible room they could and yet they still had an “insane number of patients in the waiting room.”
“We had extra staff come in,” Chandra says. “I remember Kevin and Amy Elmer, the assistant ED manager, came in and helped. The house supervisor that day came down and helped. And we just couldn’t stay on top of it. Our providers were great. They’ll see patients out in the waiting room if we need them to. We set up an accelerated care area that we put patients in so our providers could see patients faster.”
That day Chandra made the decision to activate status red for the hospital.
“I think this is an example of how the ED team and the hospital team work together on busy days like this,” Kevin says. “I think that that also only happens because the charge nurse in the ED activates that status red. That got more people’s awareness in the hospital about what was going on in the ER so that if anybody was available to help they could come down and help. Our inpatient units played a key role by prioritizing and taking ED admissions in as quickly as they could.”
“In every Intermountain ED there are caregivers who face these kinds of emotionally taxing challenges every day and our patients benefit from their competency, compassion, and training,” Rachelle says. “The challenge of sudden increases in patients seeking emergency help is something every ED faces whether they are connected to a large or small facility. They save lives and I’m grateful for the sacrifices they make.”