Friday, May 13, 2011

Ebb and Flow of the ED

Everything about working in an Emergency Department is unpredictable.  From what the patient volumes will be to what case/illness will present to what the drama will be that day.  While we can't control what will walk in the door or when the proverbial "bus" will unload, we like to think we have some clue of how things will be.

There are some trends in the patient volumes (and somewhat illnesses) that present.  Take, Monday's for example.  They are inevitably crazy.  No matter what the staff numbers are, we get behind and usually really far behind.  When I walked in close to midnight last Monday there were wait times nearing 2 hours.  Usually, on any other night at that time wait time is 30 minutes max.  There are a few theories about why they are so busy.  Some being: people don't want to spend weekends in the ER so they wait until Monday to be seen; people waited over the weekend with their illness hoping to see their doc Monday morning, but they're too jam-packed to fit anyone in; someone is looking to get out of going to work or school.  And one that I think, but haven't really discussed with anyone - incubation periods.  Kids share germs at school on Thurs/Friday and the illness starts to rear it's ugly head 2-3 days later.  Again, all theories, who knows how much merit any of them hold.

Wednesdays are historically the "slowest" day.  If anyone knows why I'd love to be educated.  That's just the way its always seemed.

Now time.  What is the busiest time?  Seems to be right around 4-6pm.  Everyone comes home from work/school and its time to get those injuries that occurred at school taken care of.  Or they injure themselves while playing after school.  Also when people realize its too late to get into the doctor's office to be seen that day.  Slowest time?  I'd say 3-6am.  Its a beautiful thing when you've started off at midnight with 80 patients in the ED and by 4 there's only 10 (with only 1-2 coming in per hour).

Trends as far as illness presentation?  Flu and RSV/bronchiolitis season is usually November-February/early March.  However, not always the case!  This year we seemed to start early and end late.  Spring/Summer is definitely orthopedic injury season.  Once the first hint of beautiful spring sun peeks out, we are flood with broken arms, legs, fingers and even noses.  Asthma has a predilection for weather changes - i.e. end of winter/start of spring and other season changes, Texas springs full of thunderstorms, wind and pollen, and fall when all the molds are prevalent.  And seasons dictate patient volumes as well.  Winter is most definitely the busiest time with RSV, flu, pneumonia, etc on top of all the other "normal" ER things like lacerations, abdominal pain, abscesses DKA, GI get the idea

So the moral of the story?  If you want to be seen quickly in an ER - show up between 3-4 am on a Wednesday or Thursday morning in the mid Summer months, preferably not on a night with a full moon (that is if your emergency can wait that long).  ;o)

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