Musical Chairs

Roseanne Rosannadana said it best. Even if it’s not a bad day in the ED, “It’s always something.”

Today is one of the days when we have opened the observation unit in the ED. The observation unit is a great thing for patients, as it moves the admitted patient out of the ED itself and into a more comfortable bed until they are able to either get to the floor or have their care completed. However, for the ED physician, the recognition of patient benefit is, in our less altruistic moments, occasionally offset by the knowledge that once our beds have emptied into the observation unit, those beds will be instantaneously filled with three more contestants on this episode of “The Diagnosis is Right…Maybe!”

There were three patients eligible to move to the observation unit on my arrival in the ED. I already had several to see lined up before I got there. So by giving the word to move patients to other beds, I was essentially looking at doubling my workload in a matter of moments.

Fortunately, the Charge Nurse and I have worked together for a long time, and we were able to negotiate a compromise. She wanted to move all three patients; I was agreeable to giving her one. We settled for 1 ¾ patients, rounding up not allowed. However she wanted to allocate the ¾ was fine with me…she could take the head and torso, and leave me with a limb. We could move the number up to two as long as the patients moved sequentially, transporting the patient’s belonging bag first, followed every fifteen minutes by the IV pump, the stretcher, any family members present, and finally the patient themselves. But that way her observation bed gets filled, my ER bed stays filled, the angels are singing, the birdies are chirping, and all’s well in heaven and on earth. (And administration looked down from the towers above and said, “Huh?”)