Cost Containment

The first health care provider a most patients see in the ED is the Triage Nurse. It’s a pretty challenging role. The nurse out front becomes the face of the ED, not only responsible for making sure that patient and their families feel welcome and cared for, but also for sorting out the wheat from the chaff, the patients with true emergencies from those who are simply hangers-on.

The other day I saw a patient who had presented to the triage nurse with chest pain. As the story goes, she had gotten a case of the munchies that morning and, finding nothing in the icebox box save a package of questionable “Brown ‘n Serve” sausages, she popped one into the microwave for a bite. Following the obligatory “ding” from the Radar Range (I’m showing my age here), she grabbed the casing and shoved it into her gullet. However, she had neglected to wait the recommended three minutes for the sausage to cool, and developed a severe burning discomfort in her lower chest as the wrapped pork shards flamed down her esophagus and into her stomach.

In many hospitals, triage nurses are also responsible for initiating medical care protocols based on the patient’s chief complaint. Doing so often speeds care, especially when physicians are busy and cannot get to the patient to order labs, x-rays, and certain medical treatments within a reasonable time. They’re really a very good way to increase both efficiency and enhance patient care. However, these protocols are blind to circumstances and to costs. Which is why, by the time I got to the patient, she had been subject to a full cardiac workup, including an EKG; a chest x-ray; and a complete laboratory profile including blood count, coagulation studies, chemistry panels, and enzyme studies to look for evidence of heart damage. I have no idea how much all that cost the taxpayers, because Lord knows this patient is not paying her own bill.

Being the doctor, who works off no set protocol other than the 10% of medicine that is science, the 30% that is common sense, and the 60% that is voodoo, my workup cost the taxpayers less than a dollar. It was called a cold can of Sprite.

Problem solved.