QI project about wait times

[am1384]

I am working on a QI project surrounding wait times and how patients can be better informed about this. Any ideas? What, if anything, do other institutions use?

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[nexus73]

I am working on a QI project surrounding wait times and how patients can be better informed about this. Any ideas? What, if anything, do other institutions use?

For awhile I was seeing billboards with real time wait times posted for the local ED. Like show up and they'll see you in 23 minutes, that kind of thing.

 

[Dr Mantis Toboggan]

For awhile I was seeing billboards with real time wait times posted for the local ED. Like show up and they'll see you in 23 minutes, that kind of thing.

Pretty interesting Walmart is trying to keep their healthcare costs down and asked the hospitals around their headquarters in Arkansas to take them down. They didn’t want ED use promoted/incentivized. The hospitals ending up taking them down.

 

[Brigade4Radiant]

HCA door to doc metrics

 

[MechEDoc]

I am working on a QI project surrounding wait times and how patients can be better informed about this. Any ideas? What, if anything, do other institutions use?

The only place I've worked (~15 ERs) that did any sort of wait time notification was a lousy (in terms of care quality) hospital with a billboard clock.

Lots of places game the wait time by having someone "see" the patient (15 seconds from the doorway) early and enter some basic orders.

 

[sylvanthus]

I got nauseated and annoyed just reading the title. Yay metrics!

 

[southerndoc]

HCA door to doc metrics

Useless. Door-to-doc times can be fudged with screeners.

I look at the following metrics for throughput:

1. door-to-triage, door-to-room,
2. roomed-to-physician assignment (when the doc signs up for the patient),
3. physician assignment-to-order entry (for those that sign up, wait 20 minutes and then see patient),
4. physician-to-dispo,
5. roomed-to-dispo,
6. dispo-to-depart (how long for nurse to get patient out of department for primarily discharged patients, but also admitted),
7. depart-til-roomed (for bed turnover - my favorite; how long it takes to clean room and get the next patient back)

I can overlay nursing staffing, admission hold hours, etc. with LWBS rates, AMA, etc. We also track turnaround times (TAT) for CT's, CT reads, X-rays, labs, etc. We use Roundtable that automatically analyzes the data, provides box plots, etc.

 

[hundreddaysoff]

Useless. Door-to-doc times can be fudged with screeners.

I look at the following metrics for throughput:

1. door-to-triage, door-to-room,
2. roomed-to-physician assignment (when the doc signs up for the patient),
3. physician assignment-to-order entry (for those that sign up, wait 20 minutes and then see patient),
4. physician-to-dispo,
5. roomed-to-dispo,
6. dispo-to-depart (how long for nurse to get patient out of department for primarily discharged patients, but also admitted),
7. depart-til-roomed (for bed turnover - my favorite; how long it takes to clean room and get the next patient back)

I can overlay nursing staffing, admission hold hours, etc. with LWBS rates, AMA, etc. We also track turnaround times (TAT) for CT's, CT reads, X-rays, labs, etc. We use Roundtable that automatically analyzes the data, provides box plots, etc.

Random related question: I've observed at multiple shops that admin tend to care a ton about reducing ER LWBS rates to ridiculously low levels like <1%. Why do they care so much about LWBS? Eg, relative to AMA or eloped rates?

Party line from admin is always something like "all patients deserve to be seen in a timely manner". While it seems very noble of my admin to have this sentiment, I'm not convinced they really care that much as they are clearly all about the bottom line wrt other topics.

So, my theories about why LWBS actually matters so much are (1) significant amount of lost revenue on the table from actual LWBS patients, (2) actual paranoia that our hospital will draw the short straw and LWBS a patient who then strokes out and dies in our parking lot, (3) some obscure healthcare regulation that mandates tracking LWBS, or (3) second-order lost revenue due to LWBS patients trash-talking the hospital.

AFAICT, (2) is a very rare event assuming a decent triage team. I'm skeptical about (1), at least on nights when I work, because it just seems like most of our actual LWBS are patients who have very minor complaints and are not likely to have insurance or pay their bills.

 

[Brigade4Radiant]

Random related question: I've observed at multiple shops that admin tend to care a ton about reducing ER LWBS rates to ridiculously low levels like <1%. Why do they care so much about LWBS? Eg, relative to AMA or eloped rates?

Party line from admin is always something like "all patients deserve to be seen in a timely manner". While it seems very noble of my admin to have this sentiment, I'm not convinced they really care that much as they are clearly all about the bottom line wrt other topics.

So, my theories about why LWBS actually matters so much are (1) significant amount of lost revenue on the table from actual LWBS patients, (2) actual paranoia that our hospital will draw the short straw and LWBS a patient who then strokes out and dies in our parking lot, (3) some obscure healthcare regulation that mandates tracking LWBS, or (3) second-order lost revenue due to LWBS patients trash-talking the hospital.

AFAICT, (2) is a very rare event assuming a decent triage team. I'm skeptical about (1), at least on nights when I work, because it just seems like most of our actual LWBS are patients who have very minor complaints and are not likely to have insurance or pay their bills.

It’s about money also the fact that when someone saying they may be more likely to stay. Even if they leave shortly after you can still build them

 

[CoolDoc1729]

It’s about money also the fact that when someone saying they may be more likely to stay. Even if they leave shortly after you can still build them

My place is having us “see” people in the triage room and if we’re really really lucky they can have a lab draw and /or an X-ray and then to back to the waiting room. This allows our CMG to bill for us seeing them even though clearly we can’t do a thorough anything in the triage room. We’re in a current covid hotspot and having unprecedented LWBS rates ... like 20-30% 😦 We do tell people some nights that they’re probably not going to get a room in the next 8 hours, and many still stay to get a halfway decent workup in triage because the other area hospitals are just as bad 8-12-20 hour wait times ! Yikes.

 

[southerndoc]

Random related question: I've observed at multiple shops that admin tend to care a ton about reducing ER LWBS rates to ridiculously low levels like <1%. Why do they care so much about LWBS? Eg, relative to AMA or eloped rates?

Party line from admin is always something like "all patients deserve to be seen in a timely manner". While it seems very noble of my admin to have this sentiment, I'm not convinced they really care that much as they are clearly all about the bottom line wrt other topics.

So, my theories about why LWBS actually matters so much are (1) significant amount of lost revenue on the table from actual LWBS patients, (2) actual paranoia that our hospital will draw the short straw and LWBS a patient who then strokes out and dies in our parking lot, (3) some obscure healthcare regulation that mandates tracking LWBS, or (3) second-order lost revenue due to LWBS patients trash-talking the hospital.

AFAICT, (2) is a very rare event assuming a decent triage team. I'm skeptical about (1), at least on nights when I work, because it just seems like most of our actual LWBS are patients who have very minor complaints and are not likely to have insurance or pay their bills.

Yes, there are missed opportunities for lost revenue. However, the biggest push right now regarding LWBS is because it is a reportable measure to CMS and is listed on CMS' Hospital Compare website for every hospital just as ED arrival-to-departure is listed. It's an indirect measure of lengthy waits.

 

[sylvanthus]

Useless. Door-to-doc times can be fudged with screeners.

I look at the following metrics for throughput:

1. door-to-triage, door-to-room,
2. roomed-to-physician assignment (when the doc signs up for the patient),
3. physician assignment-to-order entry (for those that sign up, wait 20 minutes and then see patient),
4. physician-to-dispo,
5. roomed-to-dispo,
6. dispo-to-depart (how long for nurse to get patient out of department for primarily discharged patients, but also admitted),
7. depart-til-roomed (for bed turnover - my favorite; how long it takes to clean room and get the next patient back)

I can overlay nursing staffing, admission hold hours, etc. with LWBS rates, AMA, etc. We also track turnaround times (TAT) for CT's, CT reads, X-rays, labs, etc. We use Roundtable that automatically analyzes the data, provides box plots, etc.

Jesus, anything else you want to keep track of? Typing words per minute? Number of steps per physician per hour? Time to opiate script? Number of bathroom breaks per physician per shift?

With this kind of BS going on this specialty is fubared.

 

[GeneralVeers]

How about average waiting time for non-emergent garbage to sort itself out the door?

 

[RustedFox]

How about average waiting time for non-emergent garbage to sort itself out the door?

This is de wey.

 

[southerndoc]

Jesus, anything else you want to keep track of? Typing words per minute? Number of steps per physician per hour? Time to opiate script? Number of bathroom breaks per physician per shift?

With this kind of BS going on this specialty is fubared.

Yes, your posts per month.

 

[RustedFox]

Yes, your posts per month.

Oooh... shots fired? - Or good natured ribbing?

 

[RustedFox]

This is de wey.

 

[sylvanthus]

Yes, your posts per month.

Have fun contributing to the demise of the specialty.

 

[RustedFox]

Have fun contributing to the demise of the specialty.

I voted for "good natured ribbing"

 

[southerndoc]

I voted for "good natured ribbing"

With or without KY? LOL

 

[southerndoc]

Have fun contributing to the demise of the specialty.

These metrics have been tracked since the beginning of emergency medicine. Usually the only ones who complain about tracking these metrics are the ones who have difficulty with them. If you don't think your medical director for both the ER and ICU tracks these, then you're either misinformed or they are lucky to not have them asked for.

 

[RustedFox]

Have fun contributing to the demise of the specialty.

It officially died when that ACEP clown said right in his presentation: "We don't really need an ER doc; use what's cheapest."

That's a Peter Rosen-tier offense. Public Censureworthy.

 

[Siggy]

These metrics have been tracked since the beginning of emergency medicine. Usually the only ones who complain about tracking these metrics are the ones who have difficulty with them. If you don't think your medical director for both the ER and ICU tracks these, then you're either misinformed or they are lucky to not have them asked for.

I've seen ICUs monitor consult to time seen (or, more accurately, count the number of times/month consult->seen is >4 hours). I've never seen a "consult -> first ICU order" metric.

Of course much like the "door to doc" time and "door to first order" can be gamed easily, the consult -> seen can be gamed based on when the note is timed/started. It's a useless metric in that regards. I remember being slightly nauseated during my EM rotation with the "oh, just sign up for the patient as soon as they're available and put a simple order like UA based on their chief complaint... because METRICS! It doesn't matter if you can't see the patient immediately... by signing up and putting a simple order in, it looks like you're seeing the patient in a timely manner." Any metric that can be gamed is a useless metric. I find most ICU metrics to be more meaningful... namely length of stay and ventilator days.

 

[sunshinefl]

Useless. Door-to-doc times can be fudged with screeners.

I look at the following metrics for throughput:

1. door-to-triage, door-to-room,
2. roomed-to-physician assignment (when the doc signs up for the patient),
3. physician assignment-to-order entry (for those that sign up, wait 20 minutes and then see patient),
4. physician-to-dispo,
5. roomed-to-dispo,
6. dispo-to-depart (how long for nurse to get patient out of department for primarily discharged patients, but also admitted),
7. depart-til-roomed (for bed turnover - my favorite; how long it takes to clean room and get the next patient back)

I can overlay nursing staffing, admission hold hours, etc. with LWBS rates, AMA, etc. We also track turnaround times (TAT) for CT's, CT reads, X-rays, labs, etc. We use Roundtable that automatically analyzes the data, provides box plots, etc.

For #3, when I was on my ED rotation they gamed that by entering an obvious order immediately when signing up before seeing the patient. Like chest pain—> EKG, Abd pain—> NPO

 

[CajunMedic]

My place is having us “see” people in the triage room and if we’re really really lucky they can have a lab draw and /or an X-ray and then to back to the waiting room. This allows our CMG to bill for us seeing them even though clearly we can’t do a thorough anything in the triage room. We’re in a current covid hotspot and having unprecedented LWBS rates ... like 20-30% We do tell people some nights that they’re probably not going to get a room in the next 8 hours, and many still stay to get a halfway decent workup in triage because the other area hospitals are just as bad 8-12-20 hour wait times ! Yikes.

We’re doing this as well with a dedicated mid-level. D/C and put in the ED obs unit whatever they can. The rest wait on a bed. Our problem is excessive boarders and not enough nurses to keep the inpatient beds open.

Which led us to a new metric. We now have a “decision to admit” button for when we call whoever for admission. Stops our LOS clock and puts the onus on the admitting service to put the admission order in.

 

[docB]

LWBS is a big sore spot for me. Don't get me wrong. You shouldn't have too many LWBS and if you do there's a problem. I've seen places that had 15% or higher. I think that for most places somewhere between 3 and 5% is acceptable. They tend to be very low acuity patients or patients who would have been disruptive.
We did some things in the past to get down to about 1% such as seeing them in the WR or triage and changing the way assignments work. The biggest change that was effective was getting nursing to place people, chairs, triage, etc. and mark them as "ready to see" in the computer even if there's no specific place to put them.
My big gripe is that even at 1% we still get static about going lower which is stupid and counterproductive. This administrative idea that any metric can be better is just not true in reality particularly with this one. Here's why - once you start trying to capture LWBS under about 1% you start getting people who were not supposed to be registered into the ER in the first place. We've had docs running out to shake hands with people who were actually here for out patient labs or X-rays, here trying to visit a patient upstairs and directed to the ED sign in incorrectly, here to meet with someone like the nurse manager but were told to sign in on the wrong clipboard and on and on. You can imagine how happy these folks are when they get a level 4 bill from the doc and the facility. So then the site director or asst have to pull the chart, figure out what happened and vacate the bill. That kills about 45 minutes. And guess how those PGs read when they get picked for a survey.

 

[nexus73]

LWBS is a big sore spot for me. Don't get me wrong. You shouldn't have too many LWBS and if you do there's a problem. I've seen places that had 15% or higher. I think that for most places somewhere between 3 and 5% is acceptable. They tend to be very low acuity patients or patients who would have been disruptive.
We did some things in the past to get down to about 1% such as seeing them in the WR or triage and changing the way assignments work. The biggest change that was effective was getting nursing to place people, chairs, triage, etc. and mark them as "ready to see" in the computer even if there's no specific place to put them.
My big gripe is that even at 1% we still get static about going lower which is stupid and counterproductive. This administrative idea that any metric can be better is just not true in reality particularly with this one. Here's why - once you start trying to capture LWBS under about 1% you start getting people who were not supposed to be registered into the ER in the first place. We've had docs running out to shake hands with people who were actually here for out patient labs or X-rays, here trying to visit a patient upstairs and directed to the ED sign in incorrectly, here to meet with someone like the nurse manager but were told to sign in on the wrong clipboard and on and on. You can imagine how happy these folks are when they get a level 4 bill from the doc and the facility. So then the site director or asst have to pull the chart, figure out what happened and vacate the bill. That kills about 45 minutes. And guess how those PGs read when they get picked for a survey.

LWBS % goes negative when ED NPs start ordering CT pan scans on individuals just walking through the hospital parking lot.

 

[GeneralVeers]

LWBS % goes negative when ED NPs start ordering CT pan scans on individuals just walking through the hospital parking lot.

Just do what our one facility does: EKG every patient who walks through the door, and your LWBS rate goes down to zero.

 

[southerndoc]

LWBS is a big sore spot for me. Don't get me wrong. You shouldn't have too many LWBS and if you do there's a problem. I've seen places that had 15% or higher. I think that for most places somewhere between 3 and 5% is acceptable. They tend to be very low acuity patients or patients who would have been disruptive.
We did some things in the past to get down to about 1% such as seeing them in the WR or triage and changing the way assignments work. The biggest change that was effective was getting nursing to place people, chairs, triage, etc. and mark them as "ready to see" in the computer even if there's no specific place to put them.
My big gripe is that even at 1% we still get static about going lower which is stupid and counterproductive. This administrative idea that any metric can be better is just not true in reality particularly with this one. Here's why - once you start trying to capture LWBS under about 1% you start getting people who were not supposed to be registered into the ER in the first place. We've had docs running out to shake hands with people who were actually here for out patient labs or X-rays, here trying to visit a patient upstairs and directed to the ED sign in incorrectly, here to meet with someone like the nurse manager but were told to sign in on the wrong clipboard and on and on. You can imagine how happy these folks are when they get a level 4 bill from the doc and the facility. So then the site director or asst have to pull the chart, figure out what happened and vacate the bill. That kills about 45 minutes. And guess how those PGs read when they get picked for a survey.

It's nice to show administration the reality that LWBS goes up with increased admission boarding hours. One of the nice tools to be able to overlay the LWBS rate with staffing and boarding hours. It drives improvement in staffing (increased pay recently) and trying to fix the boarding problem.

I agree, a lot of LWBS patients could be handled in urgent care instead of the ED.

 

[docB]

It's nice to show administration the reality that LWBS goes up with increased admission boarding hours. One of the nice tools to be able to overlay the LWBS rate with staffing and boarding hours. It drives improvement in staffing (increased pay recently) and trying to fix the boarding problem.

I agree, a lot of LWBS patients could be handled in urgent care instead of the ED.

I agree but our admins have never reacted well to being told about how their staffing affects LWBS. Their consultants, hallowed be their names, their wisdom echos, have too them that LWBS is purely a provider issue, translation - it can be fixed for free as far as they're concerned. They love that idea so much they believe it no matter what we show them.

A lot of LWBS can go to urgent cares but a lot of it never intended to come to the ED and checked in accidentally. That's why going from 1% to 0.5% LWBS actually costs money. It takes a lot of admin time, ours and theirs, to negate those charts.

 

[GeneralVeers]

I agree but our admins have never reacted well to being told about how their staffing affects LWBS. Their consultants, hallowed be their names, their wisdom echos, have too them that LWBS is purely a provider issue, translation - it can be fixed for free as far as they're concerned. They love that idea so much they believe it no matter what we show them.

A lot of LWBS can go to urgent cares but a lot of it never intended to come to the ED and checked in accidentally. That's why going from 1% to 0.5% LWBS actually costs money. It takes a lot of admin time, ours and theirs, to negate those charts.

If they let us do proper MSE and turf patients who don't have emergencies we could get LWBS down to nothing. It would take me two seconds to tell the drug seeker, viral illness, or COVID patient with normal vital signs to hit the bricks.

Unfortunately every chart is money to the suits, and by making us actually see everyone and document an exam they have to accept a certain level of LWBS.

 

[RustedFox]

If they let us do proper MSE and turf patients who don't have emergencies we could get LWBS down to nothing. It would take me two seconds to tell the drug seeker, viral illness, or COVID patient with normal vital signs to hit the bricks.

Unfortunately every chart is money to the suits, and by making us actually see everyone and document an exam they have to accept a certain level of LWBS.

Not only that; but they take can this (or any) metric, get it "down to goal", and use that as an excuse to say: "Look how well I managed this process! Bigger bonus for me this quarter.

 

[Arcan57]

Any system where the patient is registered into the system prior to seeing a provider is going to have a non-zero LWBS simply due to the vagaries of human behavior. A clock-stopper in triage will significantly cut down on LWBS but most EDs are going to have that time where 10-12 check in in 15 minutes. 1 of those 10-12 is going to do some calculation regarding what they expected the rest of the day to look like and how this ED visit is going to effect that and nope out after signing in but before triage.

 

[docB]

Any system where the patient is registered into the system prior to seeing a provider is going to have a non-zero LWBS simply due to the vagaries of human behavior. A clock-stopper in triage will significantly cut down on LWBS but most EDs are going to have that time where 10-12 check in in 15 minutes. 1 of those 10-12 is going to do some calculation regarding what they expected the rest of the day to look like and how this ED visit is going to effect that and nope out after signing in but before triage.

Exactly! Which is why the goal for LWBS should never be 0. But try to get anyone at the administrative or regulatory level to understand that. It's futile. Another metric that should NOT have a goal of 0 is AMAs. But apparently that's going to be the next big push from my hospital company. Trying to beg patients who should leave AMA and punishing docs for any AMAs will clearly cause bad unintended consequences.

 

[turkeyjerky]

Exactly! Which is why the goal for LWBS should never be 0. But try to get anyone at the administrative or regulatory level to understand that. It's futile. Another metric that should NOT have a goal of 0 is AMAs. But apparently that's going to be the next big push from my hospital company. Trying to beg patients who should leave AMA and punishing docs for any AMAs will clearly cause bad unintended consequences.

Tenet?

It's hard to tell what the goal is there. I at least get that one could argue LWBS's are leaving money on the table, but why would an admin care about AMA? What an asinine idea.

 

[southerndoc]

Exactly! Which is why the goal for LWBS should never be 0. But try to get anyone at the administrative or regulatory level to understand that. It's futile. Another metric that should NOT have a goal of 0 is AMAs. But apparently that's going to be the next big push from my hospital company. Trying to beg patients who should leave AMA and punishing docs for any AMAs will clearly cause bad unintended consequences.

The way I see it is that one is opposite the other. The people who usually LWBS will simply sign out AMA and leave (or elope after screening). So you lower LWBS but raise AMA, lower AMA but raise LWBS.

 

[GeneralVeers]

Exactly! Which is why the goal for LWBS should never be 0. But try to get anyone at the administrative or regulatory level to understand that. It's futile. Another metric that should NOT have a goal of 0 is AMAs. But apparently that's going to be the next big push from my hospital company. Trying to beg patients who should leave AMA and punishing docs for any AMAs will clearly cause bad unintended consequences.

It's easy enough. When the patient wants to go AMA, the Charge Nurse gets the AOC on-the-phone at 3AM and they talk to the patient and try to prevent the AMA. It's a great way for administrators to directly affect a metric and their bonus.

 

[jhmmd]

LWBS is a big sore spot for me. Don't get me wrong. You shouldn't have too many LWBS and if you do there's a problem. I've seen places that had 15% or higher. I think that for most places somewhere between 3 and 5% is acceptable. They tend to be very low acuity patients or patients who would have been disruptive.
We did some things in the past to get down to about 1% such as seeing them in the WR or triage and changing the way assignments work. The biggest change that was effective was getting nursing to place people, chairs, triage, etc. and mark them as "ready to see" in the computer even if there's no specific place to put them.
My big gripe is that even at 1% we still get static about going lower which is stupid and counterproductive. This administrative idea that any metric can be better is just not true in reality particularly with this one. Here's why - once you start trying to capture LWBS under about 1% you start getting people who were not supposed to be registered into the ER in the first place. We've had docs running out to shake hands with people who were actually here for out patient labs or X-rays, here trying to visit a patient upstairs and directed to the ED sign in incorrectly, here to meet with someone like the nurse manager but were told to sign in on the wrong clipboard and on and on. You can imagine how happy these folks are when they get a level 4 bill from the doc and the facility. So then the site director or asst have to pull the chart, figure out what happened and vacate the bill. That kills about 45 minutes. And guess how those PGs read when they get picked for a survey.

Is there some larger organization that keeps track of AMA percentages per hospital? And do you guys think that there's a larger organization that tracks PGs per hospital, per physician group, etc?

 

[docB]

Tenet?

It's hard to tell what the goal is there. I at least get that one could argue LWBS's are leaving money on the table, but why would an admin care about AMA? What an asinine idea.

Good question and it is about money. This time it's about risk. The assumption is that there is a lot of lawsuit risk with AMA. This is true as you're starting with a situation where the patient isn't making a good decision and usually adding in some disgrunteledness (Yay! New word!). The problem is that they're going too far as usual, assuming the goal is 0 AMAs and that every AMA is a bad thing. That's just not the case.
I do think there are AMAs where we and the nurses could do better at exploring options and alternatives and find a way to avoid some of them. But we all know that AMA is often the best alternative for patients who are disruptive, hostile or unreasonable.

 

[GeneralVeers]

I love AMAs almost as much as I love elopements. In my opinion it gives me a free pass as far as patient complaints, and is better as far as legal risk. The riskiest patients for me are the ones who we have worked up fully, discharge and then miss the diagnosis. For an AMA I am free to write anything I want, and seem super reasonable and make the patient seem like the reckless one. I never try to talk patient's out of an AMA unless I a concerned they truly have a life-threatening condition.

AMAs feel like passing GO in monopoly and collecting $200.

 

[docB]

I love AMAs almost as much as I love elopements. In my opinion it gives me a free pass as far as patient complaints, and is better as far as legal risk. The riskiest patients for me are the ones who we have worked up fully, discharge and then miss the diagnosis. For an AMA I am free to write anything I want, and seem super reasonable and make the patient seem like the reckless one. I never try to talk patient's out of an AMA unless I a concerned they truly have a life-threatening condition.

AMAs feel like passing GO in monopoly and collecting $200.

What you said here speaks to some of the major problems in modern EM. Not with you. I too think of AMAs as a relief a lot of the time. It's that the patient's leaving AMA almost never have an actual life threatening condition. Yet the risk managers have the misperception that the majority of AMAs do. That's the disconnect between the view of those in charge who don't work in the ED and those of us who do.
Regardless the days of the easy AMA seem to be ending. We'll soon have to at least document how we tried to beg them to stay, tried to accommodate them and then called them after to try to get them to come back. Looks like we'll soon have a checklist we have to complete for all AMAs.

 

[hundreddaysoff]

What you said here speaks to some of the major problems in modern EM. Not with you. I too think of AMAs as a relief a lot of the time. It's that the patient's leaving AMA almost never have an actual life threatening condition. Yet the risk managers have the misperception that the majority of AMAs do. That's the disconnect between the view of those in charge who don't work in the ED and those of us who do.
Regardless the days of the easy AMA seem to be ending. We'll soon have to at least document how we tried to beg them to stay, tried to accommodate them and then called them after to try to get them to come back. Looks like we'll soon have a checklist we have to complete for all AMAs.

I've found that if I really want to keep an AMAing patient, the best way is to get their wife or whatever family they have to go in their room to yell at them.

Ironically, this often violates the bureaucrats' very own inflexible HIPAA and COVID-visitation rules. Especially if the patient is really sick or otherwise special.

 

[bravotwozero]

I don’t care about covid visitation rules and will allow one family member unless it’s actually a covid patient. Way too many run ins with upset family members about this or that for me to care. The hospital will throw you under the bus if some family member complains about not being allowed in, like they did to me.

 

[GeneralVeers]

I don’t care about covid visitation rules and will allow one family member unless it’s actually a covid patient. Way too many run ins with upset family members about this or that for me to care. The hospital will throw you under the bus if some family member complains about not being allowed in, like they did to me.

I think COVID rules are stupid in general (why are we worried about this communicable respiratory disease but not others?), however I use them to my advantage. If I have the typical 27 yo male with Marijuana-induced abdominal pain, I don't allow his enabling mother back to demand that he get narcotics, cuz "COVID".

 

[Apollyon]

I don't allow his enabling mother back to demand that he get narcotics, cuz "COVID".

But, don't you know that the COVID hurts, man? I mean, that loss of taste and smell is painful. Oh, wait - he doesn't have COVID, but, that anxiety, man - now that needs narcs! That **** is dolorous!