Night and Day: A Tale of Two Emergency Departments (EDs)

Debra L. Glasser, M.D.

PHOTO BY GLORIA TOWNE

A JOLT OF HEALTH

Reflections on a trip to Olympia’s only trauma emergency department

The piece I wrote about my son’s visit to Providence St. Peter’s ED hit a sensitive nerve in this community.  

This weekend I was called to support my son’s girlfriend (Lil) after her trip to an ED for a sudden and serious condition while he was out of town.  Though they live in South Seattle, she works and has a primary care physician in Bellevue associated with Overlake Medical Center. Successful in reaching her PCP on a Sunday afternoon, she was advised to go to the Overlake ED.

Despite being in intense pain, this tough young woman drove herself across Lake Washington, where a good friend met her to provide companionship and emotional support.  I drove up early Monday morning to be with her until my son, Elan, flew home.

Here is Lil’s brief report of the ED experience:

“It was like NIGHT and DAY compared to Elan’s experience at Providence St. Peter’s ED.”

She was one of the 4-family and loved one contingent that sat in the waiting room through his 7+ hour ED ordeal.

“The nurses were chipper and upbeat, freshly starting a new shift.”

Despite being told the wait time was 3 hours, she was seen in 2. The diagnostic tests were ordered and done promptly. An IV was placed and she was not allowed to eat or drink in anticipation of possible surgery.  She was given morphine promptly after triage, which finally offered relief after >24 hours of unremitting and intense pain.

She was admitted with an MRI ordered to confirm the diagnosis. That test was to be done as soon as the MRI machine was available, sometime in the middle of the night.

Upon my arrival early the next morning, I learned that she was not actually ‘admitted.’ She was in a lovely private room in the ED observation unit (see picture). There she was assigned a CNA (a nurse’s aide who took vital signs, responded to her call light, removed her IV, and transported her to the main entrance upon discharge), an RN, and a Physician’s Assistant (PA). A PA oversees this unit 24/7 where they attend to the patients, review the pending diagnostic tests, and consulting with the covering MD (in this case a gastroenterologist) regarding the care plan. I met every one of these staff members on both the ending and starting shifts. Each was calm (i.e., not overwhelmed and frazzled), available to help with my questions and Lil’s needs, knowledgeable of her case, and developing a plan. The PAs were willing to talk to me about the details (with Lil’s permission of course) of the evaluation in progress.

Fortunately, the pain abated, and Lil was approved for discharge with a follow-up visit within a few days.

Smooth, thorough, and safe.

Pain managed, a room to rest in overnight, a CNA available to triage call lights and assist the skilled nursing staff.

I made inquiries with several staff about the hospital. Who owns it? No one was sure! However, I learned that Lil’s young RN had started working at a hospital south of Bellevue and close to where she lives. Finding the facility unsatisfactory, she chooses to commute to Overlake, where she is happy, satisfied, and intends to stay.

As I was leaving with the patient now in my son’s care, I stopped at the front desk to inquire about her car, which would be in the parking garage for at least a few days until her condition stabilized.  The staff member assisting me immediately emailed security (who oversees the garage) about the situation. He reassured me that there would be no cost incurred for leaving it as long as needed and not to worry.  He was friendly, helpful, reassuring, energetic, and upbeat.

 I shared with him and his co-receptionist how impressed I was with the whole experience at Overlake. They too, love working there and commute from points south.  Neither knew who owned the facility, though they knew it was not associated with any large healthcare system in the area (e.g.  Providence Swedish, Franciscan, MultiCare, or the University of Washington Medical Center).

In the lobby, I noticed a young man of high school age with a volunteer tag wheeling a patient around. Ah…volunteer transportation.  Remember Candy Stripers? In the day, this was a volunteer opportunity for young people to help and experience working in a hospital. In my senior year of high school, with the intent to explore if working in healthcare was for me, I volunteered in the local ED. Assigned to stretcher duty, I transported patients on stretchers, washed them after use, disposed of the dirty linens, etc. While there, I had permission to observe much of the goings on.  I loved it! 

I did not perceive a single Overlake staff member to be disgruntled or overworked. All had time for Lil’s and my questions.

It was apparent that I was experiencing a work culture in which staff satisfaction (and in our case, patient satisfaction) is high.  This imbued the entire stressful ED experience with feelings of ease, relief, and gratitude.

Senior man talking with a medical receptionist

This was Lil’s Night and DAY.

I review, in brief, the NIGHT of my son’s 7 hours at Providence St. Peter’s ED on an extremely busy night. Arriving by ambulance notwithstanding, triage and pain management of his excruciating acute fracture/dislocation was delayed for a myriad of reasons. Intervention on his behalf involved my insistence on more immediate action with the support of the triage physician, conflicts Elan unnecessarily witnessed in his state of distress. There was no ED staff available to move him from the ambulance stretcher to a wheelchair (required for triage), carefully re-position his unstable arm, offer him a cool cloth when in shock from pain, or accompany him safely to the car upon discharge. Gratefully, two exhausted RNs offered to stay overtime to assist with the procedure to reduce the dislocation. Both physicians attended to him (triage and the physician performing the procedure) and transported him without staff assistance.  

A CNA and volunteer could have helped relieve these busy and overworked doctors and nurses. That said, even more robust staffing could not solve the lack of space for patients to be seen, triaged, and held for observation in a more expeditious manner.

What is different about Overlake?

Overlake is an independent community hospital that was established in 1953. Its history and story will be in part 2 of this series on my healthcare resource vision for Thurston County.

A smiling Asian nurse helping a patient check her temperature.

Why do I keep harping on this topic? I have a dream.

Maybe I am a naïve optimist with a pie-in-the-sky pipedream.  I believe that our community, the capital of the state, home of the governor, our state government, and our agencies deserve the much-needed additional healthcare services we currently lack. Our community's hospitals, EDs, nurses, allied healthcare workers, and doctors are overwhelmed.

Though we are a small community, according to national polls, Olympia ranks as a most desirable place to live. We are a fascinating, diverse, growing, and aging community.  It is my hope there is a way for us to manifest and create an organization and the resources to fill the healthcare needs of everyone who lives here.

How might this be possible? I want to take and share a good look at Overlake. It is unique in these times and in the PNW. This will include how it came to be, what they are doing to create such a positive healthcare environment, and answers to many more questions.  However, this is Part 2 of this story.

Stay tuned, keep reading, and hold a vision with me for all of us!

Debra L. Glasser, M.D., is a retired internal medicine physician who lives in Olympia. Got a question for her? Write drdebra@theJOLTnews.com