Friday, January 18, 2008
Steps along the Road to Reform
Earlier this month, wife Marilyn experienced a small stroke (from which, happily, she has had a great recovery).
It was late afternoon on Saturday when we realized what had happened and went to the emergency room of South Shore Hospital. Within a few minutes, she had been received, registered, and called by a triage nurse who carefully recorded her symptoms and their history and performed a simple examination. When it became clear that the symptoms had first appeared unrecognized on the previous day, the situation was no longer one of immediate emergency. Nevertheless, the nurse ordered a CAT scan (to rule out bleeding and tumors), some lab work, and an EKG, all of which were promptly performed and reported out.
Not so many years ago, nurses would not have been authorized to order these tests. Only a doctor would have been allowed to do it, which would have involved a potentially harmful delay – time usually being of the essence in the treatment of stroke patients. So having the nurse do it was a step along the road to reform.
Marilyn was then put in an exam room, where she was seen first by the ER nurse (who had by then received the results of the diagnostic work) and two hours later by the emergency physician who conducted her own examination and announced that Marilyn would be admitted to the hospital for monitoring (a small stroke is often followed shortly by a large one) and seen by a neurologist the next day.
Thinking about it later, I’m sure that having finished her work, the triage nurse knew exactly what was going to happen. She could have arranged the admission and notified the neurologist right there and then.
I predict that before long, she will be allowed to do so and still another step will have been taken on the road to reform.
Earlier this month, wife Marilyn experienced a small stroke (from which, happily, she has had a great recovery).
It was late afternoon on Saturday when we realized what had happened and went to the emergency room of South Shore Hospital. Within a few minutes, she had been received, registered, and called by a triage nurse who carefully recorded her symptoms and their history and performed a simple examination. When it became clear that the symptoms had first appeared unrecognized on the previous day, the situation was no longer one of immediate emergency. Nevertheless, the nurse ordered a CAT scan (to rule out bleeding and tumors), some lab work, and an EKG, all of which were promptly performed and reported out.
Not so many years ago, nurses would not have been authorized to order these tests. Only a doctor would have been allowed to do it, which would have involved a potentially harmful delay – time usually being of the essence in the treatment of stroke patients. So having the nurse do it was a step along the road to reform.
Marilyn was then put in an exam room, where she was seen first by the ER nurse (who had by then received the results of the diagnostic work) and two hours later by the emergency physician who conducted her own examination and announced that Marilyn would be admitted to the hospital for monitoring (a small stroke is often followed shortly by a large one) and seen by a neurologist the next day.
Thinking about it later, I’m sure that having finished her work, the triage nurse knew exactly what was going to happen. She could have arranged the admission and notified the neurologist right there and then.
I predict that before long, she will be allowed to do so and still another step will have been taken on the road to reform.
