How can you make an ED more chaotic?

Remodel it, that’s how!

My ED is a busy place, with about 75, 000 visits a year, so there’s hardly a dull moment. As with most ED’s it hasn’t had one coordinated ED rebuild, so it exists as a series of added-on areas and hallway beds to manage the capacity.

Then the fun starts: the ED had enough money to remodel the busiest area of the ED, with new floors, a new central work area, etc. From the drawings it’ll give us a ton more work space using the same floor area. That’s the pleasure.

Here’s the pain: the contractor initially wanted to do about a quarter of the area at a time, and projected they’d be there through February (!). ‘Uuh, no,’ said the Powers That Be, ‘how about we give you the entire area for one month and you get it done and outta here before flu season.’ So, that’s what we’re doing.

The best quote of what it’s like is from one of my favorite nurses: “I just act like it’s a new job: I know how to do things but don’t know where anything is”, which pretty much sums it up.

The best part is that I haven’t heard any actual griping about it, which is remarkable from this collection of characters. We’re all in the same boat, and there is a payoff.

But it’s more chaotic than usual.


  1. Our ER is sorely in need of an update. The administration keeps saying, we’re next, but then they go ahead and re-do the surgery suites or the ICU. But, supposedly we’re next again :)

  2. When an ER in which I worked was being replaced, they moved us into the new ICU they’d just built (the ICU proper could stay in their old unit awhile longer). It worked okay…except ICUs aren’t generally located near large waiting rooms. Our triage station consisted of a desk and folding chair about 100′ down a hallway from the ER, leaving the triage nurse, some paramedics and some security guards to manage the waiting room out of sight of the rest of the team. As I understand, being triage nurse is usually isolating and stressful as is. A typical shift for us would be: go to work, see ten patients or so, run outside and bring the triage nurse a coffee and an ancouraging word, go back inside, see eight more patients, run outside and give the triage nurse an ativan, go back in, try to find a new triage nurse “just for even half an hour,” see two more patients, go back outside and give the triage nurse an antipsychotic.


  1. GruntDoc says:

    Survivor: ER!

    I wrote a week or so ago that we’re remodeling a big chunk of our ED, and the controlled chaos resulting. The hospital and the docs agreed we should keep caring for the same number of patients (which is code…