They left the hospital today at around 4:00 p.m. In case you're counting, that's almost 28 hours, which is close to four times the average wait of 7.2 hours.
You'll have to friend him on Facebook to see his posts, but he offers an interesting mix of his first-hand experience as well as a brief look into Grady's tumultuous history. The kicker? They have to go back tomorrow morning for a follow-up appointment.
After the jump are a few excerpts from the mother and son's "hell of a night." Sleep well, George. We hope tomorrow's wait is much, much shorter.
From this afternoon, around 1:30 p.m.:
To Grady's credit, they're not hiding their executives from patients. Dr. Leon Haley Jr., Medical Director of the Emergency Care Center at Grady Memorial Hospital, just stopped by to chat.
He cuts a dapper figure - a bit too dapper for my tastes. He looked like he was wearing a thousand-dollar suit. The sparkling purple squares in his mottled silk tie perfectly complemented the Prince-purple poc ket square in his jacket and the shining silver inlaid cufflinks on his tailored shirt. I never thought of a wedding ring as particularly flashy, but it looked like the fat gold band on his left hand matched the onyx-set gold ring on his right.
Ties are germ magnets in a hospital with a reputation for tuberculosis, Doc, I didn't say.
Still, he gave answers to a few pressing questions. The ER saw about 438 people last night. It's not clear how many were classified at a triage level three or higher, and how many were required to sit the whole 14 hour triage time. On a busy night, there will be four professors on staff, each with a team of residents. Typically, there are no more than 10 to 12 residents tending to patients in trauma and urgent care.
There's still no good explanation for how the walk-in clinic could benefit the typical patient with an acute illness and no easily understood cause. These people are punished by the current triage regime. Haley said that the walk-in clinic was designed for folks looking for refills for their medications and the like. It doesn't have an X-ray or ultrasound capability. Anything even remotely complicated goes to the ER.
From today, around 10 a.m.:
Among the questions I asked the Director of Emergency Care Services, Michelle Wallace was this: given the risk of adding four to six hours of wait time for no additional benefit, why would anyone rationally choose to use the walk-in center of Grady Hospital and not the main ER? She had no answer. She sort of hemmed and hawed around the reduced caseload on Grady's main hospital ... but that doesn't address the question.
"Well, every case is different. Most people don't end up having to come over here."
Well. Sure. Maybe.
You've introduced a risk into the system, where the patient bears the burden of assessing that risk. If someone is dead certain they've got a minor-league medical problem, they'll be well served by using the walk-in service, where they'll be out in a few hours. But if you really do have a minor-league problem, you're also much less likely to come anywhere near Grady.
The walk-in clinic looks to me like it's going to be for people who lack insurance and have a borderline or hard-to-tell problem from the perspective of the patient. A wrong guess by the patient is more likely, or it should be.
Which, of course, leads to an entirely different set of questions. If the portion of patients directed to Grady's main services is relatively small, even though the application of adverse selection might indicate a greater-than-expected likelihood of a higher rate of more complicated problems, then ... is the clinic under-treating patients? I'd be very interested in looking at the rate of later complication and readmission among patients with first contact at the walk-in clinic.
Grady has a reputation, borne of many years of treating the indigent and the wounded soldiers of Atlanta's gang wars of developing some of the very best trauma surgeons and general practitioners in America. Grady relies almost entirely on Emory University School of Medicine and Morehouse School of Medicine to provide doctor and resident staffing. A doctor who has cut his or her teeth at Grady can expect to go on to a respected position either at Grady, another hospital or in private practice.
That said, the hospital itself has been bowing under the weight of the serious burden of underinsurance in the Atlanta population for years. The hospital has traditionally run a serious budget deficit - at one point in 2008, the hospital's $53 million budget shortfall threatened cuts to the emergency room services and its level one trauma designation. Only a public outcry from Atlanta's black community, the business community ... and from NASCAR fans fearful of losing the race because there wouldn't be a suitable hospital to treat crash victims ... saved it.
A coalition of business folks have been fighting to turn it around as a formal nonprofit organization since then. And the general verdict has been that the turnaround has been successful from a financial perspective.
But that doesn't make the experience of sitting in Grady's raucous intake waiting room any more pleasant.
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