NEWARK, NJ – Grace Regional’s ER physicians complained to leadership for years about the excess number of patients going to the ER for non-emergent conditions like headaches, colds, and rashes. Leadership heard their voice and implemented a mandatory new vital sign: rectal tone checks.
“Rectal tone is an important indicator of neurological status,” remarked Dr. Bowe Ells. “When the patient can clinch and has a good reflex, we know the spinal cord is fully intact. Other vital signs address the status of the respiratory and circulatory systems, so including one that assesses the neurological system makes sense. Additionally, patients find this uncomfortable and embarrassing, so if someone comes in with the sniffles, they may reconsider stopping up our ER unnecessarily and just go home.”
A new sign is posted in the triage room, reminding nurses to make their patients “wink” at them during the triage process. Nurses protested the new rule, claiming it wastes time arguing with the patient about why it needs to be done. However, their protests have fallen on deaf ears. Patient visits have declined steadily of the last several months, mostly with non-emergent cases. “We still see the normal chest and abdominal pain,” said Dr. Ells. “Fewer cases of the common cold come in here now. They go to Urgent Care for work notes or just suck it up.”
Many patients loyal to the hospital have left since implementation. Despite the rapid expulsion of patients, average patient satisfaction scores have remained steady overall. Interestingly, patients no longer gave mediocre reviews, but either gave very low reviews of their experience because of the new rule, or very high reviews, citing how much they enjoyed the new test.