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Oct 2016

Waiting Room Good News for Stomach Pains

Every parent’s worst nightmare happened to my wife and me. Our young son, many moons ago, woke up in the middle of the night at a hotel near Disneyland screaming in excruciating pain. He was completely hysterical and could not communicate what really hurt. It appeared he had a bad stomach pain. Not knowing the Anaheim area, we prepared to rush our son to the nearest hospital with an emergency room.

Even today, most people with severe abdominal pains rush to the ER. Many logically think they are having appendicitis. The good news is that a recent study found that adults who came to a Los Angeles County emergency department (ED) complaining of abdominal pain had shorter stays if tests were started while they were still in the waiting room.

In the randomized trial of 1,659 non-pregnant adults, a hospital’s initiating of diagnostic testing in the ER waiting room reduced the overall time spent in an ED bed, total ED time, and the rates of leaving before completion of service, a report online in the Annals of Emergency Medicine stated.

The test subjects were briefly screened in the waiting room. The stable patients were assigned either to quick, medical evaluation with waiting room diagnostic testing (WRDT) or to rapid medical evaluation only. In the WRDT group, laboratory and imaging studies were ordered at the discretion of the screening provider.

The study’s primary outcome, the time in an ED bed, was significantly shorter in the WRDT group (245 vs. 277 minutes). Even more significant was the total ED time from arrival to disposition (460 vs. 504 minutes).

Altogether, a total of 181 patients left before completion of service, including 78 of 848 patients in the WRDT group and 103 of 811 controls (9 percent vs. 13 percent).

The next logical question: Could the findings be extended to all ED patients and not just those with abdominal complaints? Many physicians think that day is coming.

Dr. Howard Mell, an ER physician in Winston-Salem, N.C., and a spokesperson for the American College of Emergency Physicians, told Reuters Health that this recent study “is a great example of a public health solution that solves medical problems.”

Dr. Mell previously worked in an institution that used diagnostic testing in the waiting room to reduce congestion. His only concern is the fear of over-testing. But most physicians concur that the over-testing percentages would be miniscule with the patient benefits far outweighing any possible negatives.

As for my infant son’s stomach-pain episode, no testing was fortunately needed. While a young overnight clerk in the hotel lobby frantically looked in the Yellow Pages for a nearby hospital, our son let out a Buddy the Elf-like belch that ceased his tears and produced a slight grin across his face. If only all of life’s pains could be cured with a burp and a smile.

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