No one wants to spend nine hours in an Emergency Room on a Sunday. I have had too many experiences in ERs with unpleasant memories. I have allergies to most oral antibiotics and pain medications and react terribly to bee and wasp stings. Other people’s cars seem to be attracted to my cars, crashing into the sides, front, and back of a variety of relatively safe cars.


Loud, chaotic, screams, blood, anxious families, impersonal nurses, residents who have been working for eighteen hours, very uncomfortable beds and plastic chairs, long waits for everything, and an occasional police with a patients handcuffed to a bed. In other words, no fun.


I recently had spinal fusion surgery for S1 – L4 in my back. I was prepared for many of the aftereffects of the surgery: wearing a brace when my feet were on the ground, pain, muscle spasms, limited mobility, and difficulty sitting and standing. What I didn’t plan for was my miniature golden doodle, Lil Jake, to dash between my legs one afternoon and knock me over. As I felt him brush my pant leg, I knew I was falling and tried to hit the ground as least destructively as possible. I landed on my left knee and my left and right hands. My right leg did a back spilt.


The next day, I saw my surgeon, and he did x-rays. My fusion looked secure and no breaks showed up. I had additional pain for the next week and a half, but seemed to be recovering nicely. One morning, though, I tried to get up to let the dog out and my right leg buckled. I cursed my bad luck and went back to using the walker I had just recently stored out of site. That is how I ended up at the ER.


We decided which ER we wanted to visit. Not the only-trauma center in the area, or the closest hospital that rated only slightly worse than where I had the surgery. We chose the one where I had my x-rays done ten days previously.


Here is what made them good. They evaluated me quickly when they heard my story, saw I couldn’t walk, and listened as I described my pain as a ten on the one-to-ten scale everyone uses. (Yes, they put me on a bed in the hallway and gave my husband an extremely uncomfortable plastic chair.) The atmosphere was urgent but not frantic. Other than one man who screamed from pain several times, the noise level was reasonable. I was right next to the command center, so I wasn’t ignored. They proactively brought me extra blankets and ginger ale.


They kept me informed and shared their reasoning for each test. When one of the residents told us that they wouldn’t do an MRI on me on the weekend because they didn’t have a radiologist on staff on Sundays to write up a report, and I assertively said I thought I needed one, she asked her manager. After reading my past x-ray and listening to my recent history. They did a MRI. Every person who pushed my bed to and from the CAT scan and the MRI was pleasant, smiling, empathetic, and positive.


It took almost two hours for the staff to get my report. How they finally got the report was the important part. An obviously seasoned nurse knew MRI reports were outsourced on the weekend to a company not associated with the hospital chain. He explained the process to the doctor who had been impatiently checking the computer every fifteen minutes for the nineteen reports queued in the system. I watched this interchange from my bed that I had been in for eight plus hours other than to go to the bathroom or be taken for a procedure. The doctor listened patiently, thanked his co-worker, and printed my report. Within forty minutes of receiving the report, my doctor-of-the-day told me I had a sacral fracture, wrote up my release papers, and I was back in the car. In case you don’t know: forty minutes is fast for a discharge.


What made this ER that day a good one are the qualities highlighted in my story. Listening, proactive attention to the patient, clear communication, competent staff who appear to like working there and with each other so they know how things work, and a clear patient focus. These qualities don’t just apply to ERs, but to any medically related business. Unfortunately, that has not been my experience. What happened to total quality, patient focus, process improvement, and teamwork in medicine? This will be the focus of future columns: what I see is wrong with the system and what my suggestions are for how to improve. I want the first column to be a positive one!


Helene F Uhlfelder, PhD is a semi-retired management consultant with over thirty years of experience in small, medium, and large organizations from family owned businesses to Fortune 100 companies. She lives in Norfolk, VA has written multiple books including one called Common Sense Advice: Simple Stories for Success in Business and Organizations. She can be reached at