With all of the trauma and transfers coming into the Accident Room, Charity was always busy and there was always a bed crunch. Another compounding factor was a rule at Charity that any patient that was clocked in by the triage nurse during your 24 hour call time, was your patient, no matter how long you had to wait to treat them. All new patients coming into the emergency room were clocked in by the triage nurse. When you were on call, you were responsible for every patient that needed your care from 7am when call started until 6:59 am the following day. The call responsibility alternated each day between Tulane and LSU services, so there was no way to pass on a patient to the next service, they were yours.
Frequently, Charity would just get completely full. All beds on the wards were taken, but there was still a full Accident Room of patients needing surgery. This was often on a Friday or Saturday night, but could happen any day. When the wards were full, the ICU and Recovery Room had nowhere to send patients to make room for the new trauma patients, and the whole place, except the Accident Room would come to a standstill. Even when the Charity ER went on diversion, meaning no ambulances could stop there, patients would still arrive. It was not unusual to have a car drive up on the Accident Room ramp and drop off a gunshot victim and just drive off.
This called for some resident creativity. Many times during my orthopedic training, I had this same conversation with a postoperative patient on a ward. It would usually happen around 3 or 4 in the morning. I would wake the patient up and say “It’s time to leave the hospital.” I was usually putting together some crutches while talking. I would quickly show them how to use the crutches and tell them when to come back to the orthopedic clinic. They would finally wake up and say “Doc, its 4 in the morning, I can’t leave now.” I would explain the situation, that we had patients, just like him in the Accident Room that needed emergency surgery. The Operating Room and Recovery Room were full, and to open back up, needed an empty ward bed to transfer a patient. The patients would complain, that they didn’t have a ride. I would send them down to the 24 hour café in the front of Charity, nic named the Fistula because it never closed. Their ride could come later. It was not a great solution, but the only solution we could come up with.