After seeing the nice spacious layout, friendly communication, standing floor orders of the Miracle Hospital in Augusta last weekend, I was nothing but frustrated today at scattered charts all over the department…the only way we have of keeping track of who we see. No patient tracking board of anytype. Sure, we have an electronic schedule, but there is no way of seeing who is taking care of what patient, who is in the waiting room, who has been seen in triage, who has been placed in a room, etc, etc. I waste endless time retrieving my charts from the desk clerk’s area and collecting and organiznig the charts that I have. Desk clerks put their complete charts in different places, some on the edge of their desk, some in a rolling cart with numbered folders, some bring them back to my desk… I like them the best! Another peeve is our overhead paging system…numbers for the line that’s waiting. If you’re in a patient room, half the time you can’t hear. If the patient happens to be talking, it’s rude to interrupt. Heck, today, we were discussing a patient with the staff doc, and we couldn’t get HIM to stop talking so we could hear the number. So what happens if you don’t catch the number? YOu call the ED yourself, they put you on hold, get your number subtract one and page it overhead again. By then there is a good chance that the caller has hung up. Sometimes you have so many things going on at once, you have no idea who is callign you about what. If you pick up a call in the back hall, you can’t answer questions about your patient who’s chart is lying in the desk clerk’s box. And finally, and endless pet peeve are the bad, bad layouts of the patient rooms. It seems like it’s always impossible to find an ear speculum, or the power isn’t working, or the bed is against the wrong wall, or the patient’s spouse is in one chair, and their clothes are on the rolling stool that I usually use. Every one of these inconveniences is a delay in doing productive work…seeing patients, looking at their past history and most importantly, MAKING DECISIONS about their care. This aspect is the most underappreciated in emergency medicine. We are constantly making decisions that affect lives in many ways…but with all of these interruptions & annoyances, it seems like there is no time left to do the things that are most important for patients. How do other people deal with all this CRAP?