- Emergency physicians are committed to providing high-quality emergency care as quickly as possible to all patients.
- A federal report last year found that patients who need to be seen in 1 to 14 minutes are being seen in twice that timeframe (37 minutes) (GAO, 2009).
- An ambulance is diverted every minute in the United States, delaying care for critically ill patients.
- The gridlock in emergency departments is caused by “boarding,” not by too many patients with routine minor problems.
- Everyone is only one step away from a medical emergency.
Why do patients wait in emergency departments?
Everyone who comes to an emergency department will be seen, regardless of the ability to pay or insurance status. Studies show the reasons patients wait include:
- A triage process, which means critically ill patients are seen first and less critically ill patients must wait. In most cases, a triage nurse will assess the severity of a patient’s condition upon arrival, based on symptoms; personal and medical history; and vital signs, such as body temperature, heart rate and blood pressure.
- Boarding of patients. Hundreds of emergency departments have closed in the United States. At the same time, the number of emergency department visits have increased to 119.2 million in 2006 (up from 110.2 million in 2004). Many of the remaining hospitals lack capacity, which means critically ill or injured patients may have extended stays in the emergency department until hospital beds become available. This practice is known as “boarding,” and it is a major factor in overcrowding. Boarding also contributes to ambulance diversion and limits a hospital’s ability to meet periodic surges in demand, such as those from disasters.
- On-call physician shortages. Emergency physicians are available 24 hours a day, 7 days a week, but other medical specialists, such as neurosurgeons, cardiologists and orthopedic surgeons, provide “on-call” backup services as needed. An increasing number of these specialists are not available due to frivolous lawsuits, increasing premiums, inability to obtain insurance and inadequate reimbursement.
- Local crises and disasters. In an emergency department, many patients may arrive at once, needing immediate medical care. This can happen when multiple motor vehicle crashes occur and during natural disasters or local epidemics, such the recent H1N1 flu.
Can patients be harmed because of waiting?
- Long waits can affect patient outcomes. Patients may get tired of waiting and leave. Some patients may wait longer than optimal, but emergency departments work hard to make sure the sickest patients are seen first and all patients are seen in a timely manner.
- In 2008, 200 emergency physicians said they personally knew of patients who had died because of the practice of “boarding,” or patients waiting for their inpatient hospital beds.
- In 2006, the Institute of Medicine released reports, which found timeliness of care to be “a growing concern” that could “result in protracted pain and suffering and delays in diagnosis and treatment.”
How much time should you expect to be in an emergency department?
- If you have a minor illness or injury, and the emergency department isn’t crowded, you may wait 1 to 2 hours to see a physician. If you require extensive diagnostic tests, your visit may be longer because it will take time to obtain the results. If an emergency physician needs to consult with other medical specialists, your wait may be extended. If you need to be admitted to the hospital, you may wait until an inpatient bed is available.
- In 2007, U.S. emergency patients spent an average of 4 hours and 5 minutes in the emergency department, a 5-minute increase from the previous year (Press Ganey Associates, 2009). South Dakota had the shortest waits (165 minutes) and Utah had the longest waits (385 minutes).
- Almost 400,000 patients waited 24 hours or more; patients admitted to the hospital, or referred for drug or alcohol treatment, were in the emergency department about 6 hours on average. (Press Ganey Associates, 2009).
Do uninsured people and patients with routine problems increase waiting times?
Patients with minor problems do not contribute significantly to long wait times. An August 2006 study published in the Annals of Emergency Medicine found that “reducing the number of low-complexity emergency department patients is unlikely to reduce waiting times for other patients.”
What steps are being taken to improve customer service in emergency departments?
- Some hospitals have stopped “boarding” patients in emergency departments and move them directly to the floors after admittance, even if it means “boarding” in the hallways there. This spreads the burden of overcrowding throughout the hospital and often results in beds becoming available quicker.
- Some are decreasing waiting times by using such measures as registering people at bedsides, streamlining systems that speed specimens to laboratories, computerizing tracking systems, and developing alternative systems for improving patient flow and processing laboratory tests. Other hospitals are establishing fast-track systems to expedite diagnosis and treatment for patients with less critical conditions. Many hospitals are hiring patient advocates to improve communication, increase the flow of information and better address patient concerns.
- New technologies using rapid tests to evaluate patients have helped reduce waiting times. Some are using sophisticated computer systems to give complete, up-to-the minute status reports on every patient in every emergency bed. A few emergency departments have customer-friendly services, such as valet parking and computer outlets, and guarantees a doctor will see patients within specified amounts of time.
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