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Why Does an Emergency Room Visit Take So Long?

One universal complaint among patients today is that the wait to be seen or the time one stays in the emergency rooms of hospitals is so long. This has been an issue for a while but it appears to be getting worse. The questions are “why?” and “what can be done about it?”.

First understand that emergency rooms (ERs), also called emergency departments (EDs) and emergency wards (EWs), are a microcosm of the health care system. Also know that 70 percent to 80 percent of hospitalized patients come in through the ER. That is a huge number. There are so many factors that are at play in delays related to this area of the hospital it is hard to know where to begin.

The ER is the major gateway to the hospital. This gateway is being impacted by:

  • An aging and more chronically ill population.
  • A shortage of nursing and ancillary staff.
  • A relative shortage of doctors.
  • A policy that forbids turning anyone away from the ER for care.
  • Triage—the system by which a member of the staff (usually the triage nurse), assesses the severity of a person’s condition and allocates the speed and intensity of care accordingly.
  • Obamacare, which has given many more Americans access to the hospital.
  • The fact that people are using the ER as a main source of their primary care, either because they don’t have a doctor or they cannot see one soon enough because of delays in getting appointments.

These are all major factors as to why ERs are so overcrowded, understaffed and full of waits and delays.

Another factor is that hospital beds are in demand, and in order to admit a patient to the hospital, a bed must be made available. This does not always occur in a regularly smooth way, and delays are inevitable.

When one realizes that in a given community, one-quarter of the population in any given year will visit the ER as a patient, it is not difficult to see why access to timely ER visits is a problem. In high tourism areas the number increases to one-third of the population.

Once in the system, other problems arise that are representative of the complexity and multifactorial reliability of the cogs in the hospital machinery. A patient finally gets admitted, may need lab tests (one source of potential delay), a CT or MRI scan (another source of delay), may need to be seen by a specialist (still another delay), may need intra-ER procedures to be performed (insertion of IVs, insertion of bladder catheters, nasogastric tubes, suturing of wounds, transfusion of blood, the list goes on) and finally, has to wait for a bed to open up in the appropriate area of the hospital.

That means that many times the ER ends up being its own ward, a boarding area to handle all of the overflow that is an inherent result of the system.

And guess what? All this leads, as one might expect, to a high burnout rate among all the members of the ER staff. This burnout serves only to exacerbate the problem and the vicious cycle continues.

So, what steps can you take to help yourself and others who truly need the ER? Consider this:

  1. Avoid, if at all possible, using the ER as a primary care venue.
  2. Try as best you can to schedule doctor office visits well in advance. Also, choose doctors, if possible, whose schedules are more open, even if it means driving extra distances.
  3. Consider telemedicine options and email to get care, if your doctor or insurance company offers that.
  4. Be very specific when talking to the triage nurse about the severity of your symptoms. This is crucial in proper and more rapid allocation of care.
  5. Always carry your essential information—insurance card, brief medical history, a list of medications and allergies and sensitivities with you so there are no delays when you go to the ER.
  6. Have a patient advocate, a spouse, family member or friend, who can assist you, if possible, in dealing with the process.
  7. Take better care of yourself so you won’t get sick. I mean this—this is not a joke! Lose weight, stop smoking, meditate, exercise and keep your friends close. This is the best strategy of all, and most of it is free!

For more with Dr. Sherer, click here for his podcast and video interviews.

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David Sherer

Dr. David Sherer is an American physician, author, writer, bloger, medical-legal and patient safety expert.

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