A Visit to the ER

Think of the last time you visited an ER.  Were you sick?  Were you involved in an accident?  Most people know which hospital they will visit in case of an emergency.  Their insurance covers them at certain facilities, so they always keep that in mind.  Throughout my life, I’ve visited the ER for many different reasons from dehydration to a broken hand or an infected bee sting to a severe sore throat.  I know what it is like to sit in pain for hours waiting on my name to be called.  It is frustrating, uncomfortable and makes me wonder what can be done to change things.  In this post, I will answer three questions about the Emergency Department and give solutions to many of the problems that prevail in ERs across the US.

The ER at Denver General (AKA Denver Health Medical Center)

First of all, why do people spend so long waiting to be treated in an emergency room?  It is quite frustrating to arrive at a hospital, spend so much time to find a parking space, locate the ER, give out all your insurance information and be asked to wait for an unknown amount of time in a crowded ER lobby.  However, one must view this frustration from a different angle.  A hospital must make money to stay in business and they don’t make much profit from operating an Emergency Department (most of their revenue comes from other departments within the hospital).  The ER is a very fast paced environment.  There is flu season, major traffic accidents, ambulance diversions or infectious epidemics where the patient load may seem unbearable.  The ER is also not like any normal doctor’s visit.  People don’t schedule appointments; they simple arrive because their needs require immediate attention.  There is also the triage process that determines which patients need to be seen first.  For example, two people might arrive at the same time.  One is showing signs of shortness of breath and chest pain (symptoms of an MI – heart attack) while the other has a bleeding cut on their hand.  Of course, the person with MI symptoms will be seen first as their situation is more urgent.  There are also lab tests where the results take time to determine, specialist doctors who need to be consulted and radiology scans that need to be interpreted.  All these factor in with the overall ER patient wait time (Wayne Memorial Hospital, 2009).

160614-denver-health-kevinjbeaty-09In an e-mail, I interviewed someone who works in ER and asked her the above question.  She answered with:

“[There is] one reason [for long ER wait times].  I think there are too many people that use the ER as their Primary Care Physician.  Those that really need to be seen are waiting for those that have a cough or a stomach ache.  Second, maybe there aren’t enough doctors on schedule,” (Lewis, 2012)

This only further confirms that people visit the ER for different needs that require much different care.  There is also the fact that there are not as many ER doctors because in reality, they make much more money working in other specialties.

The next question is: would it be more efficient if there were sufficient doctors available so that people could be treated right away?  This ties in with my interview from the last question.  Ms.  Lewis also agreed that there is a shortage of doctors who work in the ER and that greatly contributes to the long waiting lines (Lewis, 2012).

In Canada, healthcare is run by the government.  Because federal regulations and tax payer money contributes to physician salaries, the supply of ER doctors remains the same despite the increase in patient demand.  At Victoria General Hospital in British Columbia, they need a total of four additional ER doctors.  As a result, patients are not receiving enough care and many may become sicker or even die.  Negotiations were underway with the government to ask for more doctors but have since stopped.  Instead, the government added a patient care tower to Royal Jubilee Hospital, another major hospital in town.  This did not solve the problem and left both patients and ER doctors at Victoria General very frustrated.  Patients will continue to wait longer and their safety will be compromised as a result.  The ER doctors at Victoria General did not go on strike; they just wanted the public to become aware of the crisis.  In the city of Victoria, thirty additional doctors are needed to care for an increasing patient load and the problem is not going away (Hudson & Hartland, 2010).

Ontario ombudsman Andre Marin will issue a special report on hospital emergency room closures on Tuesday. (Canadian Press)

The last question is: What other solutions could or should be implemented to reduce ER wait times?  According to my interview with Ms. Lewis:

 

 

 

“They could triage and treat the ‘non-emergent’ issues at a separate location,” (Lewis, 2012)

This is probably the number one reason for long wait times at an ER.  The reason for an ER visit might be as simple as a headache that won’t go away or stomach cramps.  These issues and symptoms are clogging the lines and making it increasingly difficult for other more seriously injured patients to be seen quicker.  A solution to this problem may be that patients with less urgent needs will need to visit an urgent care center.  As a result of the increasing demand for urgent care centers, more than 600 opened in 2011.  This greatly reduces the load on hospital Emergency Departments and shifts the focus back on emergent patient care (Galewitz, 2011).

On my way to work, I pass by a digital billboard for Swedish Medical Center that displays (in real time) the average ER wait time.  Some days, it is twenty minutes.  Other days it says forty-five minutes.  The issues with long waiting lines at hospital ERs is not anything new.  There are many factors that contribute to this.  People with less emergent needs who visit an ER instead of calling a nursing line or scheduling a regular doctor visit and the shortage of ER doctors are among the top reasons.  However, the emergence of Urgent Care Centers across the US and hospitals opening less than emergent care community clinics have greatly reduced the pressure on hospital Emergency Departments so they can concentrate on those who require true emergency care.  If this trend continues, it will be a model for other countries and future hospitals to practice.

420110720165642003_5254673_ver1-0_640_480
Mercy Health in Knoxville, TN shows ER wait times

References

Wayne Memorial Hospital. (2009). Emergency department frequently asked questions. Retrieved from

http://www.wmh.org/PatientsVisitors/default.aspx?category_id=266

Hudson, M., & Hartland, L. (2010). Emergency room doctor shortage [Web]. Retrieved from

Lewis, M. (2012, June 15). Interview by D White [Personal Interview]. Interview for school assignment.

Galewitz, P. (2011, December 7). Health law may accelerate growth in urgent care centers. Kaiser Health News. Retrieved from

http://www.kaiserhealthnews.org/stories/2011/december/08/health-law-urgent-carecenters.aspx

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