Why Are the Waits So Long in the ER?
Across America, the average emergency room wait time is 3 hours and 42 minutes. Yeah, that's right. Most people don't really care about why, and I can't really blame them. Let's face it, being sick sucks. You just want to feel better! But there are reasons for the long waits, and today I'd like to talk about why.
Triage is the first step of the emergency room process. It's where a nurse checks you in and out. Patients are prioritized based on the severity of their condition. It is not first come, first serve. If you have a stuffy nose and a cough, you can bet a person with chest pain, severe trauma, or a lost limb is going through those doors before you. Yes, pain sucks, but someone else may have a life-threatening problem, which takes priority over another persons ouchie. A nurse will take your vital signs and ask about your symptoms. If something is out of the ordinary, they know to send you in.
What is being done to speed up wait times in Triage?
Doctors will sometimes come out to see patients who haven't yet been brought in the emergency room. They'll take a quick look, just to be safe. Also, a doctor (or even certain nurses) can order tests to speed up the process while you're waiting. This means you could be sitting in triage, and a doctor or nurse could come and draw labs, start an IV, or take some diagnostic imaging before you're even in a room. This also helps if you have a severe underlying problem that was not noticed after the nurse took a look at you.
The ER Room
This is the real "hurry up and wait" process. You're sitting in your uncomfortable bed, with excruciating pain. You're hoping someone will come along and give you pain medicine or at least tell you what's wrong. Trust me when I tell you this—the nurse, doctor, and all the other staff want to get you treated and home (or admitted) as soon as possible, too. 90% of ERs are extremely busy, so nobody has the time to just sit around and not work.
There are several reasons why you may have to wait for lab work. The first is that the lab results aren't back yet. It sounds pretty simple: "throw some blood under a microscope and get me the results," right? You have to remember, you are in a hospital that expands beyond the emergency room. You have your lab work, while there may be 30-40 other patients are having their lab work processed at the same time. There are probably 10 floors of patients, all waiting for their lab work, and outpatients who come in and have their lab work drawn. That's a lot of blood, and a lot of microscopes. (By the way, there's a lot more to it than throwing blood down on a slide and looking at it.) The average wait time for lab work can be from 10 minutes to an hour and a half.
What's being done to speed up lab work?
Lab techs and nurses can draw up certain blood tests and run most of them right then and there. It can take about 10 minutes with the new technology available. Some tests still take a bit of time, but the more important ones can be run quite a bit more quickly these days.
The doctor can order diagnostic imaging that can help see your inner guts for any abnormalities. There are a couple reasons why this can take time. One could be that the technologists responsible for taking the pictures are extremely busy. Nearly everyone that goes in to the emergency room will get a chest x-ray and/or a CT scan. You could also get an ultrasound or an MRI, or even nuclear medicine studies. What's taking them so long? You can read my article about CT Scans and their prep to help you understand one of the reasons for wait times in that area. But also understand that they may have 10-15 other patients who need to have their tests done as well, whether they are patients who are already admitted, outpatients, or other ER patients. Not only that, but there are patients who can be extremely difficult to image because they are uncooperative, very large, or can't move well on their own. It might take one or two x-ray techs about 45 minutes just to do one patient.
Another reason for wait times with imaging is the results. Some if not most ER physicians are trained to read an x-ray, but most can't read CT scans, MRI scans, ultrasounds, etc.. very well. Those images go to a different type of doctor, called a radiologist, who knows exactly what to look for. A radiologist has to read all those types of images, and sometimes they have images from 3-4 additional facilities (other hospitals)—and all of that can take awhile. Normally there are multiple radiologists sitting in quiet, dark rooms, mumbling their observations into recorders. Then they type up their reports, noting any abnormalities, and send the reports back to the ER physician.
What is being done to speed up the wait on Imaging?
Everything is being computerized. You really don't see films that much anymore. Everything goes to a computer where the radiologist can pull up the images, read them, and then send the report back to the ER doctor. Imaging techs don't have to run films all over the place; they take their images and send them over to the radiologists.
Much like in triage, certain patients need urgent attention more than others. A lot of times you won't know when a patient is "coding" because they won't announce it in the ER. All the staff that is needed is already there, so there isn't a need for a loud announcement. Sometimes they'll send out a code over the speakers if they need someone who isn't available, like an anesthesiologist.
Even if a patient isn't coding, again, some patients are just need more care and attention. There may be a psych patient who likes to start fights or wander off. This type of patient needs to be watched. Some patients have been diagnosed and are ready to be treated, while you are still waiting for a test result. There is always a reason! Trust me, your nurse wants you to be taken care of, so don't blame him or her.
What is being done about priority in patients?
Hospitals are setting up a "fast track" center in their hospitals. If you have gone recently, you'll see these, and they're relatively new. Patients with non-life threatening issues are sent to the fast track so they can be quickly diagnosed, given medications and instructions, then sent home (or admitted). This keeps the emergency room clear for more emergent cases, as well as speeds up turn around times for hospitals.
Also, physician assistants are in high demand. They are similar to doctors, except they don't have to deal with the legalities of being a doctor. They are under the supervision of a physician and can diagnose, treat, and prescribe (normally they get the prescription from the doctor, they usually can't "write" the prescription) medication. These people are wonderful people who can just get in there and treat patients without the many hassles that a medical doctor has to deal with. This is a fairly new position in the world of jobs, and they make everyone's lives easier.
To sum it all up
Yes, if you go to the emergency room, you will have to wait. Hopefully now you'll know the reasons why. Understand that improvements are being made, and the future looks bright for turn-around times in the ER. Well... except for the whole health care debate going on with the government.