Long wait for ER

The waiting times at hospital emergency rooms (ER) are getting even longer. Members of the American College of Emergency Physicians (ACEP) say they have long warned about difficult operational problems confronting ER units across the country. The physicians all want to care for their patients as best they can, but they simply are swamped by sheer volume.

This problem was highlighted once again by the death last week of a 58-year-old man in Dallas. He had been suffering severe stomach pains and had gone to the Parkland Memorial Hospital ER waiting room. He waited 19 hours for medical attention, but it never came. A heart attack ended his long wait.

The Dallas County Medical Examiner said the man’s death was caused by complications arising from a variety of diseases: arteriosclerosis, cardiovascular disease, morbid obesity, and diabetes. It was possible the outcome for him would not have changed much even if he had received immediate treatment, according to the doctors at the hospital.

The man’s vital signs seemed normal upon arrival at the ER waiting room. For this reason, he was categorized as a “Level 1” patient on a scale of 1 to 5, with “Level 5” getting the most urgent attention.

About 120 million Americans -- or approximately one of three Americans -- visit hospital emergency rooms each year. The U.S. Centers for Disease Control and Prevention report a 32 percent increase in patient visits to ERs in the decade 1996 to 2006. In the same period, however, there was a 7 percent decrease in the number of hospital ERs.

The ACEP believe these two trends -- increasing patient visits and decreasing emergency rooms -- have led to vastly extended wait times.

In 2004, the average wait time for ER patients was 3.3 hours, according to the CDC. But even at the time, nearly 400,000 patients had to wait for at least 24 hours before receiving care. The problem can only have worsened since then.

The ACEP has called for Congressional action on the problem. It has introduced a bill in both the House and the Senate, titled The Access to Emergency Services Act, in order for the whole country and the government to face the problem squarely and deal with it as a country.

The head of the emergency medicine department at Vanderbilt University Medical Center proposes one solution in the meantime: assign a physician to treat patients in the ER waiting room.

In effect, the waiting room becomes a processing area, to treat and, if warranted, discharge patients, before admitting those in need of further attention into the emergency rooms.

Safety Tip:

* Speed up paperwork to free up more hospital beds sooner. If you’re a hospital administrator, find ways to simplify your procedures for discharging patients. These have become so complex that patients can no longer leave at noon; they stay until early evening.