Thursday, August 14, 2008

Emergency Room Wait Times

to See a Doctor Are Growing

A story in last week’s local newspaper informed readers that the average wait time to see a doctor in emergency rooms across the nation has increased to one hour over the last 10 years, according to the Centers for Disease Control. Back in the late 90s, the average time to see a doctor was 38 minutes. If the average amount of time to see the doc is one hour, it means that many patients wait far longer than an hour before the doctor walks into the room.

But seeing the doctor is just the beginning, and the total time it takes to get through the entire process is often excessive in the eyes of ER patients, and that is a source of irritation for them. Depending upon a variety of factors, many of which occur after the patient sees the doctor, an ER visit can last several hours.

A visit to an emergency room involves several steps, including:

  • signing in
  • being triaged to determine how serious your problem is
  • seeing a doctor
  • getting whatever tests completed that may be ordered
  • after the diagnosis is made, being treated
  • being admitted to the hospital or released when all is said and done

Obviously, the more serious your problem the quicker you need to be seen by a doctor. If you have chest pain or have serious injuries from a traffic accident, for example, your triage rating is probably a 1, and you go first. If you have a sprained ankle or a cough, your triage rating is a 3 or a 4, and you go to the back of the line. To the person suffering the pain of a sprained ankle, or the parent of a child with a bad cough or some painful but not serious injury, a triage rating of 3 or 4 might seem too low, but there are well developed criteria for those ratings, and they are designed to get the most seriously ill or injured patients to the doctor first. If you have a minor problem in a busy ER, you have a long wait ahead of you.

Even after you are seen by the doctor, there’s a chance that your wait is just beginning, as you may require additional tests and perhaps some diagnostic imaging to find out what is wrong with you, and those take time; the more traffic in the ER, the longer the tests will take.

Many factors complicate a visit to the ER and affect wait times and slow progress in emergency rooms, such as fewer emergency rooms in the United States, which have dropped from 4,900 to 4,600 over recent years, the news story told us. And there has been an increase in the number of patients seeking treatment in ERs, and that includes a high number of patients who use the ER in place of a primary care physician, even some who cannot get a timely appointment with their own doctor and may go to the ER instead.

Furthermore, physician shortages exist in some medical specialties, and this situation is magnified in rural areas. Sometimes the ER visit is extended because it may be difficult to find a physician who specializes in a patient’s problem who can come to the hospital. Even a doctor is available, it takes a while for the him or her to get there. So, if you go out for a jog at 7 on Sunday morning and break your ankle, there may not be an orthopedic surgeon on call that day to come in and repair the fracture. And sometimes after a patient is diagnosed and treated, if he or she needs to be admitted to the hospital, there may not be a bed available. Nationally, the number of hospital beds is limited, we learned.

When people are sick or injured, they want and expect to be taken care of quickly and competently. However, a visit to the ER is more complicated than many people believe, and it has gotten more complicated over the years. And, some of the complications in emergency rooms are caused by people. In this day and time every patient that walks through the door is a potential litigant, and when things don’t go as expected a lawsuit may result. Consequently, doctors and hospitals attempt to shield themselves from lawsuits by ordering additional tests, or tests not normally associated with the patient’s complaint, in order to cover themselves in case litigation results.

The time it takes to get in and out of an ER is not likely to grow shorter any time soon. Increased ER traffic, fewer ERs, physician shortages, and defensive medicine practices show no signs of abating, and until they do, ER visits will take a long time.

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