The Problem that Every Emergency Department is Facing


#1

Driving along the highway you may see billboards advertising low hospital ER wait times. Sayings like “We will see you in under 15 minutes,” or “Our wait times are the lowest in the city,” are common advertisements, but are they true?

 

Hell no. ERs don’t have to advertise a current wait-time, but rather, they can advertise a four-hour rolling average updated every 30 minutes. So even though the sign says a wait-time of 5 minutes, you could actually be waiting more like 1 hour. But wait, there’s more.

These wait-times do not actually mean you will be in a room speaking to a doctor. In fact, most ERs have mid-levels like NPs and PAs that go out into the waiting area and “see the patient.” At this point, the clicking stopwatch that is the wait-time has been stopped.

It is not uncommon for me to admit patients in the evening who say that they’ve been in the ER since the morning. The fact is, ERs everywhere are constantly being flooded with new patients. And this problem just keeps getting worse, but why?

 

For starters, ERs are required by law to see and treat every patient who walks through the door. Some have insurance, some don’t. Some actually have an emergency, and some have a sore throat.

There is an ongoing effort being made by hospitals, that is trying to change the current laws to be able to legally send patients away from the ER without treatment, so long as they can be seen in a primary care facility within 24 hours.

But because so many patients (especially those without insurance) have no primary care provider, this is an issue. Even if patients have a primary care doctor, it might take weeks or months to be able to get an appointment, and additional waiting time after the appointment for results and follow-ups.

Right now, if a patient calls their PCP with what could be something serious, there’s nothing stopping the doctor from telling the patient to go to the ER. If the PCP asks the patient to wait until they can make an appointment (even if it’s squeezed in early the next morning) they risk legal blowback in event that something bad happened before then.

So to some patients, the ER sounds like a much better option, offering the same services at a similar price (with insurance), fast, and whenever it’s convenient. Fixing primary care options will likely take some of the burdens away from the ERs, but it will be a slow change, and it won’t fix the problem of overcrowded ERs alone.

 

Perhaps another option could be to set up government-funded 24/7 outpatient clinics (kind of like patient first clinics) where patients without legitimate emergencies can be deferred and treated. That way if someone walks into the ER requesting an STD panel, they can legally be sent away to one of these types of clinics for treatment.

This could lighten the load on ERs, and let them care for more patients with actual emergencies who need to be admitted. But maybe there’s a much better option that hasn’t been considered yet. Let us know your thoughts in the comments below.