Crowded EDs lead to longer wait times, delays in care

thanks for stating the obvious, captain.

I'm from Massachusetts, which has a huge shortage of PCPs and very few walk-in clinics. If you're not actively coding, you have to wait 3 weeks for an appointment. PCPs generally don't see patients after 5 or on weekends. If you need medical care any other time, the ED is your only option.

I volunteered in an ED for 2 years, and I saw a lot of people who had insurance, but couldn't wait 3 weeks to see their PCP. When my PCP dumped me, it took 6 months to find a new one, and I almost had to go to the ER for a strep test.

If you want to discourage people from using the ER for non-emergency care, provide more non-emergency options, like urgent-care centers and 24-hour walk-in clinics.

I am a nurse in a houston er where our turn around times are just under three hours. we screen out a lot of our patients with no insurance, since its cheaper to go to a clinic for small ailments

People can't get in to see a PCP, or don't have one. I understand that. That's not what I'm referring to.
What I don't understand is waiting days/weeks/months, coming to the ER, complaining, being rude, etc. because a person had to wait. It's not providing the care that bothers me, it's the unwillingness to understand that there's your emergency, and then there's true emergencies. Think of McDonald's again- a person pulls up, sees there is a tour bus, heard about the tour bus on the news even, and comes in anyhow. They wait. They get upset, they yell because the McDonald's needs to be bigger, faster, have more staff, etc.

Triage exists for a reason.

There are those who are just blatent. They want a pregnancy test, so they come in w/ c/o something that may get them one. Go to the dollar tree- that pregnancy test is basically the same as what we use.
Or... they have high blood pressure, and want the ER to manage it. That's not safe. It's not safe to come in the ER, get a med that rapidly lowers BP, and script for something that we cannot follow up on or eval for problems, etc. We just can't do it.
Or.... they have a cold/fever/ache/seasonal allergies etc. that really doesn't need a doctor eval at all, under any circumstance. Pt presents to the ER with minor illness, hasn't taken a single thing for it, and it's usually something that doesn't need a prescribed medication. If it's spring, you have a runny nose and feel run down- try claritin and tylenol at the very least before you come into the ER. You'll have a long wait if you happen to show up while chaos ensues.
Or.... kid has a fever, no meds at home, not even a thermometer. "She felt hot." Kid is alert, playful, and eating chips and drinking soda. "Fever" is 100. Wait is long.... kid gets cranky and bored, parents complain. Say it's a horrible night- all kinds of sick-by-ER-standards people. What can I do? Total ER time for this kid is over 4 hours. Final diagnosis, probably a virus. Heaven help the kid if the parents insist 'something is really wrong', then the kid gets lab work, CXR, waits an hour to pee, wait for the test..... still a virus. Everyone is ticked off, kid is screamining, it's now 0100, and no- we cannot give you tylenol and a thermometer to take home.

Now, a nagging ache in the back for months, for example, could be some horrible disease. I get this. The possibility is low, though. If you haven't at least tried OTC meds, ice/heat etc.... where so you think the ER will start?

Basic self care does not require medical management. Certainly not emergency medical management.

I understand work/school note illness visits, some places are unreasonable. But, you may have to wait.
Yeast infections are miserable, but you'll have to wait. If you insist there's no possible way this is yeast d/t whatever- you'll get a pelvic by some random doc to rule out. Isn't monistat just easier?

I've been poor. Flat out, no Christmas for my son broke. I may lose power in the winter broke. I may soon be homeless broke. I still didn't feel the need to use the ER for minor complaints.

NO duh, can we revoke that persons license for stating the obvious. Thats like saying if you eat more you are gonna poop more.

If only I had a nickle for everytime a doctor's office or their recording told the patient to go the ER. I had a GYN problem and actually got to talk to the doctor who told me to go to the ER because he could not get me in for four days.
What about educating the PCP's offices about proper use of the ER?
I have called the Ped's office before and was told to go to the ER and I did not take my kids because they could wait two days, but what about the public that just listens to their PCP or recording tell them to go?

As for the example of shoulder pain, you know the PCP, many times, will just send you over to the hospital for diagnostic testing anyway. There are many things that the PCP's will not do in their offices anymore. They won't even put a stitch in anymore for a small lac. Ped's offices (around here) won't even draw blood. Won't do xrays. Many parents after waiting to see the Ped, then need to go to the hospital anyway for bloodwork or xrays.

Back in the day, as a child, I remember my Pediatrician being able to do much more in his office. He put in stitches, drew blood ect. Those days seem long past--probably due to CYA/legal considerations.

As for the statement that ER docs are smarter. I know that is not neccesarily true, but many people, including myself never see a doctor, we see PA's whom some feel are not as capable as doctors. PA's ARE capable of handeling what most offices see everyday. To see a doctor, many offices require an even longer, multi-week wait. Some people, if they feel their problem might be complicated just think "Oh well, I'll just go to the ER and get it all taken care at once (whatever testing the doctor would send them over for anyway).

I think as part of health care reform, PCP's offices should be able/allowed/encouraged into being able to handle more. The problem for many PCP's is financial (ability to afford equipment or licensed staff to do more in their offices).

Good point. PCPs do use the ER as a safety net like that a lot.

When I messed my knee up badly in a karate class, I was seen by a NP. She was a blessing. At the time, phfffft, I didn't know the difference between a NP, PA or Physician. Didn't even notice till later when I wrote a very good review for the NP, that she was not a doctor.

She not only was the one to recognize the severity of my injury (a different hospital ER simply gave me vicodin and said it would "go away") but also talked a very good ortho. doctor into seeing me despite the fact that I had no insurance. She had to cash in some "chips" to make that happen, I could tell by the phone conversation.

You will NEVER hear me encouraging the belief that physicians are better than NPs or PAs. Different people can offer different things at different times...............I wouldn't change a thing about how I was treated.

Yes, maybe he did state the obvious to some of us that work in acute care. But he maybe using this thread to give us the opportunity to vent our problems and dissatifactions to a group of healthcare workers that understand what it is like to be overcrowded and overworked.

We are living in a society where patients (the person themselves, or their children) have been spoiled previously by their family doctors; if they had a pain, a cough, etc., they were seen by their doctor practically the same day the symptom occurred and given a prescription. This type of mentality has been passed from parent to child, and now the child is an adult and/or a parent and expect the same type of care. If they are unable to get into the family MD on the same day, no matter what the complaint is, then to them it is considered an emergency and they go to the ER.

I work in a busy ER and get pretty frustated at times, while I am not condoning this behavior I do understand the patients mindset.

Yeah, my comment wasn't directed towards Brian, it was directed towards the idiot who wrote the article.

I feel ur pain for having to have an "Evil Empire" avatar!!! I luv the Red Sox too!