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| |  Crowded EDs lead to longer wait times, delays in care
ER crowds mean longer waits, even for the very ill
Crowding in emergency departments leads to longer waits and delays in care for all but the very sickest patients, according to a study of four different ERs.
Waits of five to six hours have become the norm, Dr. Melissa L. McCarthy of Johns Hopkins University School of Medicine in Baltimore, the study's lead author, told Reuters Health. And the arrival of flu season -- with not just one, but two, strains to worry about -- has only made things worse, she added.
While it would seem intuitive that patients would have to wait longer in crowded ERs, until recently it has been difficult to actually measure crowding in an accurate way, given that crowding can fluctuate dramatically during a patient's stay.
McCarthy and her team addressed this by looking at crowding every half-hour from the time the patient arrived at the emergency department to the time they either were discharged or were admitted to the hospital.
Full Story: http://www.reuters.com/article/healt...59M4ZE20091023
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| | Advertisement Sponsored Links | | | | No. 2 | 
Oct 26, 2009, 06:32 PM
 Re: Crowded EDs lead to longer wait times, delays in care
Wait a second- People wait longer when it's crowded?
Hmmmmmm....
| | No. 3 |
Oct 26, 2009, 07:04 PM
Re: Crowded EDs lead to longer wait times, delays in care
I was also inclined to be dismissive until I actually read the article. There are some important, more finely nuanced points to be made:
1. Wait time is not just the time spent in the waiting room until the patient's treatment begins. Another important measure is boarding time for patients for whom an admission decision has been made. Now how do we get them out of the ER to an appropriate inpatient unit. " ... They report in the Annals of Emergency Medicine that patients spent a longer time in the waiting room under crowded conditions. Boarding time -- meaning the amount of time a patient spent in an emergency department bed while waiting for an inpatient bed -- also increased with crowding. While crowding also affected how long it took for patients to be treated, the effect wasn't as large. ..."
2. Patients experiencing a sudden onset of acute illness that lands them in the ER are in essence competing for the same inpatient beds as patients with prior scheduled procedures/treatments. " ... Contrary to popular opinion, McCarthy noted, ER waiting rooms aren't getting more crowded because more uninsured people are relying on them for care. "The real problem that's causing the crowding is the boarding time," she said.
And the fact that many hospital beds are reserved for higher-paying patients, for example someone undergoing elective heart surgery, makes matters worse. "Financial incentives aren't aligned properly for good patient care," she said. ..."
3. The seeming intrasigence of the problem, which has a significant impact on those who practice emergency medicine and emergency nursing. "It's depressing right now to be working in an emergency department," McCarthy said. "It seems like no matter what we're trying, it's not working."
"A lot of this crowding is just system problems within the hospital," she added. And the most promising approaches to fixing these problems involve making changes to the system, for example, using engineering-type approaches to redesigning patient care flow.
| | No. 5 |
Oct 26, 2009, 08:05 PM
Re: Crowded EDs lead to longer wait times, delays in care
Worsening economy means less people can afford to go to the PCP, and the old hat trick of using the ER for non emergent care becomes popular again.
Hey, I did it when I was young and was a landscaper. I worked hard for a living, really had no understanding of the medical field and thought nothing of it. Now I look back and think to myself........."OMG, they must have HATED me".
Well, not really, I don't think they did. I didn't go in for colds and such. Just.......GI issues a few times and a broken knee another time. IDK.
Its a tough situation.
On the bright side, ER nurses not fear layoffs. I wish I could make it into the ER somewhere.
| | No. 6 |
Oct 27, 2009, 03:51 AM
Re: Crowded EDs lead to longer wait times, delays in care
Every article I've ever read about ER wait times covers every single relevent issue but one- misuse and abuse.
Really folks, this is such an important point. We can debate healthcare refom, cost, economy, pt flow, boarding, admission delays, et al for an eternity, but none of it will help for one simple fact. Every one of those topics are out of the avereage American's hands. It's not 'their scope of practice', so to speak.
However, the average American can greatly impact one single problem- misuse. Just because we are required by law and fear of retaliation to treat every person who walks into triage does not give free license for the ER to be viewed as the McDonald's of healthcare- cheap, fast, and convienent. That's how a large portion of the population view ERs- they come in w/ a complaint, they pay nothing at that time, and they expect fast service with free extra sauce. It's like turning a shopaholic loose in a mall with a credit card that has no limits.
We need the major news networks to write articles that challenge and educate the public to do their part. I once overheard a family member complain loudly in the ER waiting room that "They act like it's not an emergency unless you can't breath or have chest pain."
Well Mr. Irate Family Member, that's excatly right. There's a few other things I can add to the list, but you've stated the basic principle quite nicely.
| | No. 7 |
Oct 27, 2009, 04:51 AM
Re: Crowded EDs lead to longer wait times, delays in care Originally Posted by RhiaRN75  Every article I've ever read about ER wait times covers every single relevent issue but one- misuse and abuse.
Really folks, this is such an important point. We can debate healthcare refom, cost, economy, pt flow, boarding, admission delays, et al for an eternity, but none of it will help for one simple fact. Every one of those topics are out of the avereage American's hands. It's not 'their scope of practice', so to speak.
However, the average American can greatly impact one single problem- misuse. Just because we are required by law and fear of retaliation to treat every person who walks into triage does not give free license for the ER to be viewed as the McDonald's of healthcare- cheap, fast, and convienent. That's how a large portion of the population view ERs- they come in w/ a complaint, they pay nothing at that time, and they expect fast service with free extra sauce. It's like turning a shopaholic loose in a mall with a credit card that has no limits.
We need the major news networks to write articles that challenge and educate the public to do their part. I once overheard a family member complain loudly in the ER waiting room that "They act like it's not an emergency unless you can't breath or have chest pain."
Well Mr. Irate Family Member, that's excatly right. There's a few other things I can add to the list, but you've stated the basic principle quite nicely.
I'll add too, because a lot of fellow landscape laborers told me this, so I know its a prevalent concept:
Lots of people go to the ER because they are under the impression the ER doctors are the better doctors. The pecking order according to many is: 1. ER doc, 2. Surgeons, 3. All other hospital doctors, 4. PCPs (they run out of their office cause they can't hack it in the hospital).
Thats what they believe. Maybe it comes from television, IDK.
| | No. 8 |
Oct 27, 2009, 07:18 AM
Re: Crowded EDs lead to longer wait times, delays in care Originally Posted by RhiaRN75 Every article I've ever read about ER wait times covers every single relevent issue but one- misuse and abuse.
Really folks, this is such an important point. We can debate healthcare refom, cost, economy, pt flow, boarding, admission delays, et al for an eternity, but none of it will help for one simple fact. Every one of those topics are out of the avereage American's hands. It's not 'their scope of practice', so to speak.
However, the average American can greatly impact one single problem- misuse. Just because we are required by law and fear of retaliation to treat every person who walks into triage does not give free license for the ER to be viewed as the McDonald's of healthcare- cheap, fast, and convienent. That's how a large portion of the population view ERs- they come in w/ a complaint, they pay nothing at that time, and they expect fast service with free extra sauce. It's like turning a shopaholic loose in a mall with a credit card that has no limits.
We need the major news networks to write articles that challenge and educate the public to do their part. I once overheard a family member complain loudly in the ER waiting room that "They act like it's not an emergency unless you can't breath or have chest pain."
Well Mr. Irate Family Member, that's excatly right. There's a few other things I can add to the list, but you've stated the basic principle quite nicely.
Could not agree more. One time had a patient bring in a family member and oh since I am already here my shoulder needs looked at its been hurting for 6 months. Of course they expected fast care & it was easier they picking up the phone and calling for an appt with their PCP awaiting for the appt date.
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