ER Wait Time Problems Widespread

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ER Wait Time Problems Widespread

Doctors, Federal Health Officials Search for Solutions to Emergency

Room Crowding By JOSEPH BROWNSTEIN ABC News Medical Unit June 28, 2007

H. Stroger Jr. Hospital of Cook County in Chicago bears little

resemblance to County General Hospital -- its fictional counterpart in

the television series " ER. "

Instead, a waiting patient may be reminded of the show " 24, " because

patients can sometimes wait a full day to receive treatment, according

to attending physician Dr. Saqueton.

E.R.

Some emergency rooms are beginning to compensate patients who are

forced to wait more than half an hour for treatment.

" Real emergencies are lost in the shuffle, " Saqueton said.

Furthermore, he added, doctors need to see too many patients to have

the type of relationship that the fictional doctors have with patients

on " ER. "

This problem and its consequences, which many hospitals face, were

brought home to many when Edith died waiting to be treated

on the floor of Los Angeles' Luther King Jr. Harbor Hospital

last month.

But while critics have pointed to poor fiscal responsibility in the

case of Stroger, or poor patient care in the case of King Harbor, a

look at emergency rooms around the nation shows that wait times -- and

their health consequences -- are increasing everywhere.

The problem isn't confined to hospitals that serve mostly the

uninsured. Wait times of several hours also occur at places like Hoag

Hospital in Orange County, Calif., according to Carla Schneider, a

registered nurse and director of the emergency care unit there.

" It does get frustrating, " she said. " People deserve better care. "

On Friday, June 22, nearly a year after the Institute of Medicine

issued three reports chronicling a rise in numbers of emergency

patients and a decline in the number of emergency facilities

nationwide, the House Committee on Oversight and Government Reform

listened to testimony from five physicians in a hearing titled " The

Government's Response to the Nation's Emergency Room Crisis. "

" It's clearly a national problem, " said Dr. Ramon , a member of

the board of directors of the American College of Emergency Physicians

(ACEP), who was among the doctors who testified.

, who lives in a wealthier part of Southern California, said

his area still lacks hospital beds.

" Even in the affluent communities, if they haven't built any new

hospitals, we're seeing the same problems they're seeing in the urban

areas, " he said.

While many people may be aware of emergency department wait times,

they don't know the potential harm, said.

Other emergency physicians share his apprehension.

" The real concern is you sit out in the waiting room with some vague

back ache, and you could be sitting on a heart attack or a leaking

aneurysm, " said Dr. Viccellio, clinical director of the

emergency department at SUNY Stonybrook.

While emergency physicians disagree about some of the specific causes

of ER overcrowding, among the leading culprits many point to is a

practice known as " boarding. "

Boarding occurs when a patient who has been treated in the ER is kept

there afterward because of a lack of available inpatient beds

elsewhere in the hospital. The ER can fill up with patients, resulting

in what Viccellio describes as " a phone booth. "

In a poll of emergency physicians in New York, New Jersey and

Connecticut conducted by ACEP this past February, just under 65

percent of physicians said they had personal experience with a patient

being harmed by boarding -- and 23 percent said they had personal

experience with a patient dying because of it.

Doctors attribute the lack of hospital beds to cutbacks in hospital

budgets. Many blame it on the growth of managed care in the 1990s,

where hospitals were forced to cut costs wherever possible.

The current situation in emergency departments, Viccellio said, is

like an airline loading its planes with exactly enough fuel to reach

its destination -- without accounting for possible landing delays or

weather detours.

Viccellio has alleviated the situation somewhat in his own hospital by

having inpatient departments each take a few extra patients in order

to get some patients out of the emergency department.

In addition to boarding, some doctors attribute the problem of wait

times to closing emergency rooms and an aging population that is

living longer than ever before.

" Across the nation, ERs are still closing, " said Ferdinando Mirarchi,

chairman of the department of emergency medicine at Hamot Medical

Center in Erie, Pa. " Patients crowd the existing facilities. Patients

are getting older and thus have more complex problems that require

attention. "

Last Option May Be Only Option

For better or worse, most emergency physicians agree that the

emergency department, once a last resort, has become a primary care

option for many.

Dr. Pepe, chair of emergency medicine at UT Southwestern Medical

Center, said that a patient who injures her knee playing tennis may

choose to go to an emergency department because she will be taken care

of faster.

While it may take days to get an appointment with a primary care

physician, Pepe explained, followed by another wait to get X-rays and

other treatments, an emergency department can diagnose and treat the

problem within hours. That's even with factoring in wait times.

" We've become victims of our own success in that regard, " said Pepe.

" We can get tests done…within the space of a few hours, even though we

have more patients than we can handle, " said Dr. Gabe Kelen, chair of

emergency medicine at s Hopkins Hospital. " Patients themselves

have now come to realize they are better off coming to the emergency

department. "

For some, though, the emergency room is the only option.

With the passage of the Emergency Medical Treatment and Active Labor

Act in 1986, patients were guaranteed treatment at an emergency

department regardless of their ability to pay. For those who could not

afford a primary care physician, the emergency department filled that

need.

" The global solution is better access to primary care -- most patients

in ERs don't need to be there, " said Dr. Dajer, acting chief

of emergency medicine at New York Downtown Hospital.

But even many insured patients lack a primary care physician and go to

hospitals only when something is wrong, said . And that

presents a problem as well.

" It makes it much more difficult to have comprehensive records for

patients, " he said, leading to emergency physicians being unaware of a

patients' history before they came to the emergency room.

No Harm, No Foul?

" People don't really see this as harming patients, " said Kelen. " So

long as people don't need it and it's OK to wait, there's no sense of

urgency. "

He explained that crowded emergency departments can't follow the

strict guidelines for care set out for them -- guidelines that are in

place to ensure the safety of patients.

Kelen isn't alone in his complaints.

The Institute of Medicine made 60 recommendations a year ago that

" garnered widespread attention from the media and health care

professionals, " wrote Berger and McKenna in a recent article

in the journal ls of Emergency Medicine.

" One fact is clear, " they continued, " few of the [institute of

Medicine] recommendations contained within [the] reports have yet been

acted upon. "

As Dr. Blumstein, medical director of the emergency department

at Wake Forest University School of Medicine explained, the problem

will only get worse without action.

" Incidents like the one in L.A. will become more frequent, " he

predicted. " Patients with heart attacks and strokes and other

conditions that need to be treated rapidly will see their care delayed. "

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