Are ED Patients Selfish?

When I first read it, I didn’t think it was a joke but actual research. When I read further and figured it was a humor based website– I was a little disappointed. 

Why? Because the article validated what I feel like at work many days. Parents of patients have a limited view of the total department and its needs or demands on my time. They simply want their problem fixed as immediately as possible.
The problem is, the reality of the ER will never meet those expectations of . . . really anyone. 
How often have you had to wait for a doctor’s appointment? That is, an actual scheduled time to meet with your physician. Rarely, am I seen within 30 minutes by the actual doctor. First, the office schedules you before your “real” time for paperwork, etc and also for the hope that you’ll show up on time for the actual appointment time even if you’re running late.
Did that make sense? 
My point is . . . why has it become the expectation that emergency care means you’ll be seen expeditiously? I’ll be the first to say that we’ve not helped ourselves as emergency care providers in this arena. I actually think posting wait times (like a restaurant) feeds into this idea that you’ll be seen upon arrival. 
Our goal is to save the sickest people first. That means we may not see you in order. That means we may not get to you in the hour you’ve allotted for your emergency care to take place. 
In my experience, most patients want to be seen by the provider within fifteen minutes of arrival and discharged home in sixty minutes. 
Once, when I worked in a dedicated urgent care, we had a sick infant come in who needed to be intubated. When explaining to families why there was a delay, someone actually said, “That doesn’t mean we should wait. That family should have gone to the ER.”
That may be true but now they’re here . . . with us . . . and we have to manage their illness. 
I’m not sure what the answer is. How do we make your ER visit more enjoyable? More timely yet still cost effective? Isn’t that the crux of the problem? You’re coming with a problem to be solved and a time frame in mind.
Just what if we can’t fix either? Is it our fault?

Curious to know what you think. 

Nine Reasons You’re Waiting in the ER

I thought I’d do a few posts on life in the ER. What’s it really like behind the scenes and provide some explanations on those things we can’t really say to patients but might be an explanation of why things are not moving as expediently as patients, parents and families would like. 
So, exactly why are ER wait times so long in some cases? 
1. Patient Load. Keep in mind there are only so many rooms in the ER and we can’t stop people from walking in. This is unlike EVERY other unit in the hospital that can close their doors and keep patients out. A ward unit or an ICU can say– we can’t take any more patients.

An ER is not like this. Sure, we can stop ambulances from coming. This is called going on diversion (and hospital administrators really hate that because it’s medical dollars going to another facility.) However, the ER must at least address every patient that walks through the door. 

It’s easy for an ER to become overwhelmed. Sometimes, this is seasonal like in the winter when the flu virus hits. When patients outnumber the staff and beds then ER wait times are going to go up.
2. The acuity is high. Acuity is how sick the patients are. The higher the acuity– the more sick. At times, there are few patients but those that are there are quite ill. The sicker the patients are, the more time it takes for the doctor to evaluate them and develop a game plan. The doctor may have to be at the bedside longer than normal to help stabilize the patient. More nurses are likely to be in that patient’s room doing multiple procedures to bring them back from the brink. This will create a back log for the other patients in the department.
3. A slow doctor. In all honesty, some people just don’t work as hard as others. Some doctors are very quick and efficient. Others, not so much. If the department is full, but the nurses are all sitting at the desk– this could likely be the problem. The nurses are waiting for the doctor to write orders, or develop a medical game plan, or give them an idea of how long the patient will be observed for. 
4. A slow nurse. Nurses can be the same. Just slow. Or, they have a heavy assignment and are working the best they can to get through their doctor’s orders.
5. A Code Blue. Most things will come to a halt when there is a code blue. All resources will be needed for that one patient. Radiology. Pharmacy. Lab. All hands on deck. One code blue is going to set the whole department back because that patient takes up a lot of staff and resources. It takes time to recover from those events. Also, the ER is generally responsible for sending a couple of their team members to code events that happen outside the ER which decreases the staff able to help in the ER.
6. Staffing shortages. It’s usual these days to be short staffed. That coupled with a heavy patient load is going to increase wait times. 
7. Emergency care doesn’t mean expedient care. Illness doesn’t cure in an hour. Our true goal is to find the one thing that might kill you in the next 24 hours. I know the goal of all patients, regardless of complaint, is to be out and completely well of their illness in under an hour. This is not a reality, even for the most minor illnesses. It takes time to evaluate a medical condition. Do you have this same expectation when your car is getting fixed? Often times, medical conditions can be kind of dicey to sort out so we’ll hold patients to watch and see how things develop. This is for your safety . . . not to irritate you.

8. Slow specialty response. If your care hinges on hearing back from the expertise of a consulting physician– then everyone is waiting. Us. You. Everyone.

9. Overwhelmed support services. Support services like lab, radiology and pharmacy aren’t just accountable to the ER but to the whole hospital– including outpatient services. So, if they’re overwhelmed, it will cause delays in the ER. There can be other critical patients than those just in the ED.

Hopefully, this gives some insight into why your ER wait time may be more than you’d like it to be. Although the current culture has equated emergency room care with expedient care, our goal is to treat the sickest patients first. 

Maybe consider waiting a gift. It means you’re likely not going to die today.