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.