in 2014, the Centers for Disease Control and Prevention reported the average ER wait time is 30 minutes and the average treatment time is 90 minutes.
Late evening: You’ve been injured, and the deep gash on your calf clearly needs stitches. Or it’s 5 p.m., and your elderly father is confused and disoriented. You call his , who tells you to take him to the emergency room.
At the ER entrance, are wheeling in patients on oxygen. Inside, the waiting room is packed. Someone mentions a multicar crash on the highway. As a relatively stable patient in an overcrowded ER, you settle in for a long wait. What should you know?
1. High-severity patients take top priority. Rosemarie Melendez is the director of the emergency department and nursing administration at Washington Adventist Hospital in Takoma Park, Maryland. The hospital ER, which serves Prince George's and Montgomery counties, and also takes some ambulances from the nearby District of Columbia, is “very busy,” she says.
As patients arrive, the triage nurse evaluates their acuity, or severity. When a high-acuity patient comes into the packed ER, “it’s like the stock exchange,” Melendez says. “You’re in the back deciding, ‘Who am I pulling out of a bed? Who am I sticking in the hall that can wait for test results? Who needs a monitor? Who do I need to sit next to me?’”
Melendez has empathy for the less severely acute but just as anxious patients waiting to be seen. But those in most urgent need come first. “Somebody with an acute, life-threatening situation – that is emergent; that is a Priority 1 and is going to take priority," she says.
2. You can’t schedule emergencies. “Emergencies happen when they happen,” says William Jaquis, member of the board of the American College of Emergency Physicians. “Things like chest pains or strokelike symptoms need to be treated very quickly.”
Customer innovations like emergency departments posting current wait times online don’t apply in true emergencies, says Jaquis, chief of emergency medicine at Sinai Hospital in Baltimore. That’s when you go straight to your nearest ER, where, for example, a patient with severe chest pains, or difficulty breathing from would go to the top of the list.
In borderline cases – you need care but you’re not in imminent danger – you have more leeway to make ER choices on where and when to go.
3. Overcrowding persists. In May 2014, the reported average emergency department wait times (about 30 minutes) and treatment times (about 90 minutes), which add up to roughly two hours in the ER. Patients with immediate, emergent and urgent needs are seen sooner (and treated longer) than urgent, semi-urgent or non-urgent patients.
A survey released Monday by ACEP suggests the Affordable Care Act may not have relieved ER crowding as hoped. For the , 28 percent said their ER patient volume has “increased greatly,” and 47 percent said their volume “increased slightly” since the ACA was implemented.
4. Speaking up can help. Ilene Corina, president and founder of PULSE of New York, a nonprofit patient safety group, spends a lot of time in ERs. When her son used to have asthma attacks, Corina says, she always called ahead to see if there was a long wait, to help her decide where to go.
As minutes spent waiting in the ER turn to hours, Corina “absolutely” recommends . “It’s about offering help and solutions,” she says. “How can I make this better? How can I help my family member or the patient?” Complaining isn’t useful, she adds. “Always be respectful. Respectful but assertive.” It’s important to have a companion, , in the ER, she says. “Patients are vulnerable. It’s intimidating; it’s a scary place to be.”
Melendez says you should let staff know if you notice a change in condition. If you came in feeling nauseous and unwell, but now you’re also dizzy, that’s a change in status. If a staff member is too overwhelmed to listen, ask to speak to the charge nurse, Melendez says. A quick recheck of your vital signs may bump up your acuity level.
5. Hospitals want to improve ER flow. Like many hospitals, the Washington Adventist ER includes a Fast Track area, where patients with less-urgent conditions like sprained ankles can see a or . The ER has also added a Rapid Medical Exam area, where patients can have intravenous lines inserted and blood work drawn, be seen by a physician and have X-rays ordered while waiting for a bed.
Some hospitals are introducing observation units, which allow unstable patients to receive care for up to 24 hours while waiting to be admitted as inpatients or discharged. The University of Kentucky Chandler Hospital, in Lexington, opened its observation unit in December. It’s too soon to definitively assess the unit’s impact on ER wait times, says Dr. Roger Humphries, chairman of emergency medicine. Encouraging signs include reduced used of hallway beds and steady “door-to-doctor” times, he says, despite a 5 percent hike in emergency department visits since the new unit opened.
6. Quicker-care options exist. Urgent care is an option when your situation is low risk but concerning enough that you don’t want to wait until the next day. Minor problems such as colds, flu, earaches and eye infections, as well as injuries such as sprains, back pain and cuts requiring stitches can be treated in urgent care. The U.S. National Library of Medicine gives on when to call 911, go to the emergency room or consider using an urgent care facility.
Some hospital systems offer apps that give ER wait times along with information such as driving directions and available hospital services. Hospitals are increasingly using online scheduling that lets patients check in at a specific time for minor emergencies rather than wait indefinitely. Options like these come with caveats that check-in times or estimated wait times aren’t guaranteed, given the unpredictability of ER admissions.
7. Tips to smooth the process. Experts recommend the following steps to make your ER visit go better:
Jaquis suggests calling your primary care physician if you’re headed to the ER. He or she can help coordinate your care with the ER physician, describe any underlying medical issues and outline your current treatment and medications.
Bring your if you can. Having your doctors’ notes, lab results and imaging tests at hand saves the ER staff time they’d spend accumulating that information.
ER wait times are cyclical in nature, Jaquis says. Mondays are busiest, spilling over into Tuesday. The end of the week is probably the least busy, he says. “If you wake up at 8:00 on a Monday and say, ‘Well, I’ll see how I feel in couple hours,’ don’t wait. The mornings are always a little less busy.”
Corina advises learning about local hospitals and the services they offer – before you need them. Which facilities have cardiac units, should you ever have a heart attack? If you’re having a high-risk pregnancy, can the hospital handle complications? Does the hospital even have a labor-and-delivery unit?
Melendez, who’s worked in the same ER for nearly 18 years, says patients today are coming in sicker, with more complex care needs and longer hospital admissions. “There’s no quick fix,” she says. “We’re here to provide care to a situation that’s emergent or an acute life-threatening situation we’re trying to resolve.” Whatever the acuity, “we want to provide you with the best care,” she continues. “If I could put everyone back at one time, I would.”