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| By John Benanti, M.D., FACEP, A special to Reminder Publications "Hello, Emergency Room." "This is Mr. Smith. How long is your wait there? Other ERs in the city are all really behind. One's on diversion, whatever that means." "That means they're sending ambulance patients to other ERs because they're too busy. If you want to go to that hospital, you better drive or have someone drive you." "I'm short of breath and have chronic bronchitis from smoking too much. What should I do?" "I can't give advice on the phone, Mr. Smith, I can only tell you to come in and be seen. Our wait time is about four hours now, but we'll do our best after you are triaged." "What's 'triage'?" "Triage is deciding how sick you are and how soon you must be seen. That depends upon when we have an available bed for your examination by the doctor. Right now we have 15 people who just walked in. Did you call your doctor?" "Yes, but the office is closed. The phone message said to go the ER if I was having an emergency." "Yes, they usually say that. Do you have a specialist that sees you? Maybe he's available?" "No, not really." "OK. Come in and we'll see you as soon as we can." The above experience is all too common for patients at today's emergency departments popularly known as the ER. Hospital ERs provide a critical safety net for many of our citizens, but today's ERs are stretched to the limit. In the last 10 years, visits have increased 24 percent nationally, while the number of emergency rooms has declined 9 percent. And since 1981, acute care hospitals in Massachusetts have decreased from 115 to 70, with an accompanying loss of 42 percent of bed capacity - thus reducing our capacity for health care. Further, the ability of a hospital to handle large-scale emergencies called "surge capacity" simply does not exist in most hospitals any more. And that's a huge concern as we try to address emergency preparedness for pandemic flu, bioterrorism, chemical spills and weather-related disasters. The average patient going to an ER today has a waiting time of nearly four hours due to the need to treat the most serious cases first. The second part of the "long waits in the ER" is caused by the boarding situation of seriously ill patients in our ERs when hospitals do not have enough beds for those who need to be admitted. No easy answers exist to solve this problem, but a hospital can do several things to reduce crowding. It can improve triage systems, educate medical personnel and the public about the causes of overcrowding, gain more cooperation from colleagues in specialty and primary care to see patients, and expand capacity as resources permit. One of the best things a hospital can do to ease the situation is to improve the rate of safe discharges of patients to free up beds. It's a difficult goal to achieve, due to such factors as wait times for test results and ensuring patients are accompanied at discharge. Several benefits would accrue by quickening the pace of safe discharges: boarders (those admitted to inpatient beds or who remain in the ER after two hours) would be reduced to manageable numbers. ER staff would be under less pressure and stress. Liability insurers would worry less about clinicians managing patients for days in the ER. Regulators such as the State Department of Public Health would not have to worry about patient safety during lengthy ER stays and physicians would not have to manage an entire unit of in-patients while continuing to care for the daily onslaught of the sick and injured who truly need emergent care. Hospitals and ER staff are working constantly to improve the situation. As an emergency physician, I urge patients to remember three important things about visiting an emergency department: You will be treated appropriately no matter what your condition, although you may have to wait until patients with more serious conditions get care; the primary reason for overcrowding is a lack of in-patient beds, not disinterested or slow personnel; and most important; emergency departments are staffed with dedicated, skilled, knowledgeable professionals who provide excellent care for patients. John C. Benanti, M.D., FACEP, Chief of Emergency Medicine at South Shore Hospital, is President of the Massachusetts College of Emergency Physicians. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org. |