Wednesday, August 17, 2011

The Evolution of a 12 hour Emergency Visit

You've either experienced it yourself or you've heard about it from other people.  It's a common complaint and one that hospital administrators, medical workers, and government officials are always trying to solve.  I'm talking about the lengthy emergency department visits. 

I frequently hear friends or family complain about waiting seven, eight, nine, ten hours in the emergency department for their medical care.  Honestly, I feel for you. I really do.  I know it can be frustrating and boring and can seem completely unnecessary to have to sit on a stretcher in a hallway for hours upon hours.

I want to shed a little light on why this happens and hopefully change a few viewpoints out there.

First and foremost, the emergency department is primarily for emergencies.  The main focus is to resuscitate and stabilize people who are very sick and who may not survive without intervention.  That's not to say that back pain, sprained ankles, vomiting, urinary tract infections, sore throats, flu-like symptoms, or lacerations don't have a place in the emergency department.  Sometimes people don't have primary care physicians, cannot get an appointment with their doctor, or feel so lousy that they want some help in the middle of the night.  I understand.  Most emergency doctors and nurses are in the field because they like seeing "any patient, any time, with any problem." We don't mind treating more minor complaints.

There's just one very important caveat:  Sick people get seen first.  Always.

This means that you may watch 20 people come through the doors and get taken back from the waiting room while you continue to sit in your chair.  This is because someone qualified and trained in medical triage decided that all those people were more sick than you.  Every effort is made to see people in a quick and timely fashion, but in reality there are just too many patients.  Sometimes it can take 4 hours before there is no one who is sicker than you are and then it's finally your turn. 

This also means that once you are in a room or on a stretcher in the hallway, it may take some time before you are evaluated by a physician.  Emergency medicine is all about prioritizing so sometimes the doctor must let someone wait so that they can tend to a critical patient.  Your physician may be spending that hour resuscitating a child who has stopped breathing.  The hour you wait is an hour that someone else is fighting for their life.

Next comes tests.  Perhaps you get blood drawn, urine tests, xrays, or CT scans.  These all take time.  It takes time for the blood to get to the lab, for the lab technicians to prepare it to go through the machines, and for the computers to calculate the results.  The final step is that your doctor has to be able to get to the computer in between patients, see the results, and decide what to do with them.

There's a good chance that you will wait hours for your xray or CT scan.  There are usually only 1 or 2 CT scanners for the whole hospital and the same concept applies here: Sick people go first.  Just as you are about to go to the radiology department, another patient may bump you out of line because they were involved in a major trauma or there is concern that they are hemorrhaging internally.  This may happen over and over again.

Technology rules the world but computers don't create results for your imaging studies.  There is a radiologist sitting in a dark room looking at every image taken from every single patient in the department and meticulously interpreting it.  This takes time and they read them in an order that puts the urgent patients first. They go as quickly as they can but they also have to be extremely thorough so that they don't miss anything on the images.  Again, these results have to be entered into the computer and your physician has to find the time between patients to view them.

Next time you are in the emergency department (I hope you never are there), take a look around at the amount of patients that are in that small space.  Your physician is treating every single one of those people at the exact same time.  It's the ultimate juggling act.

Perhaps your doctor has your discharge paperwork and prescriptions in hand and suddenly a stroke patient comes through the double doors.  Unfortunately, your paperwork will be thrown back down on their desk and that's another hour you might wait.

We live in a fast food society.  There is an expectation that everything must be done promptly, that all information can be at our fingertips in seconds, and that a few minutes of waiting is a few minutes too long.  The emergency department is it's own universe.  There are no appointments and it isn't first come first serve.  Every patient is valued but some are more critical and important than others in terms of promptness of care.

Next time you're heading into the ED for something that is not life or limb threatening, remember that there are others there for whom seconds literally count.

Grab a book, bring your ipod, and enjoy the show.


  1. Ah you are so right. I've had friends who have never been to an urgent care (despite having a PCP) when open. They don't understand the concept and just go straight to the ED thus increasing wait times. Fantastically informative post.

  2. Once again you have "hit the nail on the head" in a very concise but eloquent way!

  3. Thus the increasing need for urgent care! I'm originally from the east coast, and I had never even heard of urgent care until I got to the midwest, and I think it's absolutely brilliant. I used to have to schedule an appointment with my PCP 4 months in advance for primary care, and atleast a month in advance if something is actually wrong. So the ED was the only option. Go ED physicians for starting up the concept of urgent care! And go you for treating all those sick patients that need immediate attention!

  4. You NEVER want to wish to be the one with no wait in the emergency room. As someone who has been would much rather be waiting!

  5. This post might make a good handout placed in the ED for waiting patients to read. Well said!


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