I get asked this question all the time. While there are multiple reasons for the extended wait times and each department has its own intrinsic set of issues, the following reasons are common to most emergency departments.
- The basic answer is, the emergency department is convenient. While you may have to wait for a while, the emergency department never closes. You do not have to take off work. You do not need an appointment and you can walk in whenever. Emergency departments are popping up all over. You may be out shopping and notice there is an emergency department across the street from where you are shopping. While you are out, why not get that cough you have had for a couple of weeks checked out? It’s hard for people who do not frequently go to the emergency department to believe this, but it is true.
- You don’t have to pay to go to the emergency department. That is not exactly true. While we cannot require you to pay anything while you are actually in the department, you do get a bill later. That is the easiest way for people to get medical care if they do not have insurance. Despite the fact that the Affordable Care Act is out and more people have insurance these days, there are still people who can’t afford insurance or do not want to get insurance. Some people have insurance, but have high co-pays and cannot afford to pay it in order to see a doctor, so they go to the emergency department. In the emergency department, we are obligated by law to perform a medical screening exam. We ask for payment, but cannot deny you service if you don’t have the money to pay for the visit.
- Along the same lines, some people refuse to get a primary doctor for whatever reason, or have a primary doctor, but use the emergency department instead. We call these people “frequent flyers.” It’s hard for the general public to believe, but we have people who come to the emergency department regularly, like monthly. There are many reasons for this, but these people will come to the emergency department for anything. They may have a toothache or an ingrown toenail or they have chronic pain and need a refill on their narcotic prescription or want their intravenous pain medication. Those people frequently clog up the emergency department. Long story short, they would rather go to the emergency department instead of get a doctor to handle these issues.
- Some people have a primary doctor, but cannot get an appointment for an extended amount of time. This is especially common for cold and flu season. Despite the fact that many times you don’t really need to see a doctor because most of the time you have a virus that will go away on its own, many people want to see the doctor for their antibiotic, WHICH DOES NOT HELP VIRUSES. That’s just an example, but primary doctors have to see so many patients a day in order to be able to pay their bills, so they often have more patients than they can handle and therefore it makes it difficult to get in to see them when you are sick. So, it’s either wait to see your doctor, which no one wants to do, or go to the emergency department.
- Holidays, nights, and weekends are typically very busy in the emergency department because most doctors’ offices are closed. Once again, the emergency department never closes, so when the doctors’ offices are closed, it’s guaranteed to be busier in the emergency department. You may as well bring your tablets and e-readers because you are going to wait. Some clinics do have weekend providers or late night hours, so that helps. But for the most part, if it’s not Monday through Friday from 8-5, your options are urgent care or the emergency department. People don’t just get sick during office hours.
- People have varying definitions of the word “emergency.” While the general public may only use the emergency department for a major issue, there are people who think of their runny nose as an emergency. While you would think the emergency department is full of heart attacks, strokes, asthma attacks, broken bones, surgical issues, etc., it’s actually full of colds, sexually transmitted disease checks, toothaches, and various complaints that have no emergency in sight. Emergency departments might as well be primary care clinics because we see those cases almost as much as emergency cases in certain departments.
- There are times when staffing can be an issue. With the staff tending to sick people, we often get sick as well. Sometimes we work through it, but sometimes we have staff call-outs. This is very common during cold and flu season or when there is a GI bug going around. If there are not enough staff members to keep the department running smoothly, then we can’t get tasks done as quickly and it drives the department to a halt. Some sites only have one provider working at a time, depending on the daily census of the department, so if that provider is dealing with a critically ill patient or they are doing a procedure on a patient, then they cannot see other patients and things once again come to a halt.
- The emergency department is dependent upon other ancillary staff. We may see patients and order radiology studies or laboratory studies and so then we are at the mercy of those departments. Here’s the process. If a laboratory study is ordered, the nurse or some other staff member has to draw the blood, it has to be sent to the lab, the lab tech has to run the blood and put the results in the computer, and then the results are reviewed by the doctor, nurse practitioner, or physician assistant. The process of radiology studies is similar. The test is ordered, then you have to wait for the radiology staff to come get you for the test, which if there are multiple tests ordered, you have to wait in line, as there are only so many machines to do the study. Then you have to wait for the radiologist to read the study and then the emergency provider has to determine what to do with the results. So the moral of the story is, there are multiple things that can hold up the process when tests are ordered.
- Another frequent problem is people waiting to be admitted to the hospital. When there are sick patients that have to be admitted to the hospital, they don’t automatically get sent to a bed in the hospital. People that have been admitted to the hospital may have to wait for hours before they actually get to their hospital bed. So while they wait for a bed, guess what? They are still occupying an emergency department bed. If you have multiple people waiting for a hospital bed, then you start running out of emergency department beds to put new patients in. This is especially true with psychiatric admissions. There are a limited amount of psychiatric beds in each state because there is not much money in the budget for mental health issues. There are limited psychiatric hospitals and a multitude of people who need psychiatric stabilization. These people can wait in the emergency department for multiple days before a bed is found for them and then you have to wait for police officers to take them to those hospitals for admission if they are deemed dangerous, so that process in itself is a huge issue.
These examples are just a few of the issues that can cause emergency department delays. So the next time you get upset while waiting to be seen in the emergency department, think about all the reasons there could be a delay. We are not just sitting on our butts gossiping, or out at lunch for an hour. In a 12 hour shift, I may take 15 minutes all day to actually eat something, just because we are pressured to get people seen quickly. We are people too, so give us a break. We are trying to see patients as fast as we can.