Comments on:

By: Carsten

Carsten — Fri, 01 Apr 2005 02:00:00 +0000

Anonymous: While you may not have liked the fact that you had to wait for your care, I don’t believe poor triage was to blame in your case. Having worked triage in an ED before, an ear infection would be triaged as Class II, which means non-emergent. The purpose of triage is to prioritize patients so that those with life-threatening or potentially life-threatening complaints get treated first. Even Class III patients routinely wait four hours to see a doctor, and they actually may have something that could kill them. This was not so in your case, and I don’t think a 2-hour wait was unreasonable. Unfortunately, the public seems to think that they can walk into any ER and be treated immediately, simply because they think they have an emergency. I do empathize with patients, and would like them seen and treated as quickly as possible, with the current on-slaught of non-emergent patients and limited staff/resources, it simply is not feasible to treat everyone as they walk in the doors.

And expanding capacity does not seem to alleviate the problem. A couple of years back, the ED where I work doubled the number of treatment rooms, as well as staff. Now we are getting 3 times the number of patients presenting to be seen, so instead of ameliorating the problem, increasing capacity exacerbated it. The old adage “If you build it, they will come” seems applicable here.

There are two ideas that seem to have worked:
In California, where you would have been waiting 18+ hours for your ear infection, those with primary care/non-emergency complaints are given the option of a clinic appointment in 24-48 hours, instead of sitting in the waiting room. 70% accepted, significantly reducing the wait times for the remaining “urgent” patients.
And in Kentucky, Medicaid patients must first call their on-call primary care physician to get permission to go to the ER for non-imminently life-threatening conditions. This has reduced innapropriate ED visits by 60%.
These programs were both started around 10 years ago, but unfortunately haven’t found wider adoption. (That I am aware of.)

And finally, to address the fact that you thought the ER you visited was seemingly quiet. It is quite possible that you didn’t see much external activity, maybe it was because all staff members were in a single room with an arrest resuscitation or other critically ill patient, leading to your needing to wait.

Just food for thought

By: Anonymous

Anonymous — Fri, 01 Apr 2005 00:49:00 +0000

Part of the problem is poor triage. I have personally experienced going to a not-very-busy ER far from my home (near my college over wimnter break) and receiving nothing but a couple of questions in the first two hours. I had an ear infection, a lot of ear pain, and a headache. I left and drove for six agonizing (and no-doubt dangerous) hours to get home where my doctor would treat me immediately. I don’t know what was going on in that seemingly-quiet ER, but it wasn’t good medicine!

By: Carsten

Carsten — Thu, 31 Mar 2005 16:07:00 +0000

I agree that ED overcrowding and overutilization for primary care problems has reached epidemic proportions.

From a paper I wrote in college:

Leaving before being seen by a physician also caused the patients’ health to worsen – 21% of patients who left and returned within 2 days required hospitalization – a rate double that of the normal ED population. (Pierce, 1990, 755) Grumbach also reported the same phenomenon. When contacted 1 – 2 weeks after their ED visit, patients who left the ED without seeing a doctor were twice as likely to report a deterioration in health status as those who did see a physician. (Grumbach, 1993, 372) In this case, the long waits turned patients away from care that they actually needed. Lucas and Sanford found in their study that 60% of visits by frequent ED patients were for existing or recurrent medical problems. (Lucas, 1998, 563) So the patients do need medical care, they just did not need it urgently. Hence, a primary care provider would likely better manage these conditions.