by AlmostThere » Sat Nov 17, 2012 4:28 pm
One explanation on ER wait times:
Answer: The reasons for emergency department waits are complicated; our entire health care system is implicated. It is impossible to explain every aspect here, but one place to begin thinking about the problem is to separate waiting to be evaluated from waiting to be admitted to the hospital, if an evaluation shows that to be necessary. The reasons for each differ, although there is some overlap.
You waited to be seen, so let's focus on that. Almost every emergency department in this country is overcrowded. About 50 million Americans lack health insurance and, for them, the emergency department may be the only way to get health care: Doctors there see all patients who arrive, regardless of their health insurance status. Meanwhile, the number of emergency departments is decreasing. In 1991 there were about 2,500 departments in urban and suburban areas. Now there are about 1,800. Some additional staffing can help, but there's a fundamental problem of too many patients being funneled into too few departments.
Lack of access to primary care is another factor contributing to the overcrowding. Tyhere are too few primary care physicians, and the ones who are practicing have full schedules that make it difficult to see emergency cases. Some primary care physicians are experimenting with open-access scheduling, so more of their patients can be seen on an emergency basis. Others hold evening hours, which may also help some.
And apart from the overcrowding issues, I think waits have gotten long because the nature of emergency medicine has changed. The main focus used to be on resuscitating people and treating major trauma. We still do that, of course, but now the emergency department has become, de facto, a diagnostic center as well. And the evaluation of patients has gotten incredibly complex. Blood and imaging and other kinds of tests have to be ordered. That can create backlogs and longer waits.
Finally, patients in the emergency department are triaged: Sicker or more seriously injured people get seen first. So someone let's say, with an ankle sprain, will often wait a long time because patients with, say, serious bleeding or chest pain that could be a life-threatening heart attack receive attention right away.