Friday, June 10, 2011

Why Do Patients Wait in the Emergency Department?

I frequently receive letters from annoyed patients who had to wait to be seen in the Emergency Department. The writers often accuse me of not caring about their pain or their time and suppose that I have never gone to the ED myself to see what happens there. Nothing could be farther from the truth.
I often go to our Emergency Department to see how things are going and to thank our marvelous nurses, physicians, technicians, patient access reps, and others for their wonderful hard work, skill, caring, and perseverance. I have been a patient in an overcrowded emergency department, I have accompanied loved ones in overcrowded ED’s, and I have worked as a doctor in an overcrowded ED. When my loved one has an urgent or emergent medical need, I want them to be seen right away. I want this for everyone’s loved one.
The main cause of waiting in any Emergency Department is the bottleneck created by patients who need to be admitted to a floor of the hospital when there are no beds. Our largest fixable source of this problem is the artificial variability in scheduling elective surgeries. Hospital administrators own this problem and we are fixing it at GBMC. We must get better at scientific management to reduce delays in all of our care processes.
I get very frustrated with the letter writers who are complaining about the delays, not because I shouldn’t hear about the problem, but because the writers accept no responsibility for the problem. Patients are, in part, responsible for the second biggest reason for waiting in the Emergency Department - a healthcare system that is poorly designed to meet the needs of the patient. You see, our system is pretty good if you have an appointment with your usual provider of care. But if you have an acute need or a flare up of a chronic problem and your doctor’s office is closed or cannot accommodate you, there aren’t many good choices other than the ED.
ED waiting is nothing more than a characteristic of a system in desperate need of improvement. Emergency Departments were designed to take care of emergencies and we have now made them the path of least resistance, the catch-all for everything that is inconvenient for the rest of the system. This system would get redesigned much faster if people would demand better care! Ask your physician what he or she is doing to make care more accessible.
I laugh when I see billboards announcing shorter ED waits or a place you can check the wait online. If you have time to wait…you don’t have an emergency by definition! Our society is not well-served by driving patients who shouldn’t be there to the Emergency Department. We need better access to teams of healthcare providers who know us and our problems, who have our records and who have designed systems that can accommodate us when we need them!
At GBMC HealthCare we are racing to redesign our systems to give people in our community the care that we want for our own loved ones. We are working hard to eliminate waits and delays. We want to get to a new world where your primary care practice is the place you turn to, your medical home.  And while our physician offices won’t be open at 2 a.m., we will be open into the evening and earlier in the morning to better accommodate patient schedules so that you won’t need to go to the ED and wait. And, our primary care practices will have your electronic medical records so that if you do need to visit our ED, we’ll have access to your medical history to better care for you. It’s what we call integrated care. We’re working hard to advocate for true reform of our community’s healthcare system.
Is finding an Emergency Department with short wait times an illusion? I believe so. It’s really up to the community as a whole to be a part of the solution to the overarching issue of long ED wait times. Are you ready to get in action with us to create a system of better care? Please do your part.


  1. I am aware that some hospitals have partnered with Patient First and have a Patient First facility on campus. Have the powers-that-be at GBMC considered doing something like that? It would certainly take pressure off the ED.

  2. No, Anonymous, we "powers-that-be" are improving our systems so that the patient can get seen by their usual provider of care who knows them and has their record. I want my loved one to be seen quickly but I value the the quality of the visit more. Without my record, and the knowledge of my history, I don't believe that a good job can be done if I really need to be seen.

    I discussed this in a previous blog:

  3. I also would like to say that if patients complain about GBMC's wait time they need to check other hospitals in the area. I work at an Urgent care facility and there are some patients that tell me they had to wait 7 hours to be seen at other hospitals in town.

  4. Great thoughts you got there, believe I may possibly try just some of it throughout my daily life

    Patient Appointment Scheduling


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