What Is Really Causing Longer Emergency Room Wait Times?

 A couple of weeks ago, our Chair of Emergency Medicine, Jeff Sternlicht, MD, was asked to testify on a healthcare bill that would create a task force on reducing emergency department wait times. Dr. Sternlicht is an expert who’s been practicing emergency medicine in Maryland for more than 25 years.

Hospitals across the country struggle with emergency department overcrowding and long wait times. Unfortunately, data from the Centers for Medicare and Medicaid Services shows that Maryland’s wait times are the longest. It’s a topic I covered in detail in my post “Why Do People Wait in Emergency Departments” back in 2017 but warrants revisiting.

Often, people think long wait times exist because of barriers within the Emergency Department itself, but that isn’t the case. It’s actually a much broader issue.

The diagram below, which was created by the Robert Wood Johnson Foundation, helps explain reasons people wait in emergency departments:

Wait times increase when:

• The number of patients arriving to be seen increases (input)
• Anything slows down the assessment and treatment of patients (throughput)
• Anything prevents patient departure (output)

At GBMC, we have redesigned many of our systems to make the process more effective and efficient. Our primary care teams have addressed input by improving accessibility so patients with needs that aren’t true emergencies can be seen easily either by telemedicine or in primary care offices. And, our emergency medicine teams have done an incredible job of optimizing throughput to ensure patients are assessed and treated as quickly as possible. 

As Dr. Sternlicht (and many other experts) testified on February 21, the real culprit in ED waiting is the output of patients. While some of these output backlogs can be attributed to processes for discharging patients that are ready to leave the hospital, many challenges are often outside of the hospital’s control. 

Dr. Sternlicht and his peers across the industry shared the following challenges with our legislature:

• The lack of state-wide resources/facilities for behavioral health patients results in behavioral health patients occupying ED rooms for days, weeks, or months. 
• Admitted patients who must “board” in the emergency room due to lack of inpatient beds at GBMC or mental health facilities diverts the limited staff and space away from newly arriving patients.
• The current nursing shortage results in physical beds remaining open due to lack of nursing staff. 
• Our population is aging & illnesses are more complex than they were 20 years ago. We need to be having more conversations about advance care planning and discussions of end-of-life care so that patients consider the option of hospice versus spending their final days in the hospital. 
• We have had closures of critical pediatric beds.
• There is an evolving physician shortage. Fewer physicians are training to specialize in emergency medicine and the payment system is limiting the availability of primary care physicians.
• Moral injury & burnout have accelerated medical professionals' decisions to leave the field of emergency medicine. 

Thank you, Dr. Sternlicht, for sharing your expertise and advocating for emergency services so that we can provide the very best care for patients.

We appreciate the work of the lawmakers who are helping to bring these concerns to the forefront and look forward to working with our state healthcare agencies to be part of the solution. 

Thanking our Hospitalists

National Hospitalist Day was March 2! Hospitalists provide comprehensive, general medical care to hospital patients 24/7 during their stay. I am thankful to our hospitalists for helping to ensure our patients get the care that we would want for our own loved ones.