Long Waits in the E.R. - Commentary by Daniel Neumeister

Recently I read an article where the authors were suggesting that long waits in your local Emergency room were caused by the hospital administration because hospitals have financial incentives to keep their ER patients waiting. The author’s comments were based on the premise that patients that come through the ER are poor, and that the beds in the hospital were being kept available for paying patients.

There are many problems in our healthcare delivery system, yet I have been in the healthcare field for 27 years and do not believe that hospitals board patients in the ER due to financial reasons.

In fact, most hospital executives recognize that the Emergency Room is becoming more and more the front door to the hospital. Why is this happening? For multiple of reasons including EMTALA, a physician shortage where the ER has become more and more the entry point for patients to receive basic healthcare, and reductions in compensation from government programs where some physicians have decided to not treat these patients in their office. The number of uninsured patients continues to rise and hospital ERs are the initial entry point into the healthcare system for these patients. Hospitals routinely see 30-50% or more of all the inpatient admissions to the hospital come through the ER

It is also easy to say why not have staff ready and available on the floors to accept these patients. Hospital personnel in general are in short supply and are expensive resources. With overall reimbursement for patient care not keeping up with healthcare inflation, it is not practical to have excess personnel waiting for patients that may or may not come to the hospital. Sometimes there are just not enough beds, when all the beds in the hospital are full. This happens in the winter, especially when the influenza season hits. With the national nursing shortage, even with all the recruiting efforts and use of agency nurses, hospitals sometimes cannot get the necessary resources to provide care to additional patients.

From my experience, much work is being done across the nations in our hospitals today to reduce the waiting times for patients and to provide the appropriate care as quickly as possible. This includes triaging patients into different levels of care to expedite the care they need to receive. Hospitals are changing their staffing patterns in the ER to reflect the busy times, change the priority of lab and imaging services to make sure that ER patients are made a high priority. They are investing in IT to provide effective scheduling of their patients and implementing electronic medical records. They are also looking at the care management of the existing patients in the hospital to expedite their care so that the patient will not have to stay in the hospital. All of this activity has an impact on the timely treatment of patients in the ER. And the results of reducing waiting time have improved dramatically.

Hospitals have a lot of challenges to the waiting room problem and are tackling them as quickly as they can. But I must disagree strongly that hospitals have a financial incentive to have a patient wait in the lobby. Not only is it bad business to have patients wait (they might go somewhere else), but more importantly it is morally wrong to have patients intentionally wait. The mission of many hospitals is to provide quality patient care to the patients in the communities they serve. Administrators and care givers go into healthcare to live this mission and to take care of others. The concept of postponing care to the patients in the ER waiting room is in direct conflict with the ethics and integrity of the healthcare professionals I know!

- Daniel P. Neumeister