Wait times happen for a number of reasons, said Scott & White physician Dr. Robert Greenberg, vice-chair of the Department of Emergency Medicine and director of the Division of Prehospital Medicine.
The backup in emergency departments tends to be more of a reflection of the entire hospital process, Greenberg said.
Patients who come to the emergency department who need to be admitted have to wait for a bed in the hospital in order to leave the emergency department.
“Scott & White has taken that on and is trying to address that as best they can,” Greenberg said. “The hospital administration has been very receptive in trying help us with those throughput issues.”
The sickest patients are always the priority, he said.
In light of the release of a report by the United States Government Accountability Office - that finds emergency patients who need to be seen in one to 14 minutes are being seen in twice that timeframe, or 37 minutes - members of the American College of Emergency Physicians are urging Congress to address the needs of emergency patients as it takes up health care reform.
“Nearly 120 million people are treated in our nation’s emergency departments annually, and we expect that number to climb with each passing year,” said Dr. Nick Jouriles, president of the American College of Emergency Physicians.
“People age 65 and older represent the fastest growing segment of the population and the group whose visits to the emergency department are increasing the fastest,” Jouriles said. “These are also the patients who require the most acute care and are admitted to the hospital from the emergency department most often. This could lead to catastrophic crowding in just a few years. We are alarmed by a recent GAO report showing that patients who need to be seen in less than one minute are now waiting an average of 28 minutes for care. This trend must be reversed.”
“The Medicare population seems to be the largest growing population that we see in the emergency department,” Greenberg said.
“Any practicing emergency physician will agree that the patients are getting older and more complicated to evaluate because of their age,” he said. “When an 80-year-old patient shows up with abdominal pain their evaluation is going to take longer than and be more complicated than that of a 20-year-old patient with abdominal pain. You have to worry a whole lot more with seniors because their potential for illness is higher.”
Work force issues will continue to persist all across medicine, including emergency care, and will probably continue to grow more acute as physicians in the baby boom generation retire, according to the American College of Emergency Physicians.
Greenberg, who worked in the emergency department at Scott & White for about 15 years, said for 13 of those years there has been a shortage of emergency physicians at the hospital.
Scott & White’s emergency department’s schedule is always adequately staffed, but not without a lot of overtime, he said.
The Scott & White Emergency Department has 44 beds and at peak staffing there are three staff physicians, seven resident physicians, about 20 nurses and three technicians. There are also clerks and support staff.
Reports that universal health care coverage will ease the stress on emergency departments are not born out by the data, according to the American College of Emergency Physicians.
The Centers for Disease Control reports that 83 percent of emergency patients have some type of insurance and a 2008 study reported that the percentage of uninsured patients in the emergency department has dropped while the percentage of insured emergency patients has risen. Yet wait times continue to grow.
There are two misconceptions, Greenberg said. One is the uninsured use the emergency department for nonemergencies more than insured patients. The other is the emergency department provides primary care.
“We don’t provide immunizations, mammograms, colonoscopies,” he said. “We don’t do what the true primary care physician does - health maintenance and disease prevention.”
