Emergency room wait times getting longer

Many ER's are going out of business. In many cases, ER's are treating people who are in the country illegally, thereby getting health care for which these hospitals are never reimbursed. More poeple needing treatment means longer waits to see doctors. Bottom line is this, those who are here illegally (it doesn't matter where you are from) are taxing the health care system. This is an undisputable fact. It's not racism, or bigotry. It's a matter of followig the rule of law. The health care system will continue to suffer until illegal immigration is brought under control (border security et al).

People with non-emergent, routine illnesses are using the emergency room at the expense of people having serious life and limb threatening medical crises. I have seen cases of people foolishly braving the elements and walking miles to the local doc in the box with crushing chest pain, and others where people leave their cars in the driveway and call 911 for general illness because they think, usually erroneously, that they will go to the front of the line at the ER. Everybody gets triaged and waiting on a bed in a hallway is not "going to the front of the line."

Insurance companies, medicare, and medicaid should begin reviewing cases more closely and denying payment for frivolous trips to the ER.

There needs to be public education about when and how we should use emergency resources and a financial price to pay when we abuse our ER's and 911 services.

Maybe they should compare the wait times to the number of illegals using the emergency rooms as their primary care physician. I had an accident a few years ago where I injured my shoulder, I did not know if it was broken, dislocated, or simply sprained. I waited six hours in an emergency room, in horrible pain while watching a parade of people with bumps and bruises come in the door and be taken ahead of me. It was really insulting considering that I have what is considered one of the better insurance plans in the area. But if someone comes in with no insurance and needs a translator, then they are rushed in to keep from seeming to "discriminate". This has to stop, the services are already strained to the breaking point, do people have to die waiting in order for the people in charged to wake up? Wait, they already are dying.

I wish my nephew had only waited 20 minutes in the ER of one very well known Boston hospital. He went to the ER complaining of chest pain and told the nurse that there is a history of heart problems on both sides of his family (both his grand fathers died of heart attacks and his father has had a heart attack). They said that since he was only 25 years old and seemed healthy that it wasn't a heart attack but a virus that had similar symptoms to a heart attack. They told him to wait in the ER waiting room which he did for FIVE HOURS before they called him in to examine him. Sure enough that is when they realized that he DID have a heart attack. What ever happened to when someone is complaining of chest pains - no matter age, race, etc - they are considered a high priority??????? He and everyone else in the family has now been instructed to call 911 for any sort of chest discomfort in the hopes that they will be seen that much quicker.

In 2003 my mother was taken to the ER. They let her wait 2.5 hours slumped over in a wheelchair. During that entire time no oxygen was getting to her brain. Needless to say, she ended up with dementia and several other problems and, unexpectedly, died shortly thereafter. They literally killed my mother but no one cared because she was in her 80s.

One of the major reasons it takes longer to see a doctor is that there is no physical space to put the patients anymore. Hospitals are full; admitted patients wait for hours after they are admitted until they can physically leave the emergency department, and clog up the works for everyone else.

Since insurance pays the hospital less for the average emergency patient compared with an elective patient, hospitals don't have an incentive to save more inpatient beds for emergency patients.

Follow the money - change how we pay for emergency patients and the waits might go down.

Yet another reason why there should be more free neighborhood clinics in the Boston area (e.g., the CVS plan to include clinics at pharmacies). If such things were available, people with routine illnesses would not need to go to the ER. When people are underinsured (like so many students and working class people are, even if they have some insurance), having a primary care physician is not always an option. The problem is not with the patients, it's with the insurance system and the lack of easily accessible clinics.

Alas, there is no hope here. Things will spiral out of control soon, as unemployment increases, drug use rises, less people with insurance, etc. The whole country is slowly failing. Its too late to do anything to fix it. Time to consider moving to any country which has strict immigration laws, and has no "political correctness" . Soon we will all be eating frijoles and working at the neighborhood car wash as our standard of living drops.
ole!

At some point years ago, the Faulkner Hospital had an ambulatory care clinic and an ER. Most patients knew which one they needed, but a triage nurse was on hand to make that determination quickly and efficiently. Only real emergencies were sent to the ER waiting room, the rest of us--students and others with no primary care Dr. and/or no insurance--waited in line at the clinic.

With ER care so very expensive, in part because of mis-use of the ER, wouldn't it save hospitals money and liability, and people unecessary pain and stress, if they re-instituted wome version of this two-tier care system?

I hope all of you that realize illegal immigration and those without insurance are the major cause of ER problems and many other drains on social services are also wise enough not to vote for any democrat, McCain, Guiliani but for Mitt Romney. Let's stop complaining and pick someone who supports citizens first who pay taxes for themselves and citizens who really need help not illegals and those who are defrauding every social welfare program out there.

i think the problem is pretty obvious the outrageous cost of health care in this country. People who complain about pay tax for uni health care are simply delusional. You are gonna have to pay either way. Either in money earned or this way pick your poisen. Least with uni health the truly needy would get the care they need. For example see EVERY WESTERN EUROPEAN COUNTRY!!! If it works there why the hell cant it work here?

It doesn't work there, Commander. But the Democratic Party doesn't want you to know that.

Illegal aliens, always pushing to the front of any line, are killing Americans every day because ER and hospital routines are so clogged with these criminals, most of whom refuse to pay.

The fact that blacks and Hispanics have longer waiting times isn't proof of discrimination - it's proof that blacks and Hispanics, who are less likely to have insurance, are using ER's, which by law, MUST treat all comers, as a first line of defense. They may have longer waiting times, but they're mostly waiting behind other blacks and Hispanics.

And yes, illegal immigrants are a big cause of the problem. Note the emphasis on the waiting time increases over the LAST DECADE, which overlaps perfectly the biggest increase in the illegal population.

In May, US News had a cover story on increasing commute times all across the country. In November, Time had a story on growing water shortages all over the country (36 states now face them). And now this. Yet none of the stories has mentioned the I word - immigration. Do you think 2 million new people a year, year after year after year (especially poor ones), will increase ER wait times, increase commute times, and lead to water shortages? If you don't, then you're not paying attention. Stop the massive immigration and the assault on our quality of life will end.

It does work there EMT. Every study done rates the US last in health care in first world countries.

I have been an ER physician for 15 years. I am very ambivalent about the way this issue is being reported. I am pleased it is finally getting attention, but I do not think many (if any) of the core issues are being represented. There is tremendous abuse of the ERs in America. We are deluged from other hospitals who do not offer certain services, from nursing homes, from private physician's offices, from psychiatric facilities and rehab programs, from schools and from the uninsured and unecessary. Thjere is a law that an ER must offer a "screening medical exam" and that we cannot refuse patient because of insurance. this has opened a floodgate to all those who wish to abuse the system-- and much of this abuse comes from other healthcare personnel. And the bed shortage! Do you realize that if the hospital does not have enough beds on the floors the patients are all boarded in the ER where the sickest patients present? No one gets boarded on floors or in rooms with televisions regardless of how stable they are-- the overflow diverts to the ER and sick patients wait! It is so insane yet it happens in almost all hosptals every day!

See what happens next time you call your doctor and tell him/her that you have a sore throat or (God forbid) a stomach ache. Will they see you? Not likely. Will they do testing or schedule testing for you? Not likely. You will be told to "go to the ER." Add that to the closing of Emergency Departments all over the nation as well as the millions who have no other access.

Not paying for the visit will just shut down more EDs. EDs already have to do a ridiculous amount of paperwork and unecessary documentation just to get paid for what they DO! Now add not paying for it and the disaster worsens! It is bad enough that many insurance companies already have as policy to refuse payment for all claims initiall.

No one is looking at the way Emergency Medicine is woefully underfunded, understaffed, and continually under seige from insurance companies, lawyers and all other fields of medicine. We are Emergency Medicine professionals, not the crucible for which all problems in healthcare are addressed.

Alas, the problem is SO MUCH WORSE than the public realizes.

I agree with much of Dr. Tsoas's note. I am an Internist for over 20 years, and I recently closed my Primary Care Practice. And, my departure from practice is only the beginning of a Tsunami of closures of Primary Care practices due to: defections by Doctors to the likes of Kaiser (as is already happening here in Northern California); or to "Boutique" practices serving just a few wealthier patients across hi-rent areas like California, New York/East Coast, Florida etc.; and early retirements of an aging Internist work-force. For a population of >250,000, Santa Rosa, CA now has 15 practicing Internists (outside of Kaiser) of which only 2 are under 55 years old. More choose early retirement each day and will not be replaced in the current regulatory and economic climate. Medical students are not going into Primary Care specialties as they are not idiots. Given the unhappiness of current Primary care Docs, the huge debt accrued by Medical students and the paltry return on investment in Internal Medicine/Family Practice and Pediatrics, the collapse is inevitable and will be truly frightening in its scope and degree.

Dr. Tsoas notes that if you call you PMD with an urgent problem, they will tell you to "go to the ER." Why is that? In the past, we left "holes" in the schedule to accommodate "urgent calls", but because of declining reimbursement and ever-increasing bureaucratic demands, we are already double-booked JUST TO PAY THE BILLS.

Our medical leadership, is still not getting it. They say they want to address Primary Care’s survival; but I've seen no real action in all the years I've been practicing. They couch the crisis in Primary care with terms like "may" or "will be" as if the crisis were not already upon us and worsening by the day. They offer "pie in the sky" solutions like the "Medical home" while oblivious of the up-front costs of these programs and the EMR's (Electronic Medical Record) that would be necessary to implement them. Just where is the hapless Primary Care doc who is struggling merely to pay the bills gonna find $100,000 to 1 million dollars to PAY FOR THIS STUFF????

And to the policy wonks that say "Oh, universal single payor will fix everything", let me remind you all that IT IS THE SINGLE PAYOR, government run, entitlement driven system for all Americans over the age of 65 that has put me out of the business of seeing my patients and keeping them OUT OF HOSPITALS.

You cannot piecemeal fix a completely (fiscally, ethically and morally) broken system. It must end. As for me, I have been offered a position as Hospitalist that is too good to turn down.

Should our governments decide to remedy this situation, it would be easy enough for them to do so.

Once again this article skirts the issue but don't really hit the most important point. Primary care is unravelling around us. Indeed, all of the articles about the inordinate strain & crowding of Emergency Departments across the U.S., overlook the obvious - the impending failure of Primary Care is going to completely OVERWHELM Emergency Rooms. There is no way to prepare for this other than to save Primary Care…

The whole house of cards has begun to collapse, just as this article outline - BUT WITHOUT SUFFICIENT EMPHASIS !! Everything else in Healthcare is built upon the foundation of Primary care, and THAT is precisely what is failing across the country. Why are emergency rooms overcrowded, why are the wait times increasing even for the seriously ill? BECAUSE PRIMARY CARE IS FAILING! DUH!

Just remember, I told you so...Good luck to all of us - we're ALL gonna need it.

As a Registered Nurse for 10 years currently working in the ER, I wholehardley agree with the above posts by the docs. It is so much worse than what the public knows!! I am disheartened and apprehensive everyday I go into work worrying about what I will be responsible for that day all at one time. Will it be the cardiac patient waiting 10 hours for a critical care bed that needs 1:1 nursing care, the shock patient getting multiple blood transfusions waiting to go to the operating room, the multiple trauma patients coming through the door ,in addition to the lines of people with their minor complaints? No matter how hard the team of health care professionals work it's like taking one step forward and two step's back. ER's are dangerously understaffed, undersupplied, overcrowded and continue to worsen. I pray my loved ones will never have to step foot in one.
To the public, when you come to the ER you are first seen by a triage RN who does an assessment that determines your acuity(if you are not that sick, you are going to wait, and there is no way for us to know how long that wait is going to be. Please don't continue to come up to the window and interrupt while we are triaging the next patient. That interruption will just continue to delay the whole process, you are already registered in the computer) The triage nurse is responsible for the patients in the waiting room, so even if you don't think anyone is paying attention to you, the RN is watching for a change in assessment and will bring you in if there is a change in condition. We use a classification system based on acuity, it is not a first come, first serve basis. Please know that calling 911 unnessarily does not get you into to the ER quicker ,you are still assessed by the triage RN and if your condition warrants it, you could be sent to the waiting room. Please don"t abuse the system. We all need to start taking responsibility for our health care.

Michelle, thank you for elaborating on exactly how the triage system works.  I too, have been an ER nurse for 10 years and hear the same things day after day.  The general public does not understand the meaning of emergency, urgency and non urgent. Emergency means life, limb, sight - chest pain, sob, true trauma, etc. Common people think a broken arm is emergency..NOT. Its is urgent possible but no one has died from a fracture. I so agree with the 2 MD's above. Private practice in alarming. Patients cannot get seen in office so they show up at our ER's for us to take care of them.  Only to refer them back to their primary MD. We continue to take care of immigrants. Wearing our ER's down...not to include the financial end and adding to self pays.As to the 2 comments above about the ER patients.  I work in 3 differenent ER's (duh...nursing shortage) and not once have I ever returned a chest pain to waiting room...accept 1 time.  When the mother of a child stated he had chest pain...lungs, heart regular.  Nor, have I ever returned a "dying" patient to the front.  We as healtcare professional do not send true EMERGENCY patients to the waiting room. I get so tired of hearing "they just sitting back there doing nothing while so & so is about to die". We as ER nurses are doing the best we can under the circumstances to take care of each patient. To the two complainers above, if you want to help the problems with ER you should start by educating the public on the difference between what is a TRUE EMERGENCY so our ER's dont get clogged up with BS!

The idea that immigrants are causing the crisis in American medicine, including the crisis in emergency rooms is urban myth. When we looked nationally at the use of medical care, we found that immigrants used, on average, only half as much care as the native-born. This study, lead by Dr. Sarita Mohanty, appeared in the American Journal of Public Health, and has never been challenged.

As for the uninsured, they accounted for 17% of all ER visits in 1997 and 17% of ER visits in 2004. Obviously, their behavior can't be the cause of the increase in waiting times. Rather, we need to look at the behavior of hospitals, which try to avoid admitting patients from the ER for two reasons. 1) ER patients are often uninsured and 2) even when they have insurance, patients admitted from the ER are generally less lucrative than patients admitted electively for surgery or other procedures.

Hence, restricting inpatient bed availability for patients in the ER makes perfect economic sense for hospitals. Unfortunately, it runs counter to society's interest in assuring that the sickest patients have preferential access to health care resources. Most of us would gladly wait an extra week for our elective knee surgery if we knew it meant we could get into the hospital immediately when we had our heart attack.

That's why many of us believe that we need a single payer national health insurance system that would fundamentally change the way we pay for health care. It would cover all Americans, and pay hospitals based on a global budget --- that is, a negotiated annual budget based on the amount of work the hospital performed.

So please, let's not be fooled into blaming immigrants or the uninsured for the malfunction of our two trillion dollar health system.

This article has been cited on the Health Care Reform Now! blog, a companion to the new book by George C. Halvorson. You can view the posting at this URL:
http://healthcarereformnow.blogspot.com/2008/01/hurry-up-and-wait-emergency-care-in-us.html

Yet another reason for convenience clinics for medical assessments.

My husband has been doing Emergency Medicine for the past 15 years. I have had a nursing license for the past 5 years and have yet to pursue a career. I see my husband come home exhausted on a daily basis long after his shift is usually over because he is drowning in paperwork, short staffed, or the endless flood of patients. He takes care of critical patients from the moment he walks into the door,
he has to multi-task and be 100% at all times (no exceptions) to manage these patients, as well as the family members that are with them. Just like the other doctors and nurses that work in the ED, he frequently does not even take a break to eat because patients are constantly watching your every move and sometimes taking notes. Most of the time there just is not time because you will have to play the game of "catch up"
for the entire night if you even take a bathroom break. He only works night shift with single coverage and if he is lucky a PA will be there usually on weekends.
I am amazed that everyday he goes to work with little complaint because he truly loves what he does. I have seen him go to work as sick as some of the patients that he probably treated that night because no one else could work. He has missed one shift in 15 years. I did not write this to complain about the system or the population we all know a problem exists, I am just writing so that people realize that doctors and nurses are only human. They do not possess super-human abilities nor do they go to work to neglect or cause harm to their patients.
They go to work everyday to perform their job to the very best of their abilities with the resources they have. Just take a moment to consider what
they do and realize it is truly a thankless profession. I can count on my fingers the number of times someone has said "Thank you" and not "why have you not seen me sooner." I have great respect and admiration for all of you who go to work in the ED or any other position in a hospital because it is not easy. What the public does not realize is that the family of the doctors and nurses have the longest wait of all. We sometimes feel it would be easier to see them if we checked into the ER as well.

How is a patient billed when he/she is in the ER for over 24 hours? Does insurance company bill for 2 ER visits when this happen or is the hospital loosing money by keeping the patient in the ER?

I hope Dr. Woolhandler uses greater care in diagnosing the etiology of the diseases she treats than the social phenomena she observes. Let's not get caught in the trap of ascribing a single cause to a complex situation. To say that, because uninsured visits account for only 17% of total ER visits nationwide, uninsured visits are "obviously [not] the cause of the increase in waiting times" is to ignore the limits of the referrenced statistic.

This statement is suspect for two reasons. First, it assumes that those uninsured visits, the minority portion of all total visits, do not account for the majority of the resources expended in the emergency departments. Second, it assumes that a national perspective gives an accurate view of the problem. It is very likely that the problem is regional, and is in fact driven by uninsured utilization in limited geographical areas of the country. If this is the case, a national survey including non-problematic areas would only serve to water down and obscure those regional problems.

I have not read the article that Dr. Woolhandler is referring to; I am only responding to the post she has made. It may be the case that the referenced study addresses these issues and limitations. If so, the good doctor should reflect that fact in her statements; otherwise the post becomes misleading.

I personally do not think the problem of overcrowding can be attributed to a single factor, nor that a single factor can be ruled out as a cause due to the prevelance of an alternative factor. I also think Dr. Woolhandler is right in saying that hospital behavior probably contributes to the problem, and I think it must be examined on many levels, including at the institutional and individual employee levels.

One more note I would like to make: the mere presence of an incentive to act does not make the act itself inevitable. Just because an economic incentive may exist for hospitals to treat only the most "profitable" patients, it does not mean that this incentive will govern their behavior. Let's give the good doctors, nurses, hospitals and supporting casts a little more credit by not leveling accusations at them without any proof of specific instances of this behavior.

After 6 years of working in border town ER's, I am inclined to agree that illegal immigration is one of the major problems in ER overcrowding. It made me very sad to see how often an underfunded working white person would come to triage asking how much a visit and various lab/x-rays/procedures would cost, knowing that any type of hospital visit would likely force them to declare bankruptcy, and to also see the large number of illegals who would not only use the ER at will for any type of visit but know that since they were illegal, it was all free. They would bring their entire families in for "check ups", knowing that they didn't have to pay anything.
I am not afraid to say it: the uncontrolled Mexican immigration is increasing ER wait times, and ruining the already broken American healthcare system.

M

In addition to the long wait times (60 minutes for a broken limb), I am appalled at how much they charge a patient to just see an emergency room doctor who would tell a patient that they "can not set your broken arm tonite (Saturday). Please go to an orthopedic doctor on Monday morning" and then charge the patient $1000 for that wasted visit.

For that amount of money, you would think that they would want to get you in and out there in a heartbeat.

Go figure.