Emergency in the ER

Backlogs frustrate both doctors and patients

March 18, 2020

Karen A. Jamrog,

Illustration by Gloria Dilanni

It seems reasonable to expect that if you go to a hospital emergency room, you will receive medical care lickety-split. After all, that’s what the ER is all about, right? It delivers the ultimate in urgent care.

Depending on the medical condition that brings you to an ER though, you might find yourself sinking deeper and deeper into the cushions of your waiting room chair as minutes tick by and you continue to wait to receive care.

It’s not that you’re being ignored; the most critical patients must be seen first. But an array of other factors also contributes to ER delays. For example, many patients seek treatment at the ER for decidedly non-emergent conditions such as coughs, colds, or dental pain, taking up time and resources in the ER and making it difficult for doctors to promptly attend to patients who need care for more serious conditions, says Joseph Guarnaccia, DO, section chief and medical director of the Elliot Emergency Department, and Urgent Care Services.

Some people choose to go to an ER because their work hours make it problematic for them to visit their primary care doctor’s office when it is open. Some don’t want to wait days or weeks for an appointment with their primary care doctor, or they lack transportation to get to a primary care office. In effect, the ER has become a safety net “for people who have unscheduled or unmet medical needs,” says Christopher A. Fore, MD, chief quality officer and emergency medicine physician at Concord Hospital.

The opioid epidemic, which often involves co-occurring mental and physical health disorders, and our aging population have also increased utilization of the emergency department, says Matthew C. Dayno, MD, FACEP, assistant medical director and director of emergency ultrasound in the Department of Emergency Medicine at Elliot Health System.

In addition, costly prescription medications and worries about insurance copays, along with the difficulties faced by those who lack healthcare insurance or are on Medicare or Medicaid, lead some individuals with treatable, chronic conditions to mismanage their condition and ultimately land in the ER after their health reaches an emergency state.

A dearth of psychiatric services leads many patients to seek care in the ER too. If a hospital has no place to send those patients for help, sometimes “they end up quote-unquote ‘boarding’ in the emergency department for a period of time,” Dayno says. Meanwhile, healthcare mergers and consolidations have shuttered emergency departments and reduced the overall number of in-patient beds at some facilities, causing patients to bide their time in an existing ER while they wait for an available in-patient bed.

There is no easy fix for the predicament that plagues ERs across the country — particularly because some drivers of the problem are embedded in the US healthcare system and beyond hospitals’ and patients’ control. It’s a situation that frustrates patients and doctors alike, but Fore sees signs that in some parts of the country, at least, the situation is improving, and says that hospitals are taking steps to address the problem. At a minimum, you might have noticed efforts at your hospital or primary care doctor’s office to make it easier to book appointments. “Access to the system is one of the things that we’re trying really hard to improve,” Fore says.

More providers today see patients in the evening and on weekends, and some hospitals offer telehealth appointments and services such as online clocks that show current ER wait times — and sometimes persuade patients who don’t truly need emergency care to go to a more appropriate setting, such as a primary care office or urgent care clinic. Some hospital-owned urgent care centers even enable patients to join a virtual line before leaving home, so that they can avoid a lengthy wait-room stay after they’ve arrived at the facility. “We’re trying to [enhance] the system to make it convenient for patients,” Guarnaccia says.

“Giving people access to the most appropriate [healthcare] location is just really, really important,” Fore says, “and something that we need to continue to work on, because if you don’t give people the most appropriate access point, they’ll usually find the open door, and sometimes that’s the emergency department.”

Everyone needs the ER — it’s just a matter of timing. “You want to give the best care at the right time for each patient,” Dayno says. If an ER doctor is trying to care for a patient with abdominal pain who’s been shuffled out to the hallway to make room for a patient who arrived at the ER with symptoms of a heart attack, “it’s not good for anybody,” he says.

When to go to an urgent care center

Going to an emergency room when it’s not necessary to do so can create delays and cause frustration for everyone. It can also prevent doctors from quickly helping patients who are in serious medical trouble.

If you think that you or a loved one needs emergency care for a problem or injury that might threaten life or risk disability, do not hesitate to call 911 or to go to an emergency room.

But if you’re unsure that emergency care is necessary, call your primary care doctor’s office for advice, or consider going to an urgent care center. Many of these freestanding, walk-in medical clinics exist in the Granite State, and although they might not be open 24 hours a day, most do see patients beyond the hours when the typical primary care office is open.

Examples of medical conditions that are often better suited for an urgent care facility than an ER include: