Nov 17, 2015 — You need to go to the emergency room—how long are you going to have to wait? It’s not exactly a “take a number” process. Dr. Tom Miller talks to Dr. Robert Stephen about the process emergency rooms use to determine who gets seen first. They also discuss the different protocols put in place and what happens to waiting patients when the ER becomes too full.

Interview

Dr. Miller: You've decided to go to the emergency room. How long are you going to have to wait? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here today with Dr. Robert Stephen and he's a physician in the emergency room, an emergency room trained physician here at the University of Utah. We're going to talk about how long a patient might have to wait in the emergency department before they're seen. Because I think the public perception is that they may be waiting a long time if they're bringing in their child or their grandparent or parent. Do you have any comments on that, Robert?

Dr. Stephen: Well, yeah, the general perception is you do have to wait some time. And unfortunately, sometimes that is true, depending on the season and what's going on. Every ER, and particularly ours here at the university, does try to have novel ways of streamlining patient care and efficiency so that we can see everyone as quick as we can. You must remember that in an ER, we have this backward logic that, unfortunately, the sicker you are, the quicker you get seen. And then sometimes if you have a lower acuity complaint that still needs to be addressed, you may end up waiting longer simply because there's been someone sicker who came in.

Dr. Miller: I think the public really needs to know that this is not a queueing line or a restaurant where one takes a number and gets in line. You really want the sickest treated more immediately. The outcomes are better that way, obviously.

Dr. Stephen: Yeah. I mean, in some ways, it's a little dispiriting in that if you're seen very quick in an ER, it may mean there's something really wrong with you, which is a little disconcerting. The other thing we try to do with this is, we try to what we call "triage" patients, and try to figure out the acuity of their illness. And if it's something that can be treated relatively efficiently and quickly, we can again triage them to an urgent care or to a lower acuity center, while the more sick patients get treated to what we call the main ED, or the high acuity area. But again, depending on the patient flow, because we will see anyone at any time, and everyone at every time, regardless of their ability to pay. Sometimes even we can sometimes get overwhelmed if we have 15, 20 patients show up in 30 minutes. Unfortunately, even then, you may have to wait a little while.

Dr. Miller: I think that's a good thing to touch on because emergency rooms are the court of last resort for people who cannot pay and so there is the law, national law, that people have access to emergency departments whenever they need that. Is that correct?

Dr. Stephen: That is correct. We are federally mandated to see everyone, irrespective of their ability to pay.

Dr. Miller: And that's where people go when they're in trouble. That's a good thing. It's good that we have that as a way for people to be seen when they can't be seen in other areas or can't afford to be paying physicians on the outside in the private setting, so that's a good thing. One of the questions I have is if the patient is coming in, how does that triage process work? What does that look like? When you talk about triage, what actually happens to the patient when they come into the emergency department?

Dr. Stephen: There are two ways the patient's going to come into the emergency department. They're either going to come in by themselves or with family members, or they're going to come in via an ambulance. If they come in by themselves with family members, they present to the window where they are asked a few simple questions: What is their complaint? Why are they here? How long has it been going on? And then a few other questions, and then a quick set of vital signs: blood pressure, heart rate, temperature, respiratory rate, to see how ill or sick this person is. There are certain complaints that get our attention a little more quickly. Severe chest pain, severe belly pain, severe anything, honestly. And then the vital signs. If the vital signs are markedly abnormal, that is usually indicative of a problem, and you will be brought back much, much quicker.

Dr. Miller: Are there any specific times that are worse in terms of a patient showing up and then having to wait, especially if they have a minor problem? So would you say Friday night? Saturday night? Or is it better to be there Sunday morning when everyone's in church?

Dr. Stephen: Obviously, in an ER, we get busier when everyone else closes. So generally, the evenings to the nights, and then of course holidays, because on many holidays we are the only people that are open. Those times generally tend to be busier and you may have to wait depending, again, on how things are going and what the volume is. We try to have ways to see people. We can even flex people over from other parts of the ER to help see people up in the triage bay itself, to get orders started, to make the care more efficient. But generally, after hours, on holidays, any ER is going to be somewhat busy.

Dr. Miller: As for minor problems, I'm talking about, obviously if you have a major problem, pain, other issue, you need to come in at that time and not wait.

Dr. Stephen: Correct.

Dr. Miller: Now, could you comment a little bit, or give us your perception, of these advertising billboards that we see on the highways when we're driving down the highway, and it might say, this particular ER has a wait time of four minutes. Do you think the public should take much stock in that? What do you think about that?

Dr. Stephen: I think it's an accurate reflection of the ER at that time. But an ER is a very dynamic place and it can change within minutes from a wait time for four minutes to a wait time of 30 minutes or longer, depending on what happens. If you suddenly get an influx of patients, and although it sounds strange, it does not happen infrequently to have 10, 15 patients show up within 10, 15 minutes.

Dr. Miller: It's not a guarantee.

Dr. Stephen: It's not a guarantee. It's a picture at that moment. And it may hold true, it may not hold true.

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