The Waiting Game
By Kimiya Ghassemzadeh
4:58 pm: Tashonna Ward, a 25-year-old Milwaukee woman, arrives at Froedtert Hospital’s emergency room with her sister on Jan. 2, seeking treatment for persistent chest pain and shortness of breath [1]. She receives an electrocardiogram and chest X-ray indicative of cardiomegaly, and she is sent back to the lobby to wait for further care.
7:27 pm: After waiting for two hours and 29 minutes without so much as a wristband on her wrist, a frustrated Tashonna Ward leaves the emergency room with her sister, setting off to a nearby urgent care in seek of timelier, more acute medical attention.
8:39 pm: The hospital rings Tashonna’s phone to check on her. Her sister reveals that Tashonna had collapsed outside urgent care upon arrival and that they were headed back to the emergency room in an ambulance.
9:07 pm — 9:25 pm: Tashonna Ward arrives at the hospital, completely unresponsive. Within minutes, Tashonna Ward is pronounced dead, with hypertensive cardiovascular disease cited as the cause of death.
Tashonna Ward’s story is unfortunately not an uncommon one. Across the world, thousands of patients experience adverse effects, including death, as a direct result of medical delay. Imagine being the mother, son, or sibling watching your loved one fade away inside the very institution that promised to heal them.
ER wait time is calculated from the time of patient arrival until the time at which the patient is seen by a licensed medical professional [2]. In the United States, this number is averaged to approximately 40 minutes. Moreover, more than 16 percent of all visits involved waiting more than an hour in 2017 [3]. Recently too, the COVID-19 pandemic has only exacerbated the situation; however, the problem was one that had been around for a long time.
Sadly, the problem gets worse. After being admitted, ER patients spend countless hours just awaiting treatment. In California, the median ER wait time before admission as an inpatient was more than 5½ hours in 2017 [4]. For someone in Tashonna Ward’s condition, this simply would not cut it.
A study conducted by NHS doctors in the United Kingdom found that 960 out of 79,228 emergency room patients who waited about six hours for inpatient admission died as a direct result of the delay [5]. Moreover, they calculated that patients who waited between six to eight hours were on average 8% more likely to die of any cause in the next 30 days. Simplified, this percentage represents one extra death for every 82 patients who weren’t treated within six hours.
Health professionals cite many reasons for this prolonged hospital wait. The most popular answer is ED boarding due to the lack of hospital beds. The American College of Emergency Physicians defines ED boarding as “the practice of holding patients in the emergency department after they have been admitted to the hospital, because no inpatient beds are available” [6]. This means that critically ill patients must wait in the ER until a bed becomes available, a practice which results in overcrowding at the ER and longer wait times for less medically urgent patients. In order to reduce patient boarding, healthcare professionals should seek to move boarders to inpatient halls, utilize discharge lounges, and employ active bed management systems.
However, another part of the issue stems from the increasing use of the emergency room for non-emergent issues, a trend which greatly increases hospital wait times. The average wait-time to book a new-patient appointment with a primary care physician has increased to an average of 24 days in large metropolitan areas [7]. For that reason, patients often resort to the ER to get their concerning medical questions answered faster. Moreover, emergency room demand increases during the night and on weekends, as working Americans can find time away from work to seek medical attention [8]. These recurring trends result in longer ER wait times and can delay acute medical intervention for those who need it.
This begs the question of whether non-emergent cases should be entirely turned away from the ER. Most experts say no, as there is a fine line between emergent and non-emergent cases. However, solutions are in place to reduce the impact of primary care overload on emergency room systems. Healthcare systems can work to increase staffing during peak emergency room hours by incentivizing these peak hours and employing more. For example, innovative programs like Stanford’s Fast Track program employ a team of emergency physicians, nurses and technicians in the waiting area during peak hours to give prompt attention to low acuity patients, allowing them to get in and get out sooner and opening more time for higher acuity cases [9]. Additionally, finding solutions for primary care overload may help reduce the burden on emergency units. Options such as open-access scheduling, expansion of telehealth, and increased use of nurse practitioners can help to reduce primary care overload and decrease the number of non-emergent cases in the ER [10].
Medical emergencies are never planned, and they have a complex nature that makes it largely inconceivable to predict outcomes for certain. However, one thing is known for sure: had Tashonna’s case been given faster, more precise attention, there is a larger chance that she would have been here today.
Sources:
[1] A woman left the ER to find another hospital after a long wait. Two hours later, she was dead (CNN)
[2] ER Wait Times (West Hills Hospital)
[3] Why are wait times so long in emergency rooms? (The Washington Post)
[4] As ER Wait Times Grow, More Patients Leave Against Medical Advice (KHN)
[5] Thousands of patients die waiting for beds in hospitals — study (The Guardian)
[6] Definition of Boarded Patient (ACEP)
[7] The Complexities Of Emergency Medicine And Prolonged ER Wait Times (Forbes)
[8] Emergency Department Crowding: The Canary in the Health Care System (NEJM)
[9] ED Programs Reduce Wait Times, Improve Patient Satisfaction (Stanford Health Care)
[10] Interventions to reduce wait times for primary care appointments: a systematic review (Ansell et al.)
Kimiya Ghassemzadeh is a 2nd year Physiological Science student at UCLA and is a THINQ 2021–2022 clinical fellow.
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