ER and hospital waits

[Denver]

A couple close relatives of mine deal with health problems that have me accompanying them to the ER several times a year. I very much dislike visiting ERs, but can never really tell if our experience there has been a good one, a typical one, or an unusually bad one.

Yesterday's trip (elderly relative with unusual weakness).

1) Drove relative there (ambulance wasn't necessary this time). There were about 3 people ahead of us in the waiting room. Each takes about 15 minutes to go through an admission process before entering the ER. So we got into the ER after about an hour.

2) They parked us in a hallway because all the ER rooms were full. We got into a room in about 15 minutes though.

3) The usual endless parade of people come through, each with some special duty: fill out this paperwork, sign this waver, Hi I'm your nurse, Hi I'm a volunteer, Hi I'm just going to check your vitals, someone comes to help with changing into gown, someone comes to take blood and other samples, someone comes to hook up monitors. At some point in there a doctor comes in to evaluate things, and order tests. About an hour and half in all. But our nurse is very helpful with our questions.

4) Wait another hour. Then someone comes to take xrays (there was a fall because of the weakness). Then someone comes to take an MRI. Takes about an hour.

5) Wait for results to all come back, and a doctor to explain them. Another hour.

6) They decide to admit relative to hospital (about 4-5 hours have passed from entry). In other visits, this would be the time we would spend here before going home.

7) They have no rooms ready. So we wait. They say it could be 1 hour, unless the room isn't ready by "Shift Change", which apparently puts everything on hold another hour. Relative gets some food. 3 hours pass.

8) Relative is admitted. Get's settled. I go home. 8 hour experience. I ask when I can call tomorrow. They say any time: but not around shift change, since everyone will be busy.

Next day:

1) I call at 8am. Nurse is not very helpful: doesn't know her plan for the day, any decisions in medication I discussed with doctor the previous night, when the doctor will see her, etc. I talk to my relative, who is doing ok. I also work through another doctor office we visit who happens to be an expert on staff there, and get all kinds of good information.

2) We wait for a board of doctors to evaluate her and discuss next steps or discharge.


In overhearing some of the nurses, it seems the ER has been getting slammed lately because of H1N1. But the problem is not sick people: it's people panicking and calling their pediatricians, and being told to bring their kids to the ER and get vaccinated. But the ER's are not doing vaccinations.

So I am used to long ER experiences, and variability in helpful nurses. I assume this, and a 4 hour visit when a person does not need to be admitted, is the norm? How about room waits when admission is needed? is 3 hours a bit long?

[pgwenthold]

Depends on the condition and the extent of "emergency."

Is there any indication that the patient's medical condition was neglected? That care that should have been provided was not?

Even an admission does not necessarily mean that it is imperative.

In a good ER, "kids sent to the ER for vaccinations" will never hold up a or get in the way of a patient who is in more need of medical attention. They would be treated, eventually, but only after all the other higher priority cases are done. If things are busy, then if the patient can wait, he/she will.

The average total time in an ER in the US is about 4 - 5 hours.

(I was listening to the ER docs on Dr Radio this week, and Dr. Billy was listing the cases he had seen the previous night. Lots of drunk, homeless people (this is NYU so it's New York), but one was an INGROWN TOENAIL! Apparently it came on all of sudden?)

[Jorghnassen]

Wow, 4 hours only? Last time I went to the ER, the mode seemed to be around 13-14 hours... But Gatineau's hospital is the worst in the province for that matter, which is why next time, I'll just go directly to the Ontario side, no matter how dire the situation is.

[Professor Yaffle]

A&E where I am (UK). As an adult, I have only been twice. Once for a miscarriage - seen immediately (and moved up to the ward within a couple of hours for an overnight stay in a single room), and once for a broken toe (sticking out at right angle from where it should have been) - seen by a triage nurse quite quickly, and by a doctor in about 3 hours I think. In both cases the staff couldn't have been more helpful and sympathetic.

[Southwind17]

Originally Posted by Denver

So I am used to long ER experiences, and variability in helpful nurses. I assume this, and a 4 hour visit when a person does not need to be admitted, is the norm? How about room waits when admission is needed? is 3 hours a bit long?

I shouldn't worry if I were you. You're clearly a very patient person, evidenced by the length of your OP, the essence of which is captured, and could have been simply expressed, in just the last paragraph I've cited above.

[Amapola]

Mr. Amapola works in the ER, so this is what I hear from him.

Most of the time when people are waiting in the ER, it's because there is someone else ahead of you because they are more serious. If someone comes in having a heart attack for instance, they are whisked in almost immediately. Or if it is a gunshot wound etc. They have had people come to the ER for SORE MUSCLES. I'm not kidding. When asked, the story is something like, "I went hiking yesterday, and now my legs hurt!". People also come in for things like a cut on the finger that requires a bandaid etc. This just takes up an enormous amount of time. So unless you are in the act of dying, you might not get in right away.

It's not like the staff does not care, but the Emergency Room is not for people with sore muscles. Also it is correct, they do not do vaccines, that is for your regular doctor to do. To me, this just illustrates how badly our current "health care" system works.

There is also a great deal of abuse of the system - people who simply want pain meds for instance, who come in complaining of various things because they want the meds... and then try and sell them at the pay phone, right in the admitting area. Also of course you have what they call the "frequent flyers" - people who for one reason or another refuse to take care of themselves, and are in the ER constantly because of treatable conditions they refuse to treat themselves for. (I guess the drunks would fall under this too! But I am more meaning those who have seizures and go off their meds, those with diabetes who do not watch their diet etc.) Some of these abusers are really demanding, as they know a lot about the system, and will time how long it takes to see a doc and so on.

In short, there are a LOT of people who will suddenly decide they need medical attention NOW. The Emergency Room is supposed to be for emergencies, but there are those who use it for a primary care facility, a place to get drugs, a place to go when they feel lonely and need attention, or a place to get dried out and ready for the next drinking binge. Due to this, there are people who don't get in as quickly as they should because they have actual emergencies. The staff do their best to get people in who are in serious trouble but unfortunately the place is clogged up with some of these other people, who, if they would only think about it, do not really need to be there. It's frustrating for the workers; they have spent years of their lives to get training so they can help people and it drives them crazy when the person has sore muscles and no other problems. They want to actually help people who have real problems, not hold the hand of someone who comes in with a "boo-boo".

[Dancing David]

Originally Posted by Denver

So I am used to long ER experiences, and variability in helpful nurses. I assume this, and a 4 hour visit when a person does not need to be admitted, is the norm? How about room waits when admission is needed? is 3 hours a bit long?

Um, it really depends on what is coming through, you have a car crash, gunshot or current heart attack they tend to get priority. If there are people who have more emergent needs the doctor will focus on them first. Then it also depends on how many doctors and how many staff are there.
But be assured that the doctor talked to someone at each step, they are the ones who order the tests, each step of the way.

It can be that you are in the ER ten hours or one hour , it depends. Especially for the people whose symptoms do not appear to emergent life threatening, they will be seen after the more dangerous ones, my preferred hospital is also a trauma center, so if there is a bad car wreck the ER backs up for quite a while.

Waiting for a bed is a whole 'nother story. I have known people to be parked in the ER 24 hours or more waiting for an admission bed.

I worked as the crisis person who evaluated mental health cases for psychiatric hospitalization. When people are drunk and threaten to harm themselves that really messes up the ER because they have to wait for the person to be legally sober before an assesment can be done, could be three hours, could be twelve.

[Denver]

Originally Posted by pgwenthold

Depends on the condition and the extent of "emergency."

Is there any indication that the patient's medical condition was neglected? That care that should have been provided was not?

I don't think so. It involved an atrial fibrillation, which we didn't know until they hooked up the monitors (but has happened before). I think a lot of the time was just watching it (it went back to normal periods sometimes). For me, if your heart gets funky, that's a top emergency. But, maybe not so much: I mean, it's still going.

Originally Posted by Jorghnassen

Wow, 4 hours only? Last time I went to the ER, the mode seemed to be around 13-14 hours...

Once, we waited in an ER room over 12 hours (I slept on the floor): that was waiting for a special room to open at a different facility.

Originally Posted by Professor Yaffle

A&E where I am (UK). As an adult, I have only been twice. Once for a miscarriage - seen immediately (and moved up to the ward within a couple of hours for an overnight stay in a single room), and once for a broken toe (sticking out at right angle from where it should have been) - seen by a triage nurse quite quickly, and by a doctor in about 3 hours I think. In both cases the staff couldn't have been more helpful and sympathetic.

I do have a lot of empathy for most of the staff: they seemed overwhelmed with admissions when I was there. And when staff did get a chance to interact with us, they hid their frazzlement well, and were kind and helpful.

Originally Posted by Southwind17

I shouldn't worry if I were you. You're clearly a very patient person, evidenced by the length of your OP, the essence of which is captured, and could have been simply expressed, in just the last paragraph I've cited above.

I think wanted to provide enough details for comments. Or I just felt like venting.

Originally Posted by Amapola

...There is also a great deal of abuse of the system - people who simply want pain meds for instance, who come in complaining of various things because they want the meds... and then try and sell them at the pay phone, right in the admitting area. Also of course you have what they call the "frequent flyers" - people who for one reason or another refuse to take care of themselves, and are in the ER constantly because of treatable conditions they refuse to treat themselves for. (I guess the drunks would fall under this too! But I am more meaning those who have seizures and go off their meds, those with diabetes who do not watch their diet etc.) Some of these abusers are really demanding, as they know a lot about the system, and will time how long it takes to see a doc and so on.

In short, there are a LOT of people who will suddenly decide they need medical attention NOW. ...

I didn't realize all the abuse, and now that you mention it, I think about half the ER visits I've had, there's been a drunk in there someplace.

Originally Posted by Dancing David

...Waiting for a bed is a whole 'nother story. I have known people to be parked in the ER 24 hours or more waiting for an admission bed.

I worked as the crisis person who evaluated mental health cases for psychiatric hospitalization. When people are drunk and threaten to harm themselves that really messes up the ER because they have to wait for the person to be legally sober before an assesment can be done, could be three hours, could be twelve.

Interesting. I am pretty much resolved for 3-4 hours on a non-admission visit, and was wondering especially on the whole issue of bed availability. It almost seemed liked the beds only became available at shift end: maybe after they've reassessed all the rooms, cleaned the empties, etc. Or maybe they'd rather wait to admit new patients with the new nurse, if the shift is changing soon. Though, I also know they wanted to get us our of the ER room, so they could get more people in there too.

[borealys]

My only ER experiences for myself have been at a small suburban hospital that doesn't function as a trauma centre. When I was in for a broken ankle, I waited about five hours from coming in the door to hobbling out -- but that was not because there was anyone ahead of me, rather because there was no one at the registration desk when I got through triage, the doctor had a moment to see me while I was waiting to sign in, and since I wasn't signed in yet when he wrote it, my x-ray requisition got lost. Most of the time I spent waiting, the radiographer was twiddling his thumbs in the ICU with no idea I was there. (I was also given crutches that were too short, had my ankle wrapped incorrectly, and was given codeine to take about four hours after the Advil I'd taken at home kicked in and the pain stopped, but that's another story.)

My father, on the other hand, though he was seen quickly, ended up passing three nights in that same ER when he had a heart attack, because there were no beds open.

Not the world's best hospital, that one. Though the fracture clinic doctor was very nice.

I've worked in bigger and smaller city hospitals since then, and can tell you that people here can wait days for admission. One place I used to work prettified their wait-time statistics by having a "Medical Holding Area" which was virtually identical to one of the place's three ERs, but where you were considered to be "admitted" rather than waiting for admission. People passing through the various ERs and the MHA were sometimes five days or more getting onto a ward. Meanwhile, the ER was overflowing into the hallways, with stretchers practically piled on top of each other. Believe me, if they could've gotten people through there quicker, they would have.