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ER Dilemma: Patients Must Take a Number

by Rick Blizzard

The number of emergency department visits increased 14% in the United States between 1997 and 2000, according to the Centers for Disease Control and Prevention (CDC), even as the number of emergency departments dropped by 2% nationwide. ED overcrowding has become a serious problem; as Dr. Brent King, chair of emergency medicine at the University of Texas Medical School in Houston, said in the American Medical News, "It's a recipe for chaos, and the chaos is here."

The term "emergency room" implies a need for immediate care, yet long wait times have become endemic in hospital emergency departments. The salience of this factor is clearly reflected in patient satisfaction scores. According to Gallup's 2002 patient loyalty database, patients who said they were "very satisfied" with their emergency department experiences reported waiting an average of 16 minutes. "Satisfied" patients waited an average of 35 minutes. Patients who were "somewhat dissatisfied" with their experiences waited 72 minutes on average, and "very dissatisfied" patients waited 92 minutes.

Gallup research has found that a wait time of about one hour or less is necessary to achieve some level of patient satisfaction. If patients wait more than an hour, they become more likely to say they are dissatisfied than satisfied, and if they wait for an hour and a half or more, they will be very dissatisfied.

This is a recipe for dissatisfaction with emergency department services. The CDC reports that the average waiting time for non-urgent patients rose from 51 minutes in 1997 to 68 minutes in 2000. Thus, Gallup findings indicate that the average emergency department patient is likely to be somewhat dissatisfied with non-urgent emergency department wait times.

Bottom Line

Increased waiting time is a symptom of problems in the nation's emergency departments. To secure patient satisfaction, it appears that the goal for waiting time should be 30 minutes or less, with 15 minutes or less being optimal. While it may be easier for smaller emergency departments with fewer patients to achieve shorter waiting times, all emergency departments can improve by focusing on both process issues and human interactions. In addition to operational improvements such as well-functioning triage systems or bedside registration, communicating personally with patients during their waits can also reduce anxiety.

Another major issue facing many emergency departments is what to do with patients who require admission when a bed is not available. One idea for addressing this problem is the establishment of observation units, staffed by experienced inpatient nurses. Nurses can provide necessary care as patients await transfer to the next available bed. Further, staff members can complete unit admission paperwork while patients are in the observation unit, saving time when a bed does become available. The observation nurse can provide continuity of care by escorting the patient and family to the inpatient unit and orienting the unit staff nurse about the patient's condition and needs.

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