PD Editorial: Emergency room waits are leaving patients at risk

There's nothing fun about a visit to the emergency room - whatever brings you there. But it's even less pleasant when the emergency room is overcrowded and you end up waiting hours for the urgent care you need, and hours longer if you need to be admitted to the hospital.

In California, emergency room patients more likely than not encounter that situation. In 2017, the median wait time for patients before admission to hospitals was 336 minutes, or more than 5½ hours. For patients discharged without admission, the wait time was more than 2½ hours.

The state has been wrestling with emergency room overcrowding for years. The situation was bad 15 years ago, and it has not improved. According to a 2018 study by the California Healthcare Foundation, emergency room visits increased by 44% between 2006 and 2016 - even as hospitals worked to reduce their use.

Many factors contribute to the overcrowding. Too many people go to the emergency room for ailments that aren't actual emergencies - sometimes because they don't know better; sometimes because they don't have access to a primary care physician. Though Medi-Cal was expanded under Obamacare, many California doctors don't accept it. Sometimes it is a lack of inpatient rooms available for people waiting for admission.

Whatever the causes, those lengthy wait times and overcrowded conditions are leading to an increase in emergency room patients who essentially give up and leave against medical advice, according to a report by Kaiser Health News. And when patients leave, whatever problem brought them in originally festers, often becoming an even greater public health risk and expense.

Statewide, about 2.4% of emergency room visits ended with patients leaving against medical advice, but some hospitals had far higher rates. At Fresno's Community Regional Medical Center, nearly 10% of emergency room patients left prematurely in 2017.

That abominably high rate prompted some necessary changes. The hospital instituted a program to place caregivers in the emergency room lobby to ensure that patients get at least some immediate attention.

“When patients bring themselves into the ED, they are seen in about five minutes by a qualified registered nurse and, on average, are seen by a provider within 30 minutes of arrival,” Dr. Jeffrey Thomas, the hospital's chief medical and quality officer, told Kaiser Health News.

Internal hospital data shows that effort reduced premature departures to fewer than 2%.

Other California hospitals should take note of this approach.

If capacity can't be increased to meet the demand or if demand can't be lowered, then hospitals need to find ways to better manage the situation to ensure patients who need care don't leave before they receive it.

Ideally, an emergency room should be for emergencies, not otherwise preventable health problems. As long as too many people don't have access to primary care or choose not to fully engage with it, the problem will persist. That's a bigger issue that won't be fixed in the short term. Implementing strategies to make sure patients are seen in a reasonable time and not allowed to leave without treatment is much more attainable.

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