Patients skip care when ER waits drag on

When your ER waiting room backs up so much that you have to "board" patients, your hospital may risk losing patients--those who leave without treatment--and revenues. Researchers at the University of South Florida have linked boarding of admitted patients to the ER with higher rates of patients leaving without treatment, according to a presentation discussed today at the annual meeting of the American College of Emergency Physicians. When boarding hours reached an 8.5 percent threshold of all available emergency department bed hours, patients in the waiting room were much more likely to leave, the researchers found.
Other research on hospital policies offer glimmers of hope for some solutions to seemingly intractable ER patient flow problems. Hospital policies can shorten wait times. For example, one hospital that enforced a rule that inpatient beds be ready in 30 minutes for patients admitted through the ED to internal medicine or general surgery saw a dramatic improvement in the length of stay. Rapid bed assignments decreased overall ED time for patients in the intervention group from 421 to 374 minutes. Time-to-bed assignment dropped from 73 to 31 minutes.
A related study found that accountability to hospital governing boards can cut boarding and waiting times for heart patients. Apparently, if your hospital leadership creates and enforces policies to quickly move admitted patients out of the emergency department, the wait time for an in-patient bed falls by more than 50 percent.

It may be a while before more systemic changes are made to ease ER crowding in the country's hospitals. Wait times wouldn't pose such problems if some 100 million people who could go elsewhere for non-emergency treatment actually went to primary-care doctors or, depending on their condition, retail clinics or urgent-care centers.
To learn more:

- read the press release from the American College of Emergency Physicians
- read the abstracts from the presentations
- read the Tampa Tribune article
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Study: ER boarding, staff shortages common
100 million ED visits could be handled elsewhere