Everyone's aware that if you go to a hospital emergency room, the meaning of the word "patient" may be put to the test. But I didn't appreciate just how much patience I'd need until I actually sat in an ER for a very long time.
When you arrive at the ER for a relatively minor issue, as I did, your first thought will be, "There are probably patients here with more serious problems than I have, and of course they'll need to be seen first." They might come in from dreadful car wrecks, or they've just had near-fatal heart attacks.
But as the clock ticks, you guiltily fall prey to other thoughts, such as, "Couldn't they have planned better and had more staff, or better workflow?" You might start suspecting that this is simply a case of heedlessness toward patients' needs.
You might secretly wonder, "Does this same heedlessness exist in other parts of the hospital — perhaps the inpatient units upstairs, or in radiology or surgery?" Even against your better judgment, you might start blaming the whole institution for your wait.
I have to admit that these thoughts came to me recently when I had to bring my wife to the ER. It happened when she was alone at our winter place in Florida. I was arriving by plane and gave her a call. She told me she had just had an accident. When she pulled the cord to start a ceiling fan, the light fixture on the fan fell onto her face. It cut her over her right eye, causing a lot bleeding.
Her voice sounded weak over the phone, and I was alarmed. I drove home as fast as I could and took her to the local hospital emergency room. Things started off quite well in the ER. After my wife was triaged, we were immediately taken to a cubicle, and a nurse checked her vital signs. We were told a physician would be along soon to stitch her up.
As we waited, I looked around and noticed about five other cubicles, all filled with patients also waiting for care. We had been waiting there for about 3 hours when I decided to go to the nurse's station to inquire how long it would be. I was told the physician would arrive "sometime soon."
When I brought this news back to my wife, she did not get angry or even raise her voice. She simply said, "I'm hungry, and I want get out of here and go home!" I blubbered something about needing to stay put, but she got up and marched out of the cubical. We left the building and didn't return.
With my own connivance, my wife had just joined the ranks of "LWBSes" – ER patients who "leave without being seen." According to a 2006 study in the Annals of Emergency Medicine, a little over 6 percent of ER patients do this.
It turns out that my wife is not alone — a lot of patients put a limit on how long they will wait in the ER. In a survey of ER patients at an urban academy medical center, reported in the Western Journal of Emergency Medicine in 2012, fully half said they would not wait more than 2 hours, and only a third said they would wait "indefinitely."
When my wife and I got back home, the bleeding from her cut had virtually stopped, so we held off getting care until the next morning. By that time, an urgent care center was open and we went there instead.
She was seen almost immediately, and her cut was stitched up in a most caring and efficient manner — in stark contrast to our experiences the day before. We decided that we probably shouldn't have even bothered to go to the ER in the first place for a simple laceration.
It's well known that ERs are often used for care that could be received elsewhere. A 2010 study by researchers at RAND, published in Health Affairs, estimated that 17 percent of ER visits could go elsewhere. If your doctor isn't available, urgent care centers can treat the flu, fever, rashes and minor cuts and bone fractures, according to AmericanCollege of Emergency Physicians.
But things aren't so neat in real life. In some cases, you have to depend on the emergency room for simple issues. Urgent care centers have limited hours, and you might not think it's wise to wait until the next day.
Why do ERs have to have such long wait times? Granted, if you show up on a Saturday night at a big-city ER with a relatively minor complaint, you can't expect to be seen right away. But hospitals do have some control over wait times, and we know this because wait times vary widely, even among hospitals in the same class.
For example, in a 2013 analysis by Crain's Chicago Business, wait times at ERs in the Chicago area ranged from 3.5 hours to 10.6 hours from arrival at the ER to admission into the hospital. Suburban hospitals tended to do much better than public hospitals and academic medical centers, but there were exceptions, and there were wide variations among similar institutions, such as academic medical centers.
Why should it matter if people have to wait a long time in ERs for relatively simple care? Two influential emergency physicians, writing in the New England Journal of Medicine in 2011, stated that the ER is more than a hospital department; it's a "room with a view" into your healthcare system.
"If primary care is fragmented or weak, the ER's waiting room will be full of patients with problems that should have been prevented or treated by primary care providers," they wrote. And "if the hospital's administration is not adept at managing the flow of patients, the ER's exam rooms, resuscitation bays and hallways will be packed with ill and injured patients, many of whom were stabilized and admitted hours earlier but now have nowhere to go."
Even many hospital executives who have worked hard on ER efficiency know they can do better. When I told the chairman of a major pharmaceutical company my story about waiting in the ER, he was ready with his own.
He sprained his ankle while playing tennis, and friends drove him to the closest hospital, where he also happened to be the chairman of the hospital's board, but he didn't pull rank and was treated like any other patient. He was told to sit down and someone would be with him soon.
Well, "soon" turned into 2.5 hours, and by that time, he said, his ankle felt much better. So he simply got up and walked out of the emergency room — another patient "LWBS."
His story doesn't end there. A few days later, he attended a hospital board meeting in which the CEO of the hospital made a presentation on how the institution was becoming more efficient — especially the emergency room, where wait times had been cut from 1 or 2 hours to 30 minutes!
The board chairman waited until after the presentation to take the CEO aside and tell him his story. The CEO was embarrassed, even though this was a hospital that actually did have one of the shortest waiting times in the Chicago area, according to the Crain's survey.
More than ever, unhappy patients in the ER can affect your bottom line. The HCAHPS survey assesses ER patients' attitudes. When consumers decide which ER to go to, they can access online tools such as the ProPublica's ER Wait Watcher, which shows wait times for individual ERs across the country, based on federal data. In 2015, online consumer site Yelp started using ProPublica's data on wait times in its assessments of hospitals.
The experiences that people have in one part of the hospital can affect how they feel about another. CEOs should always be aware that the problems that exist in the ER serve as a window to the community on how well the hospital operates.