Why is it that you almost always have to wait when you go to a hospital emergency room? For some people, the wait can even be as long as two days, according to a new report issued by the Institute of Medicine.
A night with the doctors at Grady Memorial Hospital's emergency room in downtown Atlanta, Ga., reveals a lot about what's causing the problems.
"I'd estimate we probably have 80 to 86 people out here right now spread out among the benches, says Dr. Arthur Kellerman. "The earliest check-in we have at this point was 10 hours ago."
Kellerman is chairman of emergency medicine at Emory University School of Medicine. He also practices at Grady, and if anyone knows how to negotiate an emergency room, it's Kellerman.
At the ER, Be Honest and Assertive
"First thing, it's important to tell the triage nurse and the staff exactly what your problem is," he says. "Be honest, be truthful, be factual. That's the best insurance you have that the nurse and the doctor on duty will make the right decisions and get you into the queue in the proper way and as fast as possible."
But if your wait turns into many hours, or even all night, Kellerman says it's OK at that point to be politely assertive.
"It is very appropriate to go back to the nurse and say, 'I'm feeling worse, or something is going on, or have they forgotten about me? My name is Jones, could you please check and see where I am in the queue?'"
Kellerman in his white coat is something of a target in this waiting room. He's 6-foot-2, and people grab at his sleeve as he walks by.
He kneels to talk to some of them to get a sense of how long they've been waiting. The reason for the backup in the waiting room can be found through the swinging metal doors around the corner.
Beyond the waiting room and in the main emergency department, there are even more patients. Sitting on chairs or lying on gurneys in rooms and in the hall.
Kellerman checks with the charge nurse to see whether any space is available. She tells him there are no vacant beds; all of the resources of the emergency department are occupied.
After-Hours Back Up in the ER
It's 10 p.m. and about two-thirds of Atlanta hospitals have closed or partly closed their emergency rooms, which means despite the crowding here, more ambulances are coming to Grady Memorial.
One reason his emergency room is backing up, Kellerman says, is that few beds in the main part of the hospital open up at night. So when a patient is stabilized in the ER, there aren't any beds in other departments to move the patient to.
Upstairs, surgeon Grace Rozycki in the Intensive Care Unit says she has the same problem Kellerman has. Her 50 beds are almost always full, and so are her spillover beds.
"There is no place else to put them," says Rozycki, "and while we're waiting for beds to open, the patients have to wait downstairs in the emergency department. So we have a very sub-optimal situation, not infrequently, but rather frequently. This is a crisis."
Uninsured Patients a Strain on the System
The emergency department is losing money in no small part because it's seeing more uninsured patients. Hospital officials are reluctant to open more beds in other parts of the hospital because they say they can't afford to keep nurses and doctors on-hand to service what might sometimes be empty beds.
And so the emergency department gets backed up, especially at night, forcing people to wait.
To limit the wait, Grady has set up a fast track for people who aren't likely to need a bed after they've been treated. But even that unit is backed up. People without a primary doctor or without insurance fill this part of the ER every night.
As it gets later, the crowding eases a little. But Kellerman is worried by the fact that many evenings are so busy.
Who to Turn to When the ER is in Crisis
"If we're struggling to deal with tonight's 911 calls in city after city across the United States, how in the world are we supposed to handle an epidemic of pandemic flu or a major terrorist attack or the next natural disaster?" he asks.
And because the ER is so often crowded, he worries that some night, he and his overworked staff may not notice the beginnings of a heart attack in someone waiting on a gurney in the back hallway.
"When I come to work, as I get ready to leave my driveway, I say, 'Dear Lord, help me not to make a mistake tonight,'" he says. "And when I leave the hospital, I say, 'Dear God, thank you for getting me and my patients through another night.'"
As Kellerman pulls out of the parking lot, you can see the blue and white bumper sticker on the back of his car. It reads, "If I'm injured in a crash, take me to Grady."
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