Wait Times in Emergency Rooms Excessively Long
Four- to five-hour waits are now common in ERs all across the country. Patients pile up in emergency rooms and those who need to be admitted can wait as long as four to five hours before they find a bed. That’s a good day, says one doctor. On a bad day, wait times can go in excess of 15 hours—or longer—before a patient is admitted or even evaluated. In one case, they recounted a patient with chest pains waiting 47 hours in an ER hallway before a spot became available in a cardiac unit.
The practice is known as boarding. Boarding is keeping patients waiting in the ER while they are waiting for an inpatient bed. According to some doctors, the practice is rampant. The CDC reports that the majority of hospitals have boarded patients in emergency rooms for longer than two hours while they were waiting for beds to open up. Worse yet is the problem has been known for at least 20 years and it’s unclear what we can do about it.
Delays in Admission Result in Delays in Treatment
Boarding is, of course, one of the main causes of ER overcrowding. Overcrowding results in delays administering treatment such as pain medication or antibiotics. Delays in treatment result in longer inpatient stays once the patient is is admitted. Longer inpatient stays result in ER boarding and overcrowding. In other words, the problem is a vicious circle—a self-propelling spiral that gets worse as it goes along. All of this results in worse medical outcomes for patients.
So why is it happening? Are America’s hospitals just overwhelmed? Are the hospitals themselves doing something that needs to be corrected?
Why are U.S. Hospitals Overcrowded?
There appears to be a number of factors that are causing the problem of ER boarding and overwhelming U.S. hospitals. One of the largest factors is a 30% reduction in the overall number of hospitals in the U.S. since 1975 even as the U.S. population continues to increase. The loss of hospitals appears to be directly related to the cost of medical technology overall. Meanwhile, insurance reimbursement rates have diminished and many hospitals have either merged with others or gone bankrupt and closed up completely.
On the other hand, the majority of hospitals now operate at only 65% of their inpatient capacity. Once again, the issue is related to reimbursement and economics.
Medicare sets the standard for how hospitals are reimbursed as it is the largest insurer of Americans in the country with over 60 million on Medicare. Reimbursement rates favor more invasive or higher-cost procedures like surgery than non-invasive procedures. Managing medical conditions is far less lucrative. Since surgical procedures tend to require overnight stays, there are fewer hospital beds for those in the ER, and hence, wait times are longer.
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