What are we waiting for? The mess in the waiting room is a problem for everyone

by Lisa Jaffe Hubbell on December 15, 2010

What are we waiting for?

The mess in the waiting room is a problem for everyone

Name a single hospital administrator that isn’t worried about emergency department throughput. Can’t do it, can you? That’s because this problem, on the lips of the C-suite for decades, has yet to be solved. You can see just how bad the problem is by looking at the workarounds some facilities are using. In an editorial in the Annals of Emergency Medicine, the authors decry the consideration of treating heart patients in the waiting room (http://www.annemergmed.com/webfiles/images/journals/ymem/alkellermann.pdf), while acknowledging that there is often little option for patients in overcrowded emergency rooms.

Part of the problem is getting the right people to the ED to treat the patients there. A new study in Academic Emergency Medicine talks about the shortage of surgeons and other specialists to take ED call http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2010.00927.x/abstract. In many hospitals, getting a neurosurgeon to come to the hospital in the wee hours requires extra payments to the specialists.

Another issue is the number of patients who really don’t belong in the ED to begin with. Many, lacking insurance and knowing they can’t be turned away, use the emergency room as their primary care physician. RAND published a study a couple of months ago in HealthAffairs (http://content.healthaffairs.org/cgi/content/abstract/29/9/1630) that reported nearly a fifth of ED patients could be treated in another setting.

There are solutions out there – and many don’t rely on waiting room medicine. Mount Sinai Medical Center in New York brought hospitalists into their emergency department http://onlinelibrary.wiley.com/doi/10.1002/jhm.636/abstract. The result was a decrease in ED length of stay, a decrease in the number of patients “boarding” in the ED while they wait for a bed elsewhere, and reduction in the number of patients converted to inpatients. Physicians and patients loved the program, and the hospital is currently looking for funding to expand it. The physician who developed it? Alan Briones been working with other hospitals, including Henry Ford Health System facilities, to bring an ED hospitalist program elsewhere.

It takes just a few innovations from bright individuals to make a difference. What ideas do your doctors have that can keep cardiologists out of the waiting room?

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