You head to the emergency department when you feel like you have an emergency. If you arrived first, why aren't patients seen in order?
Dr. Nick Colovos, Assistant Professor Emory School of Medicine Department of Emergency Medicine and Interim Chief Quality Officer for the Physician Group Practices, explains how triage works to prioritize treatments. Dr. Colovos also advises on what to do with less acute symptoms.
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Why the Long ER Wait Times?
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Learn more about Nick Colovos, MD, MBA
Nick Colovos, MD, MBA
Nick Colovos, MD, MBA is an Assistant Professor Emory School of Medicine Department of Emergency Medicine Interim Chief Quality Officer for the Physician Group Practices.Learn more about Nick Colovos, MD, MBA
Transcription:
Bill Klaproth (Host): You or a loved one are sick or possibly have been injured, you are at the ER, but you are told it’s going to be a while, so you settle in and wait. Here to talk with us about long ER wait times is Dr. Nick Colovos, Assistant Professor at Emory School of Medicine, Department of Emergency Medicine, Interim Chief Quality Officer for the Physician Group Practices at Emory Healthcare. Dr. Colovos thank you for your time. So, in 2014, the Centers for Disease Control and Prevention reported average Emergency Department wait times to be about thirty minutes. So, that can seem like an eternity when you are sick or injured so, why so long generally?
Nick Colovos, MD, MBA, FACEP (Guest): Yeah, that’s a great study that came out to the CDC. It not only saw that it took about thirty-minute wait times for folks to be seen; but they also indicated that it was about another 90 minutes for treatment plans to be implemented. And so, that’s about a two-hour time frame that most people would spend in the Emergency Department and some even longer. The big challenge in the Emergency Department is that we really don’t take patients on a first come first served basis. We really prioritize those patients through a methodology known as triage and what that does is our nursing staff and our physician staffs will look at patients when they present to the Emergency Department, determine how severe their illness is and of course, we are going to take those that are more severely ill first rather than those that can potentially wait because their illness or injury is a little less. Somebody coming in with a sore throat or an ear infection compared to somebody coming in with a stroke or a heart attack; certainly, the heart attack and the stroke are going to be seen prior to seeing the lower acuity. So, that’s a big reason why sometimes folks have those and experience those waits is that we are really good at taking care of the very, very sick patients. Unfortunately, those that are less severe are going to have to wait.
Bill: That’s good to know. Alright so, are more people using the ER and if so, is that leading to overcrowding and how big of a problem is that if that’s the case?
Dr. Colovos: Yeah, I think if you look at any of the surveys out by the American College of Emergency Physicians and elsewhere, the real premise was that the thought behind the Affordable Care Act was that it would potentially reduce or relieve some of those pressures of patients on the ER. Unfortunately, that really hasn’t panned out and we are seeing a continual growth of the use of the Emergency Departments and that’s been in the double digits over the last several years. So, we are seeing more and more patients using the Emergency Department. In part, I think it’s just due to the fact that we really lowered the barriers to access. We are open 24 hours a day, seven days a week. We take anybody that comes. And so, that type of entry point is something that people find very valuable.
Bill: So, let me ask you this then. Is this where Urgent Care Centers come in? Are they there to relieve the pressure on the ER?
Dr. Colovos: There was a lot of debate as to whether Urgent Cares were actually reducing the number of patients going to ERs. And we are seeing some shift, some slight shift and trends seem to be moving that way with even a recent article through the CDC just this year. I think that the Urgent Cares have the opportunity to really be able to handle a substantial number of patients that are typically seen in an Emergency Department and those would be the patients that have a low acuity or less severe type of illness, the cough, cold, flu, sprains, strains, laceration or cut that needs to be sutured; those types of patients could often be well-served at a local Urgent Care, both from a perspective of the medical care that they receive as well as the time that it would take them to be seen at those facilities compared to the Emergency Departments locally.
Bill: So, when should you chose Urgent Care over the ER? Maybe you can shed some light on that for us.
Dr. Colovos: I think when you are looking at trying to decide where to go; that’s the most daunting challenge for most patients out there. It’s trying to figure out where should I go. The first thing I would advise folks is to know the availability of both hospitals within your region, what those hospitals do and what they specialize in, but also have an understanding of the location of Urgent Cares. You may not have anyone close to you or you may have one just down the block. When you are making that decision on where to go; I would say that if your symptoms need to be treated quickly but they are not life-threatening, that an Urgent Care Clinic would typically be a better treatment option than the Emergency Department. However, if you are having shortness of breath, if you are having chest pain, stroke type symptoms, things of a more urgent or emergent nature; then certainly contacting 9-1-1, getting transported to the local hospital would be the better route.
Bill: Right, and when it comes to Urgent Care, generally, are the wait times less?
Dr. Colovos: Typically, they are. And your average time and this is a national average is that from the time you walk in the door to the time you walk out of the door following treatment and evaluation is about 60 minutes on average. And that’s a very good timeframe for most folks.
Bill: And back to wait times at the ER, if you are there and you feel like you have been sitting a long time, does speaking up help?
Dr. Colovos: I think it does and I would certainly encourage people to do that. Obviously, you have to do it in such a manner that you don’t upset staff and classically you don’t want to make a scene. But I certainly think that going back to the triage nurse or the front desk personnel and making them aware that either your condition is worsening or that you have been waiting a while and if they can give you some timeframe. We work very hard at the hospitals here within the Emory System to be able to communicate to our patients and allow them to have an understanding and expectation of when they may be seen next.
Bill: So, if you are headed to the ER, are there things you should bring or do to help speed up the process?
Dr. Colovos: There are. One of the things I would strongly recommend folks do is prior to going to the Emergency Department is reaching out to their Primary Care Physician and talking with them. The second thing is to bring a copy of their medical records, particularly if they have complicated medical histories, prior EKGs or other laboratory tests that can be very valuable to the ER physician. And so those two things would be the biggest things. The third thing that we mention only briefly, and I think it’s something that we overlook sometimes is you can have somebody come with you. You really need a patient advocate to help and watch you. Going by yourself can be a pretty scary situation for most folks. So, if you can bring an advocate or a family member or somebody with you that knows a little bit of your medical history, that’s helpful as well. And bear in mind that Mondays are typically our busiest days and those spill over into Tuesdays and mornings at most Emergency Departments are a little bit slower, a little less busy than the rest of the day.
Bill: Wow, that’s interesting information and lastly is there anything else we should know about wait times in the ER?
Dr. Colovos: The wait times can vary tremendously. You will see that online currently some ERs actually post their wait times and you can even in some circumstances schedule an appointment in the ER online. The one caveat I would give to folks is that those check in times are really estimated wait times and once again, we are going to see patients based on their severity and so even though you check in online, those aren’t guaranteed and just due to the unpredictability of the Emergency Department and the admissions that we see through it.
Bill: Well you have certainly helped clear up the confusion on ER wait times and also when to go to Urgent Care and when to go to the ER. This has been very valuable. Dr. Colovos, thank you so much for your time. For more information please visit www.emoryhealthcare.org, that’s www.emoryhealthcare.org. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): You or a loved one are sick or possibly have been injured, you are at the ER, but you are told it’s going to be a while, so you settle in and wait. Here to talk with us about long ER wait times is Dr. Nick Colovos, Assistant Professor at Emory School of Medicine, Department of Emergency Medicine, Interim Chief Quality Officer for the Physician Group Practices at Emory Healthcare. Dr. Colovos thank you for your time. So, in 2014, the Centers for Disease Control and Prevention reported average Emergency Department wait times to be about thirty minutes. So, that can seem like an eternity when you are sick or injured so, why so long generally?
Nick Colovos, MD, MBA, FACEP (Guest): Yeah, that’s a great study that came out to the CDC. It not only saw that it took about thirty-minute wait times for folks to be seen; but they also indicated that it was about another 90 minutes for treatment plans to be implemented. And so, that’s about a two-hour time frame that most people would spend in the Emergency Department and some even longer. The big challenge in the Emergency Department is that we really don’t take patients on a first come first served basis. We really prioritize those patients through a methodology known as triage and what that does is our nursing staff and our physician staffs will look at patients when they present to the Emergency Department, determine how severe their illness is and of course, we are going to take those that are more severely ill first rather than those that can potentially wait because their illness or injury is a little less. Somebody coming in with a sore throat or an ear infection compared to somebody coming in with a stroke or a heart attack; certainly, the heart attack and the stroke are going to be seen prior to seeing the lower acuity. So, that’s a big reason why sometimes folks have those and experience those waits is that we are really good at taking care of the very, very sick patients. Unfortunately, those that are less severe are going to have to wait.
Bill: That’s good to know. Alright so, are more people using the ER and if so, is that leading to overcrowding and how big of a problem is that if that’s the case?
Dr. Colovos: Yeah, I think if you look at any of the surveys out by the American College of Emergency Physicians and elsewhere, the real premise was that the thought behind the Affordable Care Act was that it would potentially reduce or relieve some of those pressures of patients on the ER. Unfortunately, that really hasn’t panned out and we are seeing a continual growth of the use of the Emergency Departments and that’s been in the double digits over the last several years. So, we are seeing more and more patients using the Emergency Department. In part, I think it’s just due to the fact that we really lowered the barriers to access. We are open 24 hours a day, seven days a week. We take anybody that comes. And so, that type of entry point is something that people find very valuable.
Bill: So, let me ask you this then. Is this where Urgent Care Centers come in? Are they there to relieve the pressure on the ER?
Dr. Colovos: There was a lot of debate as to whether Urgent Cares were actually reducing the number of patients going to ERs. And we are seeing some shift, some slight shift and trends seem to be moving that way with even a recent article through the CDC just this year. I think that the Urgent Cares have the opportunity to really be able to handle a substantial number of patients that are typically seen in an Emergency Department and those would be the patients that have a low acuity or less severe type of illness, the cough, cold, flu, sprains, strains, laceration or cut that needs to be sutured; those types of patients could often be well-served at a local Urgent Care, both from a perspective of the medical care that they receive as well as the time that it would take them to be seen at those facilities compared to the Emergency Departments locally.
Bill: So, when should you chose Urgent Care over the ER? Maybe you can shed some light on that for us.
Dr. Colovos: I think when you are looking at trying to decide where to go; that’s the most daunting challenge for most patients out there. It’s trying to figure out where should I go. The first thing I would advise folks is to know the availability of both hospitals within your region, what those hospitals do and what they specialize in, but also have an understanding of the location of Urgent Cares. You may not have anyone close to you or you may have one just down the block. When you are making that decision on where to go; I would say that if your symptoms need to be treated quickly but they are not life-threatening, that an Urgent Care Clinic would typically be a better treatment option than the Emergency Department. However, if you are having shortness of breath, if you are having chest pain, stroke type symptoms, things of a more urgent or emergent nature; then certainly contacting 9-1-1, getting transported to the local hospital would be the better route.
Bill: Right, and when it comes to Urgent Care, generally, are the wait times less?
Dr. Colovos: Typically, they are. And your average time and this is a national average is that from the time you walk in the door to the time you walk out of the door following treatment and evaluation is about 60 minutes on average. And that’s a very good timeframe for most folks.
Bill: And back to wait times at the ER, if you are there and you feel like you have been sitting a long time, does speaking up help?
Dr. Colovos: I think it does and I would certainly encourage people to do that. Obviously, you have to do it in such a manner that you don’t upset staff and classically you don’t want to make a scene. But I certainly think that going back to the triage nurse or the front desk personnel and making them aware that either your condition is worsening or that you have been waiting a while and if they can give you some timeframe. We work very hard at the hospitals here within the Emory System to be able to communicate to our patients and allow them to have an understanding and expectation of when they may be seen next.
Bill: So, if you are headed to the ER, are there things you should bring or do to help speed up the process?
Dr. Colovos: There are. One of the things I would strongly recommend folks do is prior to going to the Emergency Department is reaching out to their Primary Care Physician and talking with them. The second thing is to bring a copy of their medical records, particularly if they have complicated medical histories, prior EKGs or other laboratory tests that can be very valuable to the ER physician. And so those two things would be the biggest things. The third thing that we mention only briefly, and I think it’s something that we overlook sometimes is you can have somebody come with you. You really need a patient advocate to help and watch you. Going by yourself can be a pretty scary situation for most folks. So, if you can bring an advocate or a family member or somebody with you that knows a little bit of your medical history, that’s helpful as well. And bear in mind that Mondays are typically our busiest days and those spill over into Tuesdays and mornings at most Emergency Departments are a little bit slower, a little less busy than the rest of the day.
Bill: Wow, that’s interesting information and lastly is there anything else we should know about wait times in the ER?
Dr. Colovos: The wait times can vary tremendously. You will see that online currently some ERs actually post their wait times and you can even in some circumstances schedule an appointment in the ER online. The one caveat I would give to folks is that those check in times are really estimated wait times and once again, we are going to see patients based on their severity and so even though you check in online, those aren’t guaranteed and just due to the unpredictability of the Emergency Department and the admissions that we see through it.
Bill: Well you have certainly helped clear up the confusion on ER wait times and also when to go to Urgent Care and when to go to the ER. This has been very valuable. Dr. Colovos, thank you so much for your time. For more information please visit www.emoryhealthcare.org, that’s www.emoryhealthcare.org. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.