Prolonged waiting times in Emergency Departments: Are staff to be blamed?

Jun 26, 2016 News

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By Dr. Zulfikar Bux Assistant Professor of Emergency Medicine

Emergency Departments (EDs) worldwide are faced with the ongoing challenge of prolonged waiting times for patients that visit for care.
There is no easy fix to this challenge and often, patients and relatives get angry with the ED staff and vent their frustrations on them.
It may be difficult to believe, but ED staffs are often not the main contributors to patient delays. I have never heard of an ED where the patients were all happy about their waiting times.
No such place exists, because EDs are dynamic areas where patient flow is demanding and unpredictable.
Today we will discuss the major causes of increased waiting times in EDs with the hope that we can all play our part to minimize unnecessary fury that usually occurs as a result of this matter.
OVERCROWDING
This is the number one cause of prolonged waiting times in EDs. As Hospitals run out of beds to admit patients, newly-admitted patients are kept in the EDs until beds become available on the wards. This can take days and it causes a backlog of patients in EDs. These admitted patients take up beds that would be used for incoming patients and it causes a strain on the ED. ED staff are expected to be resourceful and effectively utilize the little available space for incoming patients. Unfortunately, there is only so much ED staff can do when there is no space to see incoming patients. Their efforts are then directed at preserving life and stabilizing the very sick patients until space is available to see the not so sick patients.
STAFF SHORTAGES
Because of increasing patient demands and changes in the medical practice, staff shortages are becoming more evident in EDs. This is even more common in developing systems where it’s not as lucrative to retain staff. Nurses are the most common category that is affected.
They are also often the most reliable human resource that can contribute to minimizing waiting times in the ED.
Decreasing staff shortages in the ED by focusing on nursing human resources has been shown to minimize waiting times in EDs. It therefore highlights the importance of resourceful nursing administration in minimizing waiting times in EDs.
DELAYED LAB/ RADIOLOGY TURNOVER TIMES
ED doctors often need to do Laboratory/ Radiology testing on their patients to help ensure safe and effective care. Having X-rays, CT scans and blood testing done are often outside of the control of ED staff. They rely on resources from the Radiology and Laboratory departments to efficiently return test results. These are often departments that have their own challenges, which frequently lead to delays in the turnover of results. Delayed turnover of results means the longer the patient will have to wait in the ED for a disposition plan. Modernized EDs now have their own labs that can do testing within the ED and minimize waiting times.
UNTRAINED EMERGENCY STAFF
Emergency Departments are dynamic and care is time-sensitive. Having a team that is well-oiled and trained to be efficient and effective, should be the goal of all EDs. Developed EDs have specialist-trained emergency Doctors and Nurses who are the main staffing category that contribute to care. These emergency-trained specialists would have undergone rigorous training to ensure that they can efficiently turnover patients without sacrificing effectiveness of care. EDs that do not have these specialists, tend to have longer waiting times due to decreased coordination and inefficient management of patient flow and care. These are just some of the challenges that are present in most, if not all EDs.
The Georgetown Public Hospital Corporation is no different. It is difficult for the staff, but we do give it our best and will continue to strive for solutions to minimize your wait.
The managing board of directors of this entity has been very proactive in supporting initiatives that will help to tackle this issue. We are hopeful that delays will be minimized as we continue to find solutions to these challenges. So the next time you visit an ED and get anxious about your waiting time, take a minute or two before you begin to blame or abuse the ED staff. We do not enjoy the abuse. Especially when we know we are your main advocates and we want you to go home just as badly as you do.
Our goal is to make sure you can do that safely. This unfortunately takes a little longer than any of us would like. Just know that most of us chose this specialty of medicine, because we are outcome-driven junkies that thrive on fixing problems.
So when we can’t fix your problem, we are just as affected as you. Beating us down will only make us all more affected.

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