ER

Running head: EMERGENCY ROOM WAIT TIMES 1

EMERGENCY ROOM WAIT TIMES 1

Emergency Room Wait Times

Liannys Rodriguez

Miami Regional University

Emergency Room Wait Times

Today, Emergency Rooms (ERs) operate as the primary entrance to various acute care facilities. Patients arriving at the treatment facility through the ER are now experiencing lengthy waits. In the United States, the average waiting time for emergency patients at ERs is now about 40 minutes. According to the Centers for Disease Control and Prevention, in 2017, at least 22 million ER visits that are about 16%, included at least 60 minutes of waiting (Mahmood et al., 2020). This long waiting time has resulted in higher health risks, patients leaving without being treated, overcrowding at ERs, and decreased patient satisfaction. The primary causes of lengthy waits are complex and impacted by several factors within and beyond the emergency department.

Furthermore, in another research by Mahmood et al., (2020), the findings show that the average ED patient in the United States waits for at 90 minutes to be taken to their room and 145 minutes to get cleared or discharged. According to the research, patients arriving at ERs with broken bones painfully wait for about minutes, on average, before receiving any pain medication. The lengthy waits are due to the increasing rate of ERs visits over the past years in the U.S. For instance, McDonald Hulen et al. (2020) reveal Autoinsurance.org.'s report that shows an increase from 360 visits per 1,000 people in 1995 to 445 in 2017.

This report of Autoinsurance.org analyzed data from the Centers for Disease Control and Prevention and the Kaiser Family Foundation and revealed that Washington, D.C., has the significant average waiting time across the country. This prolonged time is for hospitalized patients waiting for an inpatient room after getting cleared by a doctor in the ER. As per the findings, hospitalized patients in the country's capital should wait for an average of 4.7 hours for their room in the care facility (McDonald Hulen et al., 2020). Delaware, New York, Maryland and Connecticut joined Washington, D.C., with median lengthy waits of more than 2.5 hours.

Countrywide, admitted patients spend at least two hours waiting for an ER. The first screening is very short and has about forty per cent of patients seeing a doctor within 15 minutes of checking into the ED. The data below summarizes the ER lengthy times in 10 states with prolonged and shortest median lengthy waits for ED patients:

States with the Longest Median Wait Times	States with the Shortest Median Wait Times
State	ER Wait Times (Minutes)	State	ER Wait Times (Minutes)
District of Columbia	286	South Dakota	46 minutes
Delaware	153	Kansas	55
New York	153	Wyoming	58
Maryland	152	Lowa	60
Connecticut	152	Wisconsin	61
New Jersey	150	Nebraska	62
. California	150	Utah	62
Rhode Island	147	Montana	63
Massachusetts	131	Mississippi	67
Hawaii	131	North Dakota	68

Source: Autoinsurance.org. report released on August 29, 2020

Current Measures to Improve ER Wait Times

The hospitals are now implementing the Emergency Severity Index (ESI) triage tool to enable healthcare workers in Urgent Care Clinics (UCCs) to triage patients. This measure enables patients with acute complications, beyond the expertise and resources of the UCC, to have timely redirection to an ED (Soremekun et al., 2018). As a result, the wait times in these UCCs get reduced since the redirected patients decongest the ERs. Mahmoodian et al., (2014) state that ESI tool has speeded up identifying acute patients in EDs and resulted in a significant decrease in lengthy waits. By introducing an emergency department information system (EDIS), wait times have decreased in hospitals'' ERs. The system allows multiple tracking of patients, simultaneous data entry, storage, and retrieval at the ER because of the computerized process (Farley et al., 2013). As a result, the workflow is rapid, hence reducing lengthy waits.

Outcome Data Related to The Measures

According to Anita et al., (2019), the "Door to Doctor" time at hospitals dropped by 12.6 minutes after EDIS implementation compared to 3.7 minutes in the ERs without the new system. In this research findings, the regression-adjusted difference-in-differences approximates for "Door to Doctor" time and "Door to Triage" time revealed a substantial decrease of time waits at EDs compared with EDs without the computerized system, 8.9 and 5.0 minutes, respectively. The computerized system has assisted hospitals in surpassing clearance time targets. In 2010-2011, waiting time reduced from 216 down to 162 minutes, and below 2.4 hours in 2011 – 2012 (Troutner et al., 2020). ESI is currently averaging the waiting time at 1.4 hours. These reductions directly link to the real-time tracking resulting from the implemented measures.

Advantages and Disadvantages of The Measures

Generally, these measures have led to improved efficiency of higher volume EDs. For instance, EDIS removes setbacks such as slow data entry and retrieval, which impede or slow down patient and workflow at ERs because of the manual system used. Hospitals have ensured high volumes of less urgent patients get sorted within the shortest time using the automated system; thus, reducing overcrowding that increase wait times. Easy patient tracking and automated provider order entry are crucial features of the EDIS, reducing wait times (Farley et al., 2013). Also, through the measures, EDs have enforced a province-wide standard for patient triage and waiting times to get first medical concentration. For instance, ESI has been a significant classification system for establishing the adversity of patients' condition on arrival to the ER.

However, these measures have some cons. For instance, EDIS'EDIS' pitfalls include increased risks of medical errors that threaten patient safety. According to the IOM, Health IT and Patient Safety: Building Safer Systems for Better Care, poorly installed EDIS creates new risks in already complicated delivery of emergence care services because of dosing errors (Farley et al., 2013). Also, the system breakdown leads to overcrowding that implies increased wait times. Similarly, the Emergency Severity Index (ESI) complicates nurses' work, leading to lengthy waits (Mahmoodian et al., 2014). For instance, different ESI level triage scales at the same ER facilitates differing communications. Thus, the tool is prone to delays at all levels of the entire ED.

In conclusion, the data on emergency room wait times proves the current problem in hospitals' emergency departments in the United States. The lengthy waits contribute to overcrowding and slow workflow at ERs. However, the implementation of ESI and EDIS solves the challenge by decreasing the average waiting time. Through EDIS, automatic patient data tracking and storage have solved the problem of lengthy waits as ESI prioritizes acute patients' care needs to get treatment within a short time.

References

Anita, A.V., Farnoosh, H.S., & Lisa, A.N. (2019). Applying Lean Principles to Reduce Wait Times in a VA Emergency Department. Military Medicine, 184,1-2, 169–178.

Farley, H.L., Baumlin, K., Hamedani, A., & Cheung, D. (2013). Quality and Safety Implications of Emergency Department Information Systems. Annals of Emergency Medicine 62(4).

Mahmood, A., Wyant, D. K., Kedia, S., Ahn, S., Powell, M. P., Jiang, Y., & Bhuyan, S. S. (2020). Self-Check-In Kiosks Utilization and Their Association with Wait Times in Emergency Departments in the United States. The Journal of Emergency Medicine, 3(5), 34-39.

Mahmoodian, F., Eqtesadi, R., & Ghareghani, A. (2014). Waiting Times in Emergency Department After Using the Emergency Severity Index Triage Tool. Archives of Trauma Research 3(4): e19507 DOI: 10.5812/atr.19507.

McDonald Hulen, M., Hodgson, B., & Fogarty Gramme, B. (2020). Department of Insurance. California Regulatory Law Reporter, 25(2), 14.

Soremekun, O. A., Takayesu, J. K., & Bohan, S. J. (2018). Framework for analyzing wait times and other factors that impact patient satisfaction in the emergency department. The Journal of Emergency Medicine, 41(6), 686-692

Troutner, J. C., Harrell, M. V., Seelen, M. T., Daily, B. J., & Levine, W. C. (2020). Using Real-Time Locating Systems to Optimize Endoscope Use at a Large Academic Medical Center. Journal of Medical Systems, 44(4), 1-6.