We have learned that our emergency department has a concerning increase in patients who have ‘left without being seen.’  Likewise, we have had an increase in the amount of time admitted patients wait for a room.

This is an ongoing battle in American emergency departments.  Both issues, those who leave without evaluation and those who wait too long for inpatient rooms, pose significant problems with customer satisfaction/public relations.

Furthermore, patients who leave without seeing a physician often (and contrary to popular belief) have serious medical problems.  And obviously, the problems are tied together.  When admitted patients have to wait in the ER, then rooms are congested and new patients cannot be brought into the ER as rapidly as they need.

The problem is engineered and re-engineered.  It is visited and revisited.  Discussions and arguments always ensue about how to improve triage, how to put beds in the hall.  How to see patients ‘in 30 minutes or less.’  Nurses argue over when the admitted patients should go ‘upstairs,’ and how best to call report.  It goes on and on,  and JCAHO (Joint Commission) looks closely at numbers that have to do with through-put of patients and patient elopement.

Even as I know I could do better, and we probably could all do better, I realize that rarely does anyone look at the obvious issues.  For instance, when ERs become holding cells for large numbers of committed psychiatric patients,  and when nursing staff are tied-up sitting at the bedside of those patients, is it possible that efficiency is affected adversely?

Is it possible, as nursing coverage is reduced for budgetary considerations, that there simply aren’t enough warm bodies to bring patients into the ER, treat them and get them admitted as quickly as before?

Could it be that, as hospital see increasing numbers of uncompensated care due to the economic downturn, the reduced payment and increased acuity of patients (without personal physicians) puts an increased burden on the ER?

Let me break it down:  more patients, more acuity, less money, less staff.  Do we really need to assess, in all its glorious and painful minutiae, the ways we can be faster, better and more efficient?

I fear that we may be reaching a break-point, beyond which no scheme will help; no regulatory burden, no threat of litigation, no fine can make finite facilities and staff see unlimited volumes of patients.

Am I crazy here?


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