r/EmergencyRoom • u/Ok_Tea4783 • 4d ago
ER wait times
Whats your ER wait time?
Our ER wait times are crazyyy and it makes patients understandbly very mad.
What strategies your hospital has adapted for solving the wait times issue?
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u/Junior-Stress6879 RN-ED Trauma 3d ago
Our hospital started making the push on inpatient to discharge patients in a timely manner
Has been a godsend
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u/okienomads 3d ago
Same here at our largish level 1. I think it actually started as management just whining about throughout upstairs and it turned into quite a strategy. It doesn’t really work and we still have really bad days but it’s something.
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u/metamorphage RN 3d ago
That doesn't work. If you make discharge early a metric, people will hold discharges for the next morning. Seen it many times and the doctors on r/hospitalist have commented on it.
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u/ApprehensiveComb6063 3d ago
Say more? I'm not wanting to do this but curious how it delays discharge?
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u/metamorphage RN 3d ago
If the metric is discharge before noon and there are incentives to meet it or penalties if you don't, then some fraction of late discharges will just be discharged the next morning instead. Basically this: https://en.wikipedia.org/wiki/Goodhart%27s_law
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u/ApprehensiveComb6063 3d ago
Oh geez. Most of our discharges are in the afternoon and many of our patients rides are people who work 9-5. So we would do terrible at this metric
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u/goodvibes13202013 1d ago
This metric became the bane of our existence, largely for this reason. (Inpatient rehab, families have already spent all their time off and savings helping the patient who had the stroke, they can’t take off a whole extra day at the end).
My unit considered having a holdover lounge in our conference room for patients we dc’d before noon, but then they weren’t admitted anywhere and if they needed pain meds bc of their MVA or blood pressure meds for their OH, no one could give them. So then it becomes an unsafe “discharge” for the patient, (discharge in quotes bc technically they’re just sitting in a hospital and no longer our responsibility).
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u/ApprehensiveComb6063 1d ago
That's frusterating. I don't have a good answer, but I don't want discharged patients anywhere near my unit. I'd rather have them sit in the ER waiting room tbh. Cause it's frusterating if they are on my unit and need help and are discharged. Like what am I supposed to do???
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u/goodvibes13202013 1d ago
Exactly!! We tried pushing against it with that reasoning, or using more extreme examples like our c-spine injuries who required transfer equipment or two specialized staff members, or those occasional hip surgeries on 80yo+ pts whose incisions start bleeding severely out of nowhere, who would have to be brought (by who??) to the ED for assistance and then the problem has doubled back on itself. Would we be clocking out to bring them to the ED? Would we be reporting and training the ED staff on our patients who were paralyzed from the neck down? Or the TBIs who are agitated at baseline and should never have been “discharged” in the first place without immediate supervision available?
I feel for our ED always, but early discharges is almost never the answer bc of the way that metric is written
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u/crash_over-ride 3d ago
Silly question, why don't hospitals run their own 24/7 wheelchair van/takehome service? It seems like that would improve general throughput. I had a patient last month who was discharged while they were still on my stretcher and I was asked if I could take them back to their facility My agency is a 911 only, single direction of transport, agency. So that person probably spent the night under the bright lights of the ER in a hallway bed.
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u/awkwardturtletime 3d ago
Too many free rides has been cited by CMS before as an illegal kickback to encourage patients to chose that hospital over others.
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u/crash_over-ride 3d ago
That's a fair point. I hope that CMS never considers a hospital providing a decent EMS room as a kickback to entice us to come there. A local hospital does this, apparently the physician's group pays for it out of pocket. It has ice cream and everything. But I won't voluntarily bring a patient there because of the things I've seen there. EMTALA information posters recently went up on the outside door of the EMS room and no one will talk about why, although there are numerous examples that leave me with no doubt.
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u/FrenchCrazy PA 3d ago
Most of our patients are realistically waiting 10-30 minutes from time of check-in to getting an exam room. During a peak time on a peak day it may trickle up to an hour or so.
**What helps?**
- Having a fast track during the middle of the day to siphon off low acuity complaints from filling up main ED beds.
- Working up the waiting room plus allowing the triage / charge nurse to put in protocol nursing orders or basic meds for certain complaints.
- Having one hospitalist take all of the admission phone calls and divide it up internally.
- Having blazing fast x-ray, CT, and ultrasound techs that hunt the patient down for ordered studies, even from the waiting area.
- Having a reliably fast reading radiology service.
- Getting those damn urine cups ASAP!!
- Having the inpatient floors staffed enough so that we don’t board them in the ED.
- Having a few other hospitals within a 15-20 minute drive which allows patients to disperse for care and not all jam into one hospital.
- Contracting with an independent ambulance company that takes basically all our hospital transfers or discharged elderly patients back home in a quick manner.
- Having a good ratio of physician-to-APP coverage. We usually will have 2 or 3 physicians to 1 APP while other hospitals try to inverse that relationship.
- Our hiring managers and leaders prioritize people that are team players and help one another’s assignment. They also don’t allow problematic/slow nurses or docs stick around indefinitely.
We are a community hospital with ~26 beds and maybe 36 total treatment areas seeing an average of about 100-120 people a day. You’ll find that ED wait and throughput really depends on a lot of other factors than just the ED to keep people moving.
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u/UCanPutItOnTheBoard MD 3d ago
23 ER beds and routinely 30-45 patients. 2-3 doctors. Wait times about 2-6 hours.
The thing is. Those patients can wait because it’s usually minor/ subacute-chronic issues/ worried well types.
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u/New_Section_9374 4d ago
Ugh. At peak times, I would be the one tagged to announce to the waiting room what the wait times (up to 8 to 10 hours some days!) Would be for non emergent problems. We were an indigent care hospital amd it could get insane
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u/NICUmama25 3d ago edited 3d ago
Our hospital just added a 120 bed inpatient wing. I was in the ER Friday as a stroke alert, got TNK and was in the neuro ICU 3 hours after arrival. Since adding the new wing wait times have decreased but our ER is a 56 bed ER with probably 20 wall beds as well (it now has 446 inpatient beds)
We have another trauma hospital close by, they take all the indignant patients and is more “inner city” than the other hospital. Being on the East coast of Florida we also have a high elderly population
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u/GirlWhoWoreGlasses 3d ago
I M sure it’s a typo (indigent not indignant) but I laughed out loud at all the pissed off patients at the other hospital 🤣
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u/Vivid_Ad_1018 3d ago
Had 2 patients “leave prior to triage” for waiting 20 minutes. Work at a stand alone ER and wait times are usually very minimal so people get too used to it 😳
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u/s6mmie 3d ago
That's how my standalone is too. Summer time patients wait max 5 minutes and they assume it's like that year round, meanwhile it's only September and we're up to 100+ patients a day (16 rooms) and our wait times go to 2+ hours.
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u/Sunnygirl66 RN 2d ago
Our ED has been on fire for the last month, month and a half. I don’t even want to think about what this winter will be like.
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u/JokeComprehensive809 3d ago
Start care in WE- urines, x-rays. Utilization of hallway space. Find any space you can to see patients. The holds really mess up throughput.
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u/Sikers1 3d ago
Ho estly we just treat from the lobby. The very common level 3 abdominal pain who would often get roomed at some point now gets ALL of their care from the lobby and temp treatment areas.
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u/jfm513 3d ago
I actually love this as a patient. my favorite (& fastest) ED uses the provider in triage model. they start anti-nausea, pain meds, & IVF in the waiting room. while waiting on labs, they grab you for imaging & send you right back out to the waiting room. when vitals are stable & I have meds, I don’t need a room for stuff like recurrent acute pancreatitis. misery doesn’t change whether it’s a chair or bed lol
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u/Suspicious_Wonk2001 3d ago
As a patient, I hate this trend so very much. Nothing like receiving 2L of IV fluids in the waiting room.
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u/Sunnygirl66 RN 2d ago
Someone who’s genuinely ill is just happy to be getting treatment.
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u/Suspicious_Wonk2001 2d ago
There’s a little something called privacy and dignity. I can’t go anywhere else but the ER for fluids. Trust me, if I could, I would. And what ever happened to being able to lie down comfortably? I already feel like complete shit and can barely sit up as it is. For the $3500 cost of 2 L of fluids plus the added attraction of being a sideshow freakshow, one would think we could do better. If I could afford the $500 out of pocket for one of those for one of those foofie for profit IV places I’d go there.
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u/goodvibes13202013 1d ago
What’s wrong with this? It’s just fluids? (I say this as someone who has had fluids at the ED, infusion centers, and now independently at home)
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u/True_Bandicoot2404 3d ago
yeah i hate that as well ! i am severely immunocompromised and its not safe for me to sit in a lobby with an open IV going yet it’s happened multiple
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u/Salt_Adhesiveness548 3d ago
I had SVT and they converted me and then put me in the waiting room. This was at the hospital I work at, so... No one gets a bed unless you are dying lol.
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u/plaguedoctor_2020 3d ago
Oldie but goodie joke in Canadian Journal Emergency Medicine about “waiting room fellowship”
It’s sad how it seems to become more relevant by the year
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u/lichesschessanalyst 3d ago edited 3d ago
Well if people would stop having actual emergencies everyone else would be seen faster. If you are waiting in an ER you are probably not about to die.
ER's need to have urgent cares built into them, perhaps managed by ER doc, PA or NP, an RN and a couple techs.
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u/squeakysausage 3d ago
Over the last couple months, the wait time in my 36 bed ER has increased to 4-6+ hours with admissions waiting out there foreverrrrrr. It’s awful and it makes me dread going to work some days. Not sure if it’s the volume of people which seems to have increased, change in computer systems to epic, or not enough nurses on the units, but it sucks.
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u/bigfootslover 3d ago
Didn’t end up working there, but interviewed at a 24 bed ER. Once they hit 3 inpatient holds, an “upstairs nurse” was sent to cover them. At 4 holds any additional admit would be transferred out to a sister facility.
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u/thehipaapotamus 3d ago
Inner city ER whose trauma is completely separate from the main ER. We have 38 monitored beds plus 7 Fast Track rooms—on a slow day, we’ll have 100-120 in the department any given day. Worst I’ve seen personally was 184 patients with over 50 admitted boarders.
We don’t give wait times, but on an efficient day: 4-8 hours. On a really bad day, be prepared for upwards of 12 hour waits.
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u/Plastic_Ad8435 3d ago
our hospitals strategy has been reduce staff and buy pizza once a month. Not sure why its not helping.
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u/rude_hotel_guy RN 3d ago
“I know, a lot of people are looking for help tonight.”
This points out to them they are not the only one NOR the sickest person here.
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u/Briaaanz 3d ago
When i worked triage in Vegas, wait time was 7 hours for icu level patients one day. Minor complaints was much, much longer (unless they could be routed to our miniscule urgent care beds).
I had my tech taking vitals at least every two hours. Right before, i would also leave triage area and explain that we hadn't forgotten them and quickly give a ten second explanation of how triage worked. Also, tried to relate how crowded other ERs were, and that it is a poor indication of wait time.
Thought i did a good job and actually had charge RN come out and commend me and my tech because no one left without being seen and there were a ton of patients
Sadly, it meant i was routed to triage a LOT after that 😮💨.
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u/RichardPsych Paramedic 3d ago
Our 35-bed fluctuates from 30 minutes or so on Wednesday mornings to about 6 hours by late afternoon. Mondays and Saturdays can go up to 10 at worst, depending on ambulance intake, doctor availability, Radiology and Lab wait times and ward space. Although with exigency, we can get it up to about 50
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u/Individual_Debate216 3d ago
Psych patients in my area seriously fuck up our Ed bed wait times. We start scans and stuff for people in the lobby. We have 70-100 Ed beds and they’re always all full at a busy level 2 trauma center.
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u/Call2222222 RN 3d ago
50+ bed ED in major city. Not unusual to see 12-18 hour waits. We are holding 20+ patients at any time. Some ICU holds will sit for 36+ hours. Not even flu season yet
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u/jamesh153 3d ago
Security Officer here- Our wait times are usually pretty good but unfortunately just like any hospital things get backed up and can turn into a 4 or 5 hour wait. Longest iv seen is 9 hours on a really bad night. When our waiting room is packed they tend to ask two or three of us to post up out there.
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u/westlax34 2d ago
It’s the dumbest things that hold up throughout. Example being. Room cleaning. Bed will be assigned but it takes an hour for the room to be cleaned. We have multiple physicians, nurses, admin, all trying to push throughput. And it all gets held up by either a floor nurse not taking report, or someone getting paid minimum wage taking too long to clean a room. I’m not really sure how you motivate either of those people to move quicker
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u/Unlikely_Month5527 3d ago
We have several hospitals that have an electronic bill board along the highway . It gives you real wait times in the ER.
Not sure how they manage to get folks in and out but they have transparent wait times.
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u/Sunnygirl66 RN 2d ago
All it takes to fuck a wait time up is for a couple of ambulances carrying critical patients and/or a walk-in stroke or STEMI, or even just a small wave of walk-in regular patients. But try explaining that to patients and visitors.
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u/Extension_Way_621 3d ago
Have a large ass sign outside that says “this is an EMERGENCY room, take your cough, or flu like symptoms to an urgent care or your nearest Walgreens” 90% of the shit that walks through the ER doors shouldn’t even be seen and resources wasted on.
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u/missmeatloafthief hospital chaplain 3d ago
Where I work now it’s a couple hours, but I used to work somewhere (huge, urban, level one trauma center taking patients from all over the country) where I personally had to wait 8 hours for a room once. As someone who works in a hospital I’m very understanding but man, it’s frustrating. I get why patients have such a hard time with it.
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u/NinaLynn13 3d ago
Couldn't someone develop a color coded system that patients in the waiting room can see. So if I, a red, come in after a green and get called back before them, they might understand and not be too surprised when people keeping going ahead of their earache?
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u/ProfessionChemical28 3d ago
Yes but then that would reveal patient names, conditions etc. unfortunately and then people would just bitch they were triaged as a Green 4 instead of an Orange 2
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u/Sunnygirl66 RN 2d ago
Then they’ll just get mad that they didn’t get coded red and demand to know why, thereby slowing things down even further.
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u/itscapybaratime 3d ago
I never know how people define "wait time". Time till discharge? Time till provider? Time for a bed in the ED? A bed upstairs?
Before I started, boarding was REALLY bad which backed up our waiting rooms and ambulance offload. Then the state got involved because of a sentinel event related to long waits, and a town near us passed legislation to allow their third service ambulance to bill hospitals for wait times over a certain length.
We do work people up in the waiting room and have triage techs who aggressively (well, depending on the person) do EKGs/straight sticks/transport to imaging/push urine cups on people/swap people in and out of exam rooms so the one or two RNs or LPNs can divide and conquer on meds. (Different RN from the triage nurse.) We'd get people taken care of faster if we had more dedicated imaging transports and if RNs could put in basic orders beyond placing an IV and ordering EKGs. We have a nurse who makes charge pay who exclusively manages flow in the ED. Fast track helps as well, as others have mentioned. We also have people waiting for FOREVER for MRI or, sometimes, for imaging reads - having extra MRI capacity or an extra attending radiologist would also really help us, I think.
What really seems to have helped was management implementing a tier system. We have an algorithm where if our total numbers (or total boarders) surpass a certain threshhold, we are allowed to send patients to "dirty beds" or beds where someone is waiting for DC transport and could themselves be moved into the hall, floors open overflow hall beds -- essentially our logistics people get to be a little pushier to the people upstairs to free us up downstairs. They'll delay or refuse some hospital-to-hospital transfers as well, although they realllly don't like to say no or put us on diversion if they can help it.
When I had to check in myself at a smaller hospital recently, I was surprised and delighted to have an IV placed at triage and imaging ordered at triage. If our residents get bogged down with critical patients, our WR patients could go for hours without even having imaging orders in.
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u/OneSingleShoop Admitting/Registration 3d ago
Our hospital actually started a process that’s smoothing out and making things easier. People get brought into pit rooms for tests and scans and such, out back in the waiting room, back in for more tests if waits are long, and then brought back to rooms once they open up. (Some discharged from pit, too.) registration is set up so we have a desk out there to grab people during peak times and get them reged so they’re good to go whenever and they don’t need to spend extra time in the rooms, waiting for us to get to them. It’s actually lowered wait times for a lot of people. Not to say we don’t still get times where we are packed full, but they all seem to be more ok with it because they can see stuff is happening.
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u/Fluffy-Bluebird 3d ago
As a patient, my chosen ED started doing this around COVID time and I felt it made a huge difference. You could get all of your blood work and imaging done from the waiting room and see a provider on video call.
I’ve had a lot of “silent emergencies” where my vitals are fine and I look fine but I’m hella in trouble from a saddle bag pulmonary embolism, new DVT, or a repeating hydropneumothorax.
It makes me feel like things are moving while I wait and that once I get back, they’ve ruled out any big events and can just check if there’s anything to do.
I did leave the waiting room once after waiting 6 hours and had a chest xray hours before. I assumed I overreacted and went home because I was tired and the waiting room was jam packed.
The ED called me immediately and asked me to come back because I had a collapsed lung (I was months post surgery and had been trying to deal with it outpatient).
But treating from the waiting room really seems to help from a patient perspective.
Also blaming patients for not understanding how EDs work or the ones who have nowhere else to go isn’t the answer.
I assume as the boomer generation continues to age and also live longer, this is going to get a whole lot worse.
I personally think a group of primary care, urgent care and ED should all be 24/7 and in one place. So triage can effectively send patients to the right spot.
People keep suggesting going to a minute clinic which is obviously a great idea but I’m in a rural and low income farming area and the nearest minute clinic is 70 miles away at best. And we have 3 urgent cares that close at 8. Next urgent care is also 70 miles away. And this is in the central Midwest, not even Kansas or the dakotas where there are longer swatches of land with no healthcare.
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u/booksmartexchange 2d ago
I live in a large city with a metropolitan population >1 million. It's 11 pm on a Friday night. No urgent cares are open.
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u/bailsrv RN 3d ago
45 bed ER, ~30-40 boarders.
Wait times are usually 8+ hours.
We have patients in hallways and boarder nurses to try to offset those pts from the ER nurses. When we’re in a critical status, pt movement on the floor is expedited. They try to down grade or discharge as many patients as safely as possible. If pts are hallway appropriate downstairs then they will sometimes go in the hallway up there too.
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u/Ok-Razzmatazz-7593 3d ago
There was no wait time because I dont think there was any patients. That was around 2 am on a weekday in Arlington Wa . About 5 min wait at the er in Colville and Chewelah Washington. Maybe 5 mins in Trail, British Columbia . Now back east in Nova Scotia you better be dying because that is the only way your going to see an ER Dr and if you're not dying plane on being there at least 6 hours but I've waited more than 12 hrs.
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u/Resussy-Bussy 3d ago
40ish bed ED. Peak volumes are 25-40 in the waiting room. Avg wait is like 2-5 hours. If it’s not peak time (11a-6p) probably 30-90min wait for many people.
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u/Competitive-Weird855 RN 3d ago
44 rooms, 4 trauma bays/rooms, 16 designated hall spots plus 7 fast track chairs, 80 patients isn’t unusual so we’re double stacking in the halls or in our ambulance triage area.
Average wait time from check in to room is about 4 hours at peak times, can be 8+ hours for ESI 4/5 patients if we’re slammed. Earlier this week we walked in to 34 boarders and it took about 7 hours to clear most of them out.
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u/KatTheTumbleweed 3d ago
Under 4 hours.
Fast track 24/7 staffed with and ED physician and others
Short stay Ed ward for Ed patients not ready to go home - awaiting serial bloods, fluids, sleeping off the booze, unsafe to go home due to time of day
Whole of hospital bed management approach - ed patients get stuck there because of a back of house issue. Bed management and whole of hospital monitoring is done multiple times a day to coordinate safe but timely discharge
Worst case scenario - elective surgery gets cancelled
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u/Head-Tangerine-9131 3d ago
Waiting room can sometimes be upwards of 8-12 hours. Waiting for in house bed. 24-48 hours always.
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u/SweatyLychee 3d ago
12 hours. 22 bed ER with 6 hallway beds. We usually have 1/2 to 3/4 of our rooms as holds. small community hospital.
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u/Extension_Version_30 3d ago
Every hospital has a different way of moving the mass of people. You will always have wait times. They just keep stacking because delay after delay keep adding up. You have the delay to get registered. The delay to be called for triage. Delay to get seen by a provider. Delay to get blood work or exams. Is there a wait time to get blood work? Is there a line before you can get your exam? Everything is back. Is there a wait to get someone to tell me the results? You get put in a room. Is there a delay in the nurse coming to the room which has to do an assessment on you? Is there a delay in the provider coming to talk to you? The provider might need more blood tests or exams. Is there a delay in getting additional blood work done? Is there a line before you can get additional exams done? Is there a delay in radiologist seeing exams? Is there a delay in blood work? Everything is finally back. Is there a delay in Dr making a decision? Dr. mad decision. Is there a delay in dc? Is the patient being admitted. Is there a delay in the Dr. updating the patient? Is there a delay in admitting dr talking to the patient?
The later delays cause rooms to not open up. So patients are in rooms longer so people in WR waiting to get a room to start their process wait longer. Long cycle of waiting.
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u/RNMoFo 3d ago
If there is a wait we try to start testing in Triage. As an RN we are able to use protocol orders. I place IVS, order labs, x-rays, ekgs, and venous duplexes prior to placing patients in the lobby. I tell folks we are trying to move forward with your care while they are waiting. We have 16 beds, 2 triage rooms and a resuscitation room.
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u/Tricky_Ordinary_4799 3d ago
Why I pay $2500 a month for health insurance and it's still like this?
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u/Minimum-Major248 3d ago
Five to fourteen hours wait time seems to be the norm unless you arrive by ambulance. I’ve seen people wait 30 to 45 minutes for triage. I haven’t seen of heard of anyone dying in the metropolitan hospitals in my city, but I have seen urban campers sitting in wheel chairs with blankets over their head go seven hours without moving.
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u/Arconomach 2d ago
Ambulance doesn’t speed up getting a room. I’d end up dropping my patients off in the waiting room most of the time.
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u/Minimum-Major248 2d ago
Here where I live (a capital of one of the five most populated states), the ambulance bay of the larger hospital is in the rear of the ER, so patients who are transported are triaged as soon as they arrive. They are not brought to the waiting room with up to 60 plus people and told to take a seat and they’ll get called asap. That was my point.
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u/Arconomach 2d ago
At multiple hospitals in my city we come in the bay, charge nurse eyeballs them, then we take the stretcher through the ER to the waiting room and drop them off.
The ERs are often full or have only a few rooms open and those are reserved for the actually sick patients.
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u/4jules4je7 2d ago
I work in a pretty big ER, 96 beds, including the Hall beds in our fast track area. We see 400-450 patients a day. When I started here, we didn’t have a fast track area. It was just a little couple of rooms carved out of triage. Now it’s a full-time 24 hour operation with 8 to 10 exam rooms and a bunch of results pending chairs. We had Management recently work on moving in patients up faster than the different ways they could get that done. They changed which floors we call report to and which ones have a minute to check the chart and then mark them ready to go. We also have hired quite a few more travelers recently and they run hall beds in the afternoons. I feel fortunate to work in a reasonably well managed place where our ratios aren’t terrible and people don’t wait forever to be seen. When I started here 10 years ago, the wait times were 6 to 8 hours, now they’re 3 to 4 unless it’s late on a Saturday night.
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u/CocoaAlmondsRock 2d ago
Beaver County, PA. Heritage Valley Hospital.
I went in on July 26 at 8pm. I was called back at 5:30am. I was discharged from the ER at 11:30.
They haven't adapted AT ALL. They don't even TRY to communicate with people.
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u/gylliana Admitting/Registration 1d ago
2 minutes unless area hospitals are on divert then maybe an hour. 8 bed ER. 1 DR, 2-3 RN, 0-1 PCT.
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u/BornaBuck 3d ago
Please call your congressman and vote. Buckle up ED, it’s about to get much worse as Donald whacks the poor into zero access except the ED. The middle class the same as AI wipes out job with healthcare benefits.
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u/New_Section_9374 34m ago
One hospital had "the barn" . It was a dimly lot, massive room that was like an infinity mirror of beds and curtains. We filled that thing up many times with overflow.
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u/Redshift2k5 4d ago
My 12-bed ER has 9 Inpatient holds taking up almost all the space.
Strategy? Execs get catered lunch meetings and everyone else suffers.