a hospital emergency room entrance, crowded emergency rooms, emergency room

Have you ever had to wait for hours to be seen in an emergency room? Who hasn’t?

A Crowded Emergency Room May Mean Doctors Miss Information:

A new study shows, unsurprisingly, that care may be compromised in overcrowded emergency departments (Stoklosa et al, Emergency Medicine Journal, online Feb. 7, 2018). That is particularly true if doctors must treat patients in a hallway rather than a separate exam room.

Researchers surveyed 440 emergency room doctors. The majority of these physicians said they changed their physical exam practice and took less comprehensive histories when the environment was not private. Clinicians who were frequently required to treat patients in a hallway because of a crowded emergency room said that made it less likely that they could reach an accurate diagnosis.

Crowding in the Emergency Room May Lead to Critical Problems Being Overlooked:

They also reported that they were more reluctant to explore sensitive questions such as domestic violence, child abuse, suicidality or substance abuse unless there was an opportunity for greater privacy. Emergency departments are the first line of care for people under such conditions, so when patients are relegated to a cot in the hallway, no one else may pick up on the underlying problem.

How Crowding Affects Emergency Stroke Treatment:

This is not the first study to indicate delayed diagnoses can result from conditions related to crowding. In 2016, researchers reported on stroke treatment in emergency departments.

When it comes to strokes, doctors say, time is brain. In other words, getting a prompt diagnosis and emergency treatment is crucial for limiting brain damage. According to one study,  crowded emergency rooms put people at risk for death or serious disability (Reznek et al, Stroke, online, Nov. 17, 2016).

Crowded Emergency Rooms Mean Delayed Imaging:

In an ideal situation, a patient with symptoms such as a sudden severe headache, one-sided numbness or paralysis, trouble speaking, difficulty seeing or trouble walking should have brain imaging within 25 minutes of arriving at the emergency room. To reduce damage to the brain, experts recommend treatment with clot-busting drugs within three hours of the onset of symptoms. But not everyone should receive such treatment. It is appropriate for a stroke caused by a blood clot in the brain (ischemic stroke), but could make a stroke cause by bleeding into the brain (hemorrhagic stroke) much worse. That is why the imaging is crucial to determine what type of stroke is occurring.

How Crowding Affects Timing:

Crowded emergency rooms may not meet these goals for door-to-imaging time. Researchers reviewed medical records for nearly 500 patients treated for stroke over the course of a year. About 60 percent of the patients got brain scans within 25 minutes.

When the emergency department was crowded, however, it took longer to get patients in for imaging. The number of people waiting there accounted for a significant proportion of the slowdown for the 40 percent of stroke patients whose imaging was delayed.

What Can You Do?

Overall, this is a health system problem that won’t be easily fixed by patients. People who suspect their symptoms might be related to a stroke should act as quickly as possible to call 911 and take an ambulance to the hospital, since this usually triggers a more rapid response by emergency personnel. If there is a choice of hospital, ask the emergency medicine technicians to choose the one with the less crowded emergency department.

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  1. Susan

    I was taken to a trauma center ER by ambulance following an auto accident, and never saw the waiting room, which was probably full since it was Saturday evening.

    Due to moscommunication between the EMTs and hospital staff, my femur was x-rayed instead of my bruised and swollen knee. In my less than calm and collected state, I went along with what they told me, and assumed that would include my knee – it didn’t. Because I was bleeding from a bump on the forehead, I did have imaging done on my head.

    An X-ray Technician instructed me to keep my clothes on, but to remove my bra fo a chest X-Ray, and stood there watching while I struggled to do as I was told.

    Despite having chest wall injuries, multiple bruises and abrasions, no one in the ER helped me out of my clothes to put on a gown so I could receive a thorough examination of my injuries. Had they bothered to look, they would have x-rayed the knee.

    And, had they seen my badly bruised chest, they might at least have informed me that it would take several months for the small cracks and fractures to heal. I found that out for myself.

    I didn’t question the protocol the medical staff followed for getting me in and out of there as quickly as possible. That resulted in my not getting the treatment I needed.

  2. Douglas
    Philadelphia, Pa.

    Until we get money out of politics we will have the best politicians money can buy. I want their health insurance, are they better than us?

  3. Gw

    “If there is a choice of hospital, ask the emergency medicine technicians to choose the one with the less crowded emergency department.” It seems more important to choose a hospital with the most expertise in treating strokes.

  4. Gerry

    Had to go to e.r. when I fell and broke femur badly, unfortunately it was in midst of a horrible rainstorm that had flooded all the operating rooms. I waited nearly 40 hours for surgery and during this time was moved upstairs to surgical floor when they had a bed. Then two young (obviously untrained) girls came and announced they were changing sheets in my bed. I said, no no don’t touch me, my leg is broken. WIth hard little mean eyes, they proceeded to log roll me up on the side of the bed on my right side, my broken leg, I could hear my bone crunching and crackling, changed the sheets on my bed and left me, crying. As a result I am crippled for life after having been an active teacher of line dance and exercise for over 25 years.

  5. Larry M
    Raleigh, NC

    > Overall, this is a health system problem that won’t be easily fixed by patients. People who suspect their symptoms might be related to a stroke should act as quickly as possible to call 911 and take an ambulance to the hospital, since this usually triggers a more rapid response by emergency personnel.

    In many locales including the Research Triangle (where People’s Pharmacy is located), current emergency room wait times are readily available via the web or specific phone apps. Since there are at least four major facilities and over a dozen satellites with emergency rooms, the patient or ambulance service can easily make the best choice.

  6. Kimberly
    Portland OR

    This was absolutely the case with my husband. We went to the local emergency room when he was having severe symptoms of appendicitis. We had to wait nearly 5 hours with him sweating, vomiting and in acute pain. I begged the attendant nurse for help repeatedly. By the time he was seen, his appendix had burst, he had a perforated bowel and sepsis. I nearly lost him. The surgeon later told me that the only way to be taken care of quickly was to arrive in an ambulance or fake a heart attack- infuriating!

  7. Carol N.
    Salem, Oregon

    I waited for 8 and 1/2 hrs in a crowded December emerg room with symptoms of flu one year. I had chronic kidney disease stage 4, and I was seen/sent home with “no reason to be there,” altho I came by ambulance. The kidney dr three days later took a blood test, and kidney function had declined yet again. This could’ve killed me! I hate going to my local hosp to sit in a waiting room like that. My immune system is shot. I get every cold if someone with one is within five feet of me. They treat me as if I’m retarded. They are rude and nasty and make you wait .

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