Friday, August 12, 2011

ER Question: "Why the Long Wait?"

Many people are concerned with wait times in ERs. It is an "Emergency Room" so why aren't you always treated immediately? Not just in the lobby, but also once you get to a room. Think about it this way, there is a long sequence of events before you can be treated. A delay in any one of those steps can cause other delays. Let's take a look what's going on while you are waiting for treatment.

1. Checking in: When you first enter an emergency room, you check in at the desk and are soon sent to triage. Triage determines your priority for an ER bed. They may give you a colored wrist band, or assign you a color in our computers (people get mad when they see their low priority). In triage, we take your vitals like blood pressure, heart rate, pulse oximetry, respiratory rate, and your chief complaint (what you are seeking help with). After this, we assign you a color. Red is immediate (suspected heart attack, stroke, aneurism, etc.), yellow is delayed, green is minor, and blue is our nice way of saying really, you're fine. If you came in on an ambulance, you usually skip this step because ambulances don't transfer unless it is urgent.
2. At the Room (Part 1): So now that you have finally been given a room, why haven't you been given meds? The nurse will usually draw some blood and start an IV. IVs (intraveneous therapy) are hollow needles with tubing that are placed directly into a vein on your arm. This enables fast administration of meds or to set up a IV pump/drip.  The drawn blood will to the hospital lab for testing (drug test only if there's suspected abuse). These tests determine blood components like white cell count, platelets, red blood cells, dehydration, diseases, etc. In addition to this, you may receive X-Rays, EKGs, MRIs, etc. at this point.
3. At the Room (Part 2): Great! So now they've thoroughly tested you. Where is the doctor? Well most docs don't like treating until they've seen all the test results. Some blood tests or cultures can take up to 2 hours. At this point, the doctor will come in and ask you some questions about your diet, exercise, health history, and habits before leaving again. He can then allow meds for pain, anxiety, blood pressure, etc. because he has had the "face-to-face examination". The nurse will then administer the meds, or an ER Tech may perform a splint, or finish bandaging. The doc may also call specialists like neurologists, cardiologists, internists, plastic surgeon, etc. for consultation. After you have stabilized, the doctor takes a last look at you, writes out a few prescriptions, and then the nurse goes over paperwork with you.
4. Discharge: You are free to go and we certainly have a lot of other people to see!

While you will be asked for identification, next of kin, brief history of your complaint, and medical insurance, you will always be treated regardless of your ability to provide all of these things. If you receive a bill, you may want to apply for money from the government and or your insurance company (or both). Your bill will generally explain this.


  1. i never understand why people moan when it takes them ages to get seen, can they not see there are more people there and secondly how overstretched you are. Especially the nhs in england.

  2. So many people seem to think they are better than everyone else.. I would be pissed if I was code blue though.. I don't end up in the hospital though, so its cool :p

  3. Thanks for the insight! Hopefully this will inspire patience in.. patients.

  4. See, my problem is this. With the color coding, if they have blue, tell them to go see a doctor at a free clinic. My wife was about to pass out due to asthma and nothing curing it not her inhaler or vent thingy. Well, it took over 2 hours for her to be seen. I showed back up to check on her and raised hell, then she was seen. They checked her lungs and only 40% was in use. The people working up front got bitched out by the nurse from the back. I was still pissed though.

  5. @This Guy,
    that is strange because asthma should be red or yellow, depending on pulse oximetry (how well their red blood cells are oxigenated).

  6. Thanks! I think I understand now. Still... I also get why people want to be treated immediately.

  7. this is a great advice! most people have no idea on how the medicine works, and can just be bitching around the hospital, making it worse to everybody! good one!
    +following and supporting! ;)

  8. Only time I went to the ER was when I needed stitches, fell out of a tree onto a glass jar as a kid, carried into the ER by my parents with a towel to stop blood while screaming from pain. I dont mind tell you that we didnt have to wait more than a few second haha. Guess a blood soaked towel qualifies me for code red eh?