It sounds like a scene out of a nightmare.
It starts with chest pains. At first, you might mistake the sensation for heartburn, but the pain keeps getting worse and worse until it feels like the life is being squeezed out of your heart. The pain spreads into your arms, your neck, and even your jaw. Breathing becomes difficult, and suddenly so does moving and even standing. You feel nauseated and notice the sweat pouring from your body. You cry out for help, but your body has suddenly become so weak that everything turns fuzzy.
The next thing you know, you’re being pulled out of a loved one’s car and hauled through the entrance of a hospital emergency room. The pain that keeps shooting through your body tells you that you might be having a heart attack. Within an instant, dozens of fears pass through your mind. If you don’t make it out of this, what will your family do without you?
Then you see doctors and nurses hustling down the hallway toward you. You may think that you made it just in time. You may believe that everything is going to be okay – until they walk right past you.
“Have a seat,” the receptionist tells you. “Someone will be with you. Eventually.”
You look around and realize the waiting room is packed. With no chairs left, you collapse on the floor, leaning against the wall. In pain and fear, knowing that you could very well be dying, you wait to get the medical care you need. You may wait for as long as 11 hours without ever knowing what’s wrong with you, getting relief for your pain, or even knowing if you will survive. The only thing more frightening than experiencing a serious medical emergency is being denied urgent care at the very place you are supposed to go for help – a hospital emergency room.
It should be obvious that an emergency room is the place to go in a medical emergency. Yet with more than 90 percent of all emergency rooms in the United States struggling with overcrowding, according to The Huffington Post, patients are facing longer and longer wait times, even for severe illnesses and injuries.
A heart attack is truly life-threatening. One American suffers a heart attack every 20 seconds, and heart attack deaths happen every minute, according to AllHeartAttack.com. Yet heart attack victims often wait for hours in the emergency room lobby without ever being seen by a medical professional other than a triage nurse who makes a quick and sometimes inadequate determination as to how severe a condition is. Patients in the midst of a heart attack have been known to wait as long as 11 hours inside an emergency department waiting room before being treated – and when they do, the wait may actually be causing even more health problems, new research suggests.
You might think that, if you’re already having a heart attack, you can’t really get much sicker. Unfortunately, that doesn’t seem to be the case. U.S. News recently reported that heart attack survivors have an increased rate of developing post-traumatic stress disorder (PTSD) after the cardiac event if they waited as long as 11 hours in the waiting room.
It’s not hard to imagine that waiting for 11 hours to be treated for what you know is a prevalent and deadly disease could be traumatizing. Patients who develop PTSD might consciously fear that they will suffer another heart attack in the future. The anxiety, depression, flashbacks, and physiological symptoms that accompany PTSD may, in turn, make patients more susceptible to actually experiencing a second and potentially deadly heart attack. So, yes, the anxiety you feel during the agonizing wait for help actually could worsen your health.
In February 2013, a 26-year-old Pine Bluff, Arkansas, woman named Charlesetta Brown, died in an emergency department waiting room, reported KATV News. She didn’t have what most people would consider obvious life-threatening symptoms: no gaping open wounds gushing blood, just a serious asthma attack.
Brown had suffered from asthma attacks throughout her life, according to the article, and her family reported that this attack was no different than the rest. The only difference was that during previous attacks, hospital staff administered treatments and medication that allowed Brown to breathe again. During this attack, she simply waited inside the Jefferson Regional Medical Center emergency room for help that never came. What happened next remains unclear, with the only known information being that Brown passed away still waiting for care and the hospital lists both asthma exacerbation and pulmonary embolism – a serious condition that is more common in asthma sufferers than in the general public – as causes of death.
Charlesetta Brown may be the most recent waiting room death to shock the nation, but she’s not the only such death or close call in recent years. In January 2011, two-year-old Malyia Jeffers of Sacramento, California, developed a strep A infection, the slang term for which is “flesh-eating bacteria.” The family waited in an emergency department waiting room for hours while Malyia’s health rapidly deteriorated due to what staff mistook for a rash but later turned out to be toxic-shock, according to CNN. When the young patient was finally examined and sent to a different hospital, doctors battled the infection for two weeks just to keep her alive. She was eventually forced to undergo amputations on both legs below the knees, her full left hand, and part of her right hand as a result of oxygen loss to the limbs.
In June 2008, an incident at a Brooklyn, New York, emergency room at Kings County Hospital Center sent city officials searching for answers to prevent further unnecessary deaths. Surveillance camera footage showed 49-year-old Esmin Green collapsing in the psychiatric ward waiting room after almost 24 hours of waiting for a bed, according to ABC News. Perhaps even worse than the unbearable wait is the treatment – or lack thereof – that Green received next. Reports say she writhed on the floor for about half an hour after collapsing, during which time camera footage repeatedly showed hospital staff members seem to notice her fallen body – and walk away each time. Approximately another half hour went by after Green had ceased moving before staff finally came close enough to see that the patient had died.
At least Esmin Green’s death – and the sickening video footage released by news media like the Associated Press – drew enough criticism from advocacy groups and the public to fuel the initiative to make concrete changes. By increasing the number of staff members on duty, enhancing staff training programs, checking on each individual patient every 15 minutes, and otherwise speed up processes of all kinds, the hospital intends to decrease the median wait time to 10 hours.
If you’ve ever waited in any kind of emergency room, though, you know that 10 hours is a long time to wait in pain.
Research published in the U.S. National Library of Health showed that 210 cases of early mortality – patients dying within 24 of an emergency room visit – occurred during a three-year period, more than one-quarter of which were determined to be preventable.
In September 2008, ABC News reported that a survey by the American College of Emergency Physicians found that out of 1,500 emergency physicians studied, 200 said that they personally knew of patients died as a result of being kept in an emergency room rather than being admitted the hospital. This process, known as boarding, creates overcrowding and makes it more difficult for every patient in the emergency room to get the necessary care. That means even more pointless deaths.
“Researchers determined that being admitted at times when the ER was overcrowded was tied to a five percent increase in dying before being discharged,” reported Reuters Health, adding that “as many as three in 100 heart attack patients die unnecessarily” due to overcrowded emergency rooms. CNN calls hospital overcrowding – in emergency rooms and otherwise – “a national problem.” In fact, the United States Government Accountability Office released a report in 2009 illustrating that wait times had become so problematic that some patients were waiting twice as long as recommended based on their health conditions.
The national average of time patients wait in the emergency room to be treated and released from care is just two hours and 20 minutes, according to a report by WHAM News of Rochester, New York. To be admitted into the hospital, the sickest patients nationwide wait for an average of just four hours and 37 minutes. Yet in areas throughout the nation – including regions of New York, Pennsylvania, and New Jersey – patients are waiting much longer. And the problem has gotten worse, not better, over time. The Centers for Disease Control and Prevention reported that from 2003 to 2009, the average amount of time that patients waited before seeing a medical care provider – that’s not necessarily getting treatment or even seeing an actual doctor, by the way – increased by 25 percent, showing that patients typically waited almost a full hour without any help or assessment.
Hospital emergency rooms are not first-come, first-serve institutions, reports Syracuse.com news site. And for the most part, that makes sense. You may very well be in pain and need X-rays and casting or splinting for your broken finger, but the patient with serious chest pains or severe accident wounds probably does need stabilizing medical care to treat their time-sensitive injuries first. When a health condition starts to get worse in the ER, though, it’s time for hospital staff to reevaluate the patient. That minor difficulty breathing, agitation, or rash and fever should never be allowed to get so much more serious in the waiting room. No one likes to wait, but there is a big difference between complaining about the inconvenience and sounding the alarm that care is needed more urgently than originally thought. Unfortunately, hospital staff may become so used to complaints that they fail to pay adequate attention to the instances that have become truly life-threatening.
In an attempt to decrease wait times in the emergency room, some facilities are implementing reservation or “call-ahead” programs. Just as you can call to be put on the list for your favorite restaurant, you can now do the same at the emergency room. The concept is part safety procedure and part marketing ploy. Other emergency rooms use call-ahead programs just to notify emergency room staff to be prepared to handle an incoming patient’s life-threatening condition. Still, other hospitals are taking a different tactic, and are, instead, posting wait times online, texting wait times to patients, or even offering smartphone apps that list wait times.
Yes, I have a reservation. Heart attack, party of one. Photo Credit: Flickr (Creative Commons license).
The idea is somewhat controversial. On one hand, it does make sense to keep foot traffic congestion out of the emergency room whenever possible. Hospital staff can more efficiently and thoroughly evaluate and process the other patients if there’s not an overwhelming backup of others waiting. For people with depleted immune systems, such as those undergoing treatments for cancer, avoiding hours spent in the crowded waiting room can mean less exposure to potentially dangerous communicable diseases.
The controversy surrounds the questions of whom and how these reservations or appointments will help. Does a call-ahead appointment privilege certain groups, like the insured over the uninsured? Will the ability to make an appointment encourage people with non-urgent conditions to bypass busy primary care physicians and clog up the emergency department with non-emergency problems? How will staff balance call-ahead appointments with the most life-threatening of “walk-in” (or more likely, roll-in) patients?
“Some experts also question whether such services might send a mixed message to people with life-threatening symptoms,” reported The Chicago Tribune. “Those patients shouldn’t waste time looking for the shortest line, doctors say; they should go directly to the nearest ER, where they will be seen immediately – regardless of anyone’s appointment.”
As these wait time-reducing measures become more common nationwide, we will see whether they really make a difference in patient care, or whether a different solution is needed in hospital emergency rooms. Each new program – whether it’s reservations, call-ahead, in-hospital wait time limits, or electronic broadcasts of wait times – is a step toward helping people get the care they need. But we still have a long way to go.
Photo Credit: Flickr (Creative Commons license).
In hospital emergency rooms across the United States, patients with health conditions of all kinds have seen their health deteriorate, even to the point of death, because they could not get care even while inside a medical facility. It happens to every age group, to both genders, and to patients with any kind of serious condition. Being unable to get help is a completely rational fear, and the terrifying truth is that it can happen to anyone.