Waiting at the ER is a dangerous game

When ambulances are delayed, the community’s safety net becomes a teetering house of cards

Ambulance diversions and prolonged emergency department wait times continue to plague EMS systems across the country. Judging from the story of nine Calif. ambulances delayed, two for 3½ hours, it’s an issue that isn’t about to go away anytime soon.

It adds unnecessary complexity and uncertainty to system operations. Patients are less satisfied. Relations between EMS and ED staff strain. There is unnecessary risk to the critical patient who must wait for emergency care and/or transport.

When ambulances are delayed, the community’s safety net becomes a teetering house of cards.

I suppose it can be emblematic of a complex, bureaucratic, fractured national health care system that is facing an impending meltdown. But the article does a very good job pointing out that most of the other hospitals within the system appear to be handling the patients being transported by ambulances in a timely manner.

I’ve heard this is much more the case in most areas where ambulance diversions are an issue — only a very few hospitals appear to not be able to manage their internal operations in an efficient manner. 

Indeed, there are hospitals that have not only addressed their ED overload situations, but improved their overall patient throughput. They do it by seeing patients right away, getting them triaged to the right level of care, and moving them through the hospital system with data systems that every link in the care chain has access to quickly. More importantly, the medical staff develops a mindset that promotes rapid care implementation — it improves patient satisfaction and improves the bottom line.

There is nothing wrong with that. 

I am a bit concerned that the EMS provider in this story is trying a workaround to what is a hospital throughput issue. It will cost them money and resources to implement a “concierge” system — and clearly, they are desperate to try anything that will help their operations avoid response time penalties.

While noble, this is no long term fix. It may take a heavy-handed approach by county regulators to force changes to a poorly managed system.

In the meantime, I’d be interested in knowing if you are experiencing ED delays within your system. Let me know your issues in the comments below.

About the author

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at Art.Hsieh@ems1.com and connect with him on Facebook or Twitter.

Join the discussion

logo for print