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.

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