Long wait time leads to patient frustration

Of the Associated Press

SALEM — Sonya Pierce arrived at the Salem Hospital emergency department at 9:30 p.m. recently, with severe stomach pains. She says she was cramping and couldn't stand or walk.

When she was finally seen at 6 a.m. the next day, she was diagnosed with ovarian cancer.

“I felt like I'd been abused as a human being there,” she said.

It wasn't just that Pierce, 51, had to wait more than eight hours in pain to learn of her cancer diagnosis. She also felt she was mistreated by the triage nurses, who told her she was “low priority.”

Pierce doesn't believe her lack of insurance at the time helped her situation either.

“They actually saw everybody in the ER room before they saw me that day,” Pierce said. “They act like it's a normal situation.”

Pierce's story is one example of how an overloaded hospital can affect an individual's experience in the emergency room. Long waits aren't only inefficient, it can feel inhumane to patients who are in crisis.

Administrators have said Salem Hospital has been experiencing high volumes since the winter of 2012. They recently opened a nine-bed transitional care unit to hold patients who are waiting for inpatient beds to free up, a common way hospitals deal with stress in the emergency room.

Chief operating officer Cheryl Nester Wolfe said emergency department staff use a prioritization system so the most acute patients are seen first. Abdominal pain falls in Level 3 of the five-level system, behind patients with symptoms of stroke, heart attack and trauma.

While the hospital declined to comment on Pierce's specific situation, citing patient privacy laws, Wolfe said lots of factors can lead to long waits. For one, between noon and midnight is the busiest time for the emergency room.

During the month of August, 32 percent of all emergency patients arrived at the hospital between 6 p.m. and midnight.

But the hospital does have written expectations on how patients waiting in the lobby should be treated. It includes taking vitals every two hours for Level 3 patients and at least once for Levels 4 and 5 (minor conditions), according to a standard work procedure document provided by the hospital. Nurses are also to check on the patients every hour, update them and apologize for the wait and provide blankets, water and coffee.

Pierce said her vitals were checked only once, 35 minutes after her arrival. And she doesn't believe nurses were courteous or compassionate to her when she asked for updates.

Dr. Howard Mell, a Cleveland-based emergency physician and spokesman for American College of Emergency Physicians, said emergency room volume has been growing nationwide, and it has been attributed to the expanded availability of health care coverage through the Affordable Care Act.

But it's not because people are misusing the emergency room, Mell said. Rather, the patients’ lack of primary care leads to a legitimate emergency.

“If they could've been seen three days ago for asthma medication, they wouldn't be at the ED with an asthma attack,” he said.

Only about 8 percent of emergency room patients have needs that are not considered urgent, Mell said.

At Salem Hospital, however, an average of 23 percent of the patients coming to the emergency room in August had minor and non-life threatening conditions. These patients are categorized in Level 4 and 5 and have symptoms like sprains, urinary tract infections, sore throats, cold symptoms and rashes. Urgent care or doctor's offices could be a cheaper and more efficient option for many of them.

The hospital operates a “fast-track” system for this group to move them along quicker, but only from 3 to 11 p.m. every day.

Abdominal pain falls in Level 3, along with stable asthma, complex lacerations and stable extremity fractures. So it's possible the hospital was seeing a lot of acute patients while Pierce was seeking care.

Mell said that in addition to more people having insurance, hospitals are seeing sicker patients with more complex conditions. And triage nurses have to think in terms of “what's going to kill this person in the next five minutes,” he said.

Often, even when doctors and nurses are providing the best possible care, a patient's experience might be the opposite, Mell said, especially when they receive a life-altering diagnosis.

“It's hard to manage the patient's perception when they're having the worst day of their life,” he said.


Information from: Statesman Journal, http://www.statesmanjournal.com

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