Patients are losing patience in the ER
Increased volume has bumped wait time for emergency departments

By Lisa Rosetta

The Salt Lake Tribune

Article Last Updated: 09/26/2007 10:13:04 PM MDT

Posted: 10:15 PM- Getting treated in some of Utah's emergency rooms is going to cost you more than money - it's also going to cost you time.

With a growing number of people seeking primary health care at emergency departments - and too few nurses, specialists and hospital beds to accommodate them - the state's two Level I trauma centers say they are seeing the average amount of time their patients spend in their emergency rooms inch upward.

Patients at LDS Hospital, for example, can expect to spend an average of three hours and 10 minutes in the emergency department, from the time they're admitted to the time they leave, said clinical nurse specialist Roger Keddington. That time is up 18 minutes from 2004.

For one, Keddington said, patient volume is growing. With just a few months left of 2007, LDS' emergency department patient volume is 3 percent higher than what it was at this same time last year.

University Hospital, too, is seeing more patients, to the tune of 5 or 6 percent more each year, said Erik Barton, chief of the University of Utah's division of emergency medicine. In 2002, its emergency department saw 28,000 patients; so far this year, it has seen 36,000.

As a result, patients' average time in the University Hospital emergency department is now four hours and 49 minutes - a time that has increased by almost two hours in the last three years.

"It's a numbers game," Barton said. "You can only put so many patients into the system at a time and as you increase your numbers, your efficiency drops."

Utah patients surveyed last year reported they spent an average of six hours and 21 minutes in emergency departments, a figure that is well above the national average (four hours) and that makes the state's emergency department turn-around time the worst in the country.

That data, published in the 2007 "Emergency Department Pulse Report: Patient Perspectives on American Health Care," is based on surveys by Press Ganey Associates, a South Bend, Ind., firm that about a third of the nation's hospitals hire to measure patient satisfaction.

In 2006, about 3,200 Utahns - patients at five hospitals in the state that contract with Press Ganey - responded to the surveys, said Laura Lindberg, the company's knowledge manager and editor of the report. She declined to release the names of those hospitals, citing confidentiality.

A year earlier, Press Ganey had surveyed about 2,200 Utahns, who said they spent an average of four hours and five minutes in emergency departments. The national average that year: three hours and 42 minutes.

"We have a huge issue going on all across our nation," said Donna Mason, president of the Emergency Nurses Association (ENA), which is holding a conference this week in Salt Lake City. "This is not an issue that is located in any one area. It is truly a United States issue."

Patients' increasingly long stays in emergency departments is a trend hospitals across the country are grappling with as a growing number of uninsured or underinsured show up seeking "non-emergent" care.

"What they do is they wait until they're very sick because they don't have the money and then they present to the (emergency department)," Mason said.

Utah's percentage of emergency department admissions for uninsured patients increased from 27 percent in 1997 to 42 percent in 2005, according to the Department of Health. Although a similar trend is being seen nationally, Utah's rate increase was higher than most comparable states.

Between 2001 and 2005, four out of every 10 visits to emergency departments in Utah were considered by the state to be "primary care sensitive," according to the health department.

But the increasing number of people going to emergency departments for primary health care may be just part of the problem.

Once patients are admitted, they may wait in hallways for hours before hospital beds open up, or nursing staff or specialists are available to help them - problems both LDS and University hospitals say they are experiencing.

And with Cottonwood Hospital closing and LDS Hospital moving its trauma services to Intermountain Medical Center in Murray, Barton said, University Hospital is poised to see its volume of trauma patients grow - by perhaps as much as 10 percent.

"It's certainly going to impact trauma care because obviously more of the north Salt Lake, west valley trauma would come to University Hospital," he said.

Even with the longer times, Barton said he believes University Hospital is on par with other academic institutions with level one trauma centers - and much better than many other emergency departments across the country.

"I can tell you there are departments (around the country) that consistently report up to 24 hours wait time," he said.

The problem crystallized in one Illinois emergency department this year, ENA president Mason said, when a woman who walked in complaining of chest pain was found dead two hours later.

"We're forced to try to have alternative ways to care for people - so we don't have someone die in our waiting room," she said.

lrosetta@sltrib.com

http://www.sltrib.com/ci_7009442