We’ve been hearing a lot about long wait times in emergency rooms, clinics, and urgent cares across the country. And, we have yet to fully enter the winter season which is traditionally worse, when it comes to respiratory illnesses…especially in children. So, why have we had such long wait times? The obvious answer is that there are large volumes of sick people going to the emergency rooms, clinics, and urgent cares. But, the answer requires a little more in-depth discussion because one could say that the medical teams should just see the patients quicker to get more people seen in and out in an expeditious manner, so people don’t have to wait hours to be evaluated.
Discussing the anatomy of a medical visit may shed some light on why it takes the medical team some time to see a sick patient. The medical visit can be broken down into three stages: the registration/triage stage, the actual medical evaluation stage, and the discharge stage. Each stage has its required tasks and function which takes time.
Next, the main part of the visit entails the clinical encounter where the assessment and management occur. The nurse or medical assistant will obtain a brief history of the illness and vital signs, such as heart rate, blood pressure, temperature, respiratory rate, and oxygen saturation. With kids, body weight must be obtained because almost all medication dosing for children is based on their weight. So, a body weight needs to be obtained for pediatric patients. Next, the clinician sees the patient and obtains a history of the present illness and other pertinent pieces of information which may include underlying chronic medical issues, medications being taken, prior surgeries, allergies to medication, and other general background information if they were not obtained by the admitting nurse or medical assistant.
The time required for obtaining information about the illness or injury and examining the patient, obtaining lab tests, or performing procedures also depends upon the cooperativeness of the patient. Negotiating with a toddler or young child about anesthetizing a wound and closing it with stitches is usually not a productive conversation. Also, obtaining a history from someone with a complex underlying medical history will extend the conversation because understanding the context of an illness or injury is crucial to making a correct diagnosis and managing it appropriately. There are many other instances and conditions under which obtaining efficient evaluations and efficiently managing medical conditions are fraught with stumbling blocks that prolong a medical visit.
The process of assessing sick patients in the emergency room, clinic, and urgent care is a complex orchestration of events. While parts of the processes can be made more efficient and faster, the ultimate goal is to provide quality care. Registration/triage, medical evaluation, and discharge do take time. In order to not compromise quality under the duress of quantity, there has to be some acceptance that one will have to wait while others are guided through the process. Some patients require shorter visits depending on the complexity of their illness and others require longer visits. Shepherding patients through the process of a medical visit does take time. So, the next time someone asks “why do I have to wait so long to be seen?”, you have the answer and understand what the medical team is dealing with during these times of surging patient volumes while they try to maintain the best quality of care that they can.
How would you improve the emergency room, clinic, and urgent care wait times?