Frustrations mount for ER patients
ALLISON RUPP Star-Tribune staff writer | Posted: Friday, September 12, 2008 12:00 am
On a weekday just past 1 p.m., the emergency room at the Wyoming Medical Center begins its busy time.
By 1:30 p.m., about eight people sit in the ER waiting room.
One girl with a kidney infection cries as her mother and sister try to comfort her. Another man, who came in for kidney problems, complains about the wait.
Chris Propst says he's been waiting for more than 30 minutes. Rachael Shippen, who accompanied Propst, says she always has to wait in the ER.
"A few years ago, I brought my son in for a cold," Shippen said. "There were a lot of other kids in too, and it took about an hour to be seen. It's kind of annoying."
Then, Shippen notes, they still have to wait for the doctor and lab results.
"I don't know what the problem is," Shippen said. "Today, it doesn't seem that busy."
A nurse brings Propst back to a patient room about 1:45 p.m., 45 minutes after he checked in.
Dr. Ron Iverson sees what patients don't, each factor playing a role in their wait time.
Iverson, director of the ER, said staff members try to see everyone within 30 minutes of arrival.The half-hour wait isn't bad considering figures from the Centers for Disease Control and Prevention, which suggests average wait times to see a doctor across the country were 56 minutes in 2006.
On rare occasions and typically on holiday weekends, Iverson said, patients have to wait as long as two hours to see a doctor.
Lisa Kraft decides she doesn't want to wait in the ER for her daughter, Brittney, to have her kidney checked. Her doctor's office is still open, so she decides to take her daughter there.
"She's hurting," Kraft said. She said she doesn't understand why there is always a long wait at the ER. She cited several examples of waiting for more than two hours.
"Do you have to be bloody and half dead for them to help you?" Kraft said.
Wait times, Iverson said, "are not as simple as you would think."
Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@trib.com.
Here's why patients have to wait
Patients need to understand why they have to wait in emergency rooms, said Tracy Garcia, assistant director of emergency services at Cheyenne Regional Medical Center.
"There might be too few physicians. There might be no beds," Garcia said.
Most patients are alerted to waits by a patient advocate at Cheyenne Regional, Garcia said, but sometimes it's just too busy.
Dr. Ron Iverson, director of the ER at Wyoming Medical Center, and staff members at Cheyenne Regional outlined some of the reasons for wait times in the ER:
* Not enough staff members: Staffing is not a huge issue for the Casper and Cheyenne hospitals, but increasing those levels could improve wait times, suggested Lisa Kraft, the mother of a patient at the WMC ER.
During busy times, both hospitals have at least two doctors and either a nurse practitioner or physician assistant on duty. During slower times, only one physician works.
Iverson said Wyoming Medical is actively recruiting an ER physician.
* Not enough beds: WMC has just 17 ER beds.
"We should probably have 24 to 26 beds, based on our patient load," Iverson said.
If there isn't an open bed, a patient can't be brought back. Staff members are in the process of adding four beds within the next month.
Over the next few years, Wyoming Medical will expand its ER by at least six more beds.
Cheyenne Regional has 17 beds but treats fewer patients.
* Difficulty admitting patients: If patients' conditions are serious enough, they have to be admitted to the hospital. Sometimes it can prove difficult to find an available bed in the appropriate department and finish paperwork needed for admittance.
If officials can't admit a patient to the hospital, he or she stays in the ER.
"Sometimes there are 10 people on the waiting list," Iverson said, "and I'm not doing anything because we're waiting for six people to be admitted."
Before patients can be admitted to the hospital, they might need tests or X-rays to determine the best course of treatment.
Iverson said more tests are now done in the ER that were done on hospital floors in the past.
* Increase in volume: The Wyoming Medical Center ER treated 31,560 patients in 2004. This year, it expects to treat more than 38,000.
Three years ago, Cheyenne Regional was treating only 60 patients a day in its ER, Garcia said. Now, it sees more than 90 a day.
Teri Grassau, chief nursing officer of Cheyenne Regional, said more people are uninsured and come to the ER for care.
"Over the past decade, ERs have become the front door to the hospital," Grassau said. "People have to have health care."
* Trauma and triage: Cheyenne follows a five-step triage system in which staff members decide who needs to be treated first, based on the seriousness of his condition.
"If you come in with chest pain, you're seen immediately," said Arleen Campeau, service line director for clinical care at Cheyenne Regional. "If you come in with a laceration on your finger, your wait time could be longer."
A major trauma might take much of the ER's resources. One patient with a serious injury might require two physicians and several nurses, Iverson said.
Patients in the waiting room might not even see the trauma arrive. All patients arriving via ambulance or aircraft are treated first, according to Iverson.
* Time of day: ERs are the busiest from about 1 p.m. to 11 p.m., according to Iverson. When people come during those times, they should expect longer delays.
Holiday weekends also play a role. Iverson said some people waited two hours to see a physician during Labor Day weekend.
"7:30 a.m.," Iverson joked. "That's when people should come."
- Allison Rupp