When Denver resident Jera Parker showed up in a yellow chiffon dress at her daughter-in-law’s college graduation, she had no idea she’d leave in that dress, drenched in blood, head wrapped in a turban by a paramedic.

A fall in high heels on slick stairs in the auditorium of the BYU graduation ceremony caused a long deep gash to her head, necessitating a 911 call and a visit to the emergency room at Utah Valley Regional Medical Center in Provo. There, because of the seriousness of her injury, she was whisked through the doors, triaged and assigned a room for care.

“A receptionist asked a few cursory questions and then a triage nurse came in and took me to check-in,” Parker said. “The fact is I never sat down. They took care of me immediately – no wait period.”

Fast-forward a year, when Parker visited the same ER, this time with a bad case of pneumonia.

“They had us fill out paperwork and wait in the waiting room. We waited for 45 to 60 minutes. When we went back into the ER it was full … of people being seen,” Parker said. In a treatment room a nurse took her vitals and got her ready for the doctor where they waited another 30 minutes.

“He was great though – very thorough and very funny and reassuring. I went right into X-ray and the doctor came back to read the films quickly. He also apologized for the business of the day which led us to believe that they were hurrying as fast as they could.”

While Parker’s emergency room wait was seemingly long, the national average is just under four hours with some waits clocking in at two and three times that. A one day snapshot of an average ER wait at Utah Valley Regional Medical Center showed “a door to discharge time of one hour, 53 minutes,” said Dale Maughan, nurse manager of the ER at UVRMC. “That’s door to doctor to discharge time – well under the national average.”

Callie McKay, a nurse in the same ER, said sometimes wait times are long, but people are assessed according to their medical needs.

“Team leaders watch the wait times and control the flow of the ER,” McKay said. One of the first people someone sees when they walk in is the triage nurse who assesses the needs of the patient.

“The triage nurse puts down who is most severe,” McKay said. “It’s not a first-come, first-serve basis, but who is most critical.”

As patients with lesser problems sit in the waiting room, they sometimes see someone go in ahead of them that looks less critical. One thing waiting patients don’t understand is the setup behind the waiting room doors.

“The ER is divided up into critical and less critical areas,” McKay said. “It might look like someone who is less critical is going before someone more critical, but that’s because there might not be a bed available in the critical area.”

McKay added that some patients with conditions require rooms with certain monitors and other equipment but if there isn’t space, there is a wait.

One suggestion McKay has for ER visitors is to use another resource if urgent care isn’t needed. She recommended “Ask a Nurse” hotlines and online sources.

A Google search for “Ask a Nurse” or “Ask a Doctor” listed multiple sites for online help by typing in a question or toll-free numbers where a nurse or doctor takes calls, listens to ailments and gives suggested courses of action. Some sites charge a fee but many are free, run by hospitals around the country.

Another resource patients can use is an Instacare clinic where minor ailments such as sore throats or more urgent care, like broken bones and cuts, are treated.

Misty Lundell, a Pleasant Grove mother of two young children, is far too familiar with emergency rooms and prefers Instacare facilities.

“I’d rather go to Instacare because the wait time is less,” Lundell said. Recently, she fell on the ice and blacked out, causing blurred vision and excruciating headaches. Remembering past visits to the ER – one where she waited over four hours to be seen – she decided to go to Instacare.

“I went to Instacare after I fell and hit my head,” Lundell said, “but they sent me to the ER anyway.”

Maughan suggested that Instacare facilities be used if someone can’t wait to see a doctor and if it is a minor ailment like a sprain or upper respiratory problem. He cited two reasons for choosing Instacare over an ER.

“Number one is that it’s probably not going to take as long to be seen,” Maughan said, “and number two is the cost of it. It’s extremely expensive to come to the ER.” He added that while most people have insurance, those who don’t, face large ER bills.

Maughan said they are looking at the ER waiting room process with a critical eye because the wait time is their No. 1 concern for patients.

“They are our customers,” Maughan said. “If we treat this like a business we have to ask ourselves ‘how can you meet their needs and let them have a pleasant experience, if that’s possible in an ER?’”

The bottom line is that many ERs are too busy to quickly treat all who enter their doors. But ER personnel try their best to ease the wait.

“Our goal is to get patients out of the lobby and into the ER faster,” Maughan said. “There should be a noticeable difference in the amount of time it takes to walk through the door and see a physician. That’s what the patient wants – to be seen by a doctor.”

Janet Frank, spokeswoman for Intermountain Healthcare in Utah County, said the goal for Intermountain is to reduce the time it takes for a patient to see an ER physician to 30 minutes or less. Two hospitals in Utah County in the Intermountain system have been near or below that 30-minute goal since at least August of 2006.

Utah Valley Regional Medical Center hovers around an average wait time of 50 minutes from the time a patient walks in the door to the time he or she sees a doctor, but that’s because of the care given in that larger hospital.

“We provide the most acute care in the valley,” said Frank, referring to UVRMC. “The severity of cases coming through our ER is different,” from smaller hospitals, thus the difference in wait times.

Still, that wait in Utah Valley is far below those nationally, and some hospitals around the country are now using innovative means to soothe frayed nerves of long-suffering patients. A January 2007 Reader’s Digest article found some emergency rooms give movie passes, $25 gas cards or gift certificates if patients are not seen within 15 to 20 minutes. One hospital in Virginia using this tactic now has an average ER wait time of 23 minutes.

When asked how she would feel about receiving a freebie for a long ER wait, Parker didn’t think that was necessary.

“I feel that triage works the way it should – when I was bleeding I was seen immediately; when I wasn't it was a little longer,” Parker said. “None of us like to wait, but when you see others in more need the wait makes sense.”



Copyright Brigham Young University 20 Feb 2007