When you or a loved one is sick or injured, every second matters. So when it comes to spending time in the emergency waiting room, it’s natural to be frustrated if you feel like you’ve been waiting for a long time. We spoke to Matthew Muller, M.D., an emergency medicine physician on the medical staff at Texas Health Dallas, to help explain the triage process in the Emergency Department (ED) and how the flow of care can be affected by many different variables.
The Triage Process
“When patients present to the Emergency Department, staff use a method called triage to determine who is most at risk for a life-threatening emergency and should be seen first,” Muller says. “Thus, patients in the Emergency Department are evaluated in the order of severity of illness and risk, and not by the order of their arrival.”
Muller says the triage process is a standard practice in hospitals across the world and is a rapid assessment based on vital signs, the type and severity of symptoms, and other risk factors such as age and associated medical conditions. While this can lead to longer wait times for patients with less emergent illnesses, Muller says it’s essential to patient safety and the delivery of high-quality care.
How Patient Volume Affects Wait Times
Severity can help dictate the amount of time you may spend waiting in the ED, but patient volume also has a large impact. The ED is one of the busiest areas of a hospital and a high patient volume can impact even the most efficient processes.
For very high-volume hospitals in Texas, typical of what you’d find in Arlington, Dallas, Fort Worth or Plano, the average time patients can expect to wait before being admitted is 298 minutes (4 hours and 58 minutes), while the national average is 332 minutes (6 hours, 32 minutes), according to data compiled by the U.S. Centers for Medicare & Medicaid Services.
Smaller hospitals, typical of what you’d find surrounding the Metroplex, get a bit of a shorter wait time at 233 minutes (3 hours and 53 minutes). Keep in mind, this is for patients who need to be admitted. The average time it takes to see a health-care professional is 38 minutes, slightly higher than the Texas state average of 18 minutes and the national average of 25 minutes. But Muller says timing is everything.
“Hospitals across the country attempt to evaluate their Emergency Department patients within 30 minutes of arrival,” he explains. “During the late afternoon, or during a busy flu season, wait times often exceed this goal.”
A high patient volume can also increase the time you’re waiting on lab results or interpretation of diagnostic studies, and conversations or interactions may seem brief, which can be frustrating or make you feel as if your care isn’t as important as others’.
“When there are many sick patients in an Emergency Department, patients may notice that staff and physicians work with a determined sense of urgency, as multiple life-threatening medical emergencies may be present at once,” Muller explains. “In these circumstances, conversations may seem brief, and staff visits to the room less frequent. However, it is always OK to ask for an update.”
Use the Fast Lane If You Can
For the Average Joe, it can be hard to determine what validates a trip to the ED and what can wait or be treated at an urgent care clinic, especially if it’s late at night when your primary physician’s office isn’t open, or you have a sick child. A lot of Emergency Departments prepare for this by creating a fast track triage system designed to provide care for patients with less serious conditions in the most efficient and expedited way possible. Many times, you’ll be evaluated at or near the emergency department, then return to the waiting room until your results have been processed.
Muller notes that oftentimes, wait and treatment times are much shorter in these specialized care areas, but keep in mind, even though your condition may not require emergency care, you will still most likely have to pay your emergency services co-pay on top of any care you receive at the Emergency Department.
So what validates a trip to the ED? Call 911 or go to an emergency room when experiencing any of the following:
- Difficulty breathing
- Chest pain
- Deformed fractures and fractures with open skin wounds
- Fainting or severe dizziness
- Sudden numbness or weakness
- Bleeding that cannot be stopped
- Abdominal pain that is intense and localized
- Fever with convulsions or any fever in children under 3 months old
- Confusion or rapid changes in alertness
- Coughing or vomiting blood
- Severe headache or head injury, especially if the individual is on aspirin or blood thinners
- Black or bloody diarrhea
- Sudden inability to speak, see, walk or move
While the symptoms above are not a complete list, they often represent life or limb-threatening medical conditions that should be evaluated in an Emergency Department. Patients should also consider how fast symptoms are worsening, and whether multiple symptoms are present, as multiple rapidly worsening symptoms are more concerning.
In the absence of the symptoms listed above, it is often safe to consider a visit to an urgent care center, or primary care clinic, where prompt care can often be provided within 24 hours. But if you are unsure or concerned, it’s always OK to head to the emergency room for evaluation.
Waiting for care in what seems like an emergency can be frustrating. It’s why many patients leave before being treated, seen or discharged. But Muller says hospital staff members do their best to deliver prompt, thorough care to everyone, no matter the condition. The best thing to do is to not wait until something becomes an emergency, if you can, especially during cold and flu season. Many physician offices have timeslots specifically for emergent situations and can most likely get you or your loved one in for an appointment on the same day if needed.
If you do need to visit the ED, Muller says while the wait may be a bit annoying, the triage process helps the staff take care of critical patients whose condition doesn’t allow time to wait.
“Emergency departments are vital to our healthcare system, providing necessary care for anyone who comes through the door,” he says. “No physician or staff member in the Emergency Department wants a patient to wait for care. When patients are waiting, it means that other patients with serious medical conditions are receiving necessary (and often lifesaving) care from the Emergency Department team.”