Last week I began a discussion about some of the reasons it can take quite a bit of time to be seen and treated, if you happen to be an emergency room patient.

One very important issue is that as far as emergency care goes, it is not necessarily first come first serve. Yes, I too am peeved when someone cuts in front of me to grab the first place in a newly opened grocery clerk’s check stand. Granted, it’s no fun waiting for over forty minutes to see the doctor only to see her examining some dude who just seconds ago arrived at the ER.

Well, if that dude happened to be having chest pain, a potential warning sign of a heart attack, he would indeed need to be seen right away. You might think that your broken arm needs immediate attention, but if there are patients who are felt to have more critical conditions, others who have already been diagnosed with critical illnesses and the ER is hopping, you might have to wait.

Speaking of busy ER’s, the number of patients seen in America’s ER’s is due to several reasons increasing yearly. Unfortunately, the number of ER physicians and nurses have not kept pace. Also, peculiar to California is a rule which limits the number of patients a nurse can care for at any one time. If that nurse hits a maximum, other less critical patients may have to wait.

You wonder why after the doctor says you need to be admitted it takes even more time to get admitted. In the ideal case, a emergency room doctor would call in the admitting physician, who in turn would immediately be available (ie not taking care of any other patients; not have cell phone issues and just standing around waiting for that call) who would happen to be at the hospital and  within a 30 minute drive (which is about the average time required for non ICU admissions). He would then quickly examine you;orders immediately written and the floor nurse would be called right away by an ER nurse who in turn is doing nothing else and thus would have time to make that call. An aide, also just sitting around would take you right upstairs to a bed, which happens to be free and cleaned.  All your orders would immediately be sent to the pharmacy, radiology, lab and any other departments, which as luck has it are twiddling their respective thumbs.

It doesn’t take much thought to understand that at any one, some or all of these critical moves a delay can occur. And of course, each delay adds on to the previous one.

How to manage staff and system issues which cause delays will be the subject of the third and final rant.