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ER Wait Times are Down

silive.com

Waiting times for patients seeking treatment down sharply at hospital emergency rooms on Staten Island

Published: Monday, April 11, 2011, 8:26 AM     Updated: Monday, April 11, 2011, 1:51 PM
Frank Donnelly
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Staten Island Advance/Hilton Flores
On average, doctors first see a patient about 22 minutes after the patient enters the emergency room at Staten Island University Hospital, Ocean Breeze.
STATEN ISLAND, N.Y. — Patients seeking treatment at the borough's two main hospital waiting rooms are seen, on average, by a doctor within 30 minutes of arrival, or less, statistics show.

And while ER chiefs acknowledge those numbers aren't perfect, they're a big improvement over just a few years ago when new patients waited more than an hour to see a physician in the emergency rooms at Staten Island University Hospital, Ocean Breeze, and Richmond University Medical Center, West Brighton.

Electronic record-keeping and monitoring systems have played a huge role in slashing wait times.

By logging onto a computer, ER staff can track patients, ailments, symptoms and doctors' and nurses' responses from the moment the sick walk through the doors, said Dr. Brahim Ardolic, University Hospital's director of emergency medicine.

In February, about 6,355 patients, or an average of 227 per day, sought treatment at the Ocean Breeze emergency room, said Dr. Ardolic.

Doctors, on average, first saw those patients about 22 minutes after they entered the ER, he said. That figure represents a two-thirds decrease in time from the 64 minutes it took in February 2009 and a 53-percent drop from 47 minutes in February of last year.

University Hospital is also bolstered by its state-of-the-art Elizabeth A. Connelly Emergency and Trauma Center opened two years ago. It more than triples the size of the emergency room on the Ocean Breeze campus, allows staff to operate more efficiently and is more patient-friendly, said hospital officials.

Besides carefully monitoring the ER, it's crucial to move patients who need to be admitted up to their rooms as quickly as possible, said Dr. Ivan Miller, chief of Richmond University Medical Center's emergency department since September 2007.

"That has a big impact on wait times," said Dr. Miller, who noted that 5,209 patients, about 186 per day, sought treatment in February at RUMC's emergency room.

Those patients, on average, first saw a doctor about 30 minutes after entering the ER, said Dr. Miller. The average wait time was 64 minutes in February 2008, 42 minutes in 2009 and 31 minutes a year ago, he said.

While RUMC's times are good, Dr. Miller said they need to get better.

"Psychologically, 30 minutes ... is a long time," he said. "Our goal is to see patients on arrival. Our nurses and physicians are very aggressive about getting patients seen."

Even with the improved wait times, there are days at both hospitals when patients aren't seen nearly as quickly. And some still lie for hours or more on gurneys in ER halls, waiting to be admitted.

PATIENTS NEED TO BE THERE

Some critics contend that many of the combined 400 patients seeking aid each day at the two emergency rooms are clogging up already overburdened facilities. Those patients should be treated in doctors' offices or urgi-care centers, they maintain.

The two ER heads disagree.

"There's this myth that a lot of patients who come to the emergency room shouldn't, but if you look at the chief complaints ... they are all conditions that might be very serious and really need to be evaluated by a physician," said Dr. Miller. "The majority of patients who come in really need to be seen in the ER. Patients don't want to come to the emergency department. They come because they have to."

Chief complaints at both hospitals' ERs consist of abdominal pain, chest pain, fever, coughs, shortness of breath, vomiting, back pain, headaches, injuries from falls and motor-vehicle accidents.

Dr. Ardolic of University Hospital acknowledges that a small minority of patients abuse the system.

And while many patients complain of ailments, which, on paper, may not seem urgent, that doesn't mean they shouldn't seek ER treatment, he said.

"You walk into the emergency department waiting room on any given day and ask yourself, would I come in with this constellation of complaints?" he said.

In "94 to 95" percent of cases, you would, said Dr. Ardolic.

"The point is, you're not a physician and if you have this thing that's bothering you, you have to come in," he said. "For you to be able to tell the difference between a bad case and a not-so-bad case is hard."

Take, for example, patients complaining of fever and dehydration.

Many are given intravenous fluids right way. In most cases, they couldn't get a IV at a doctor's office, said Dr. Ardolic.

BUSIEST TIMES

Then, there are patients with seemingly benign symptoms such as sore throats, coughs and headaches.

While seemingly tailor-made for urgi-care centers, those patients typically start filing in around 4, 5 and 6 p.m., when physicians' offices begin winding down and closing, he said.

 "My urgi-care doesn't even get cooking until 2 or 3 p.m.," said Dr. Ardolic.

 Records also show that 49 people came in during the month with tooth complaints, he said.

"There's no question, most of our tooth patients come in after 5 p.m.," said Dr. Ardolic. "If you need medicine, where are you going to go at 5 p.m.?"

At both hospitals, almost three-quarters of ER patients in February arrived during the 13-hour period between 9 a.m. and 10 p.m.

Dr. Ardolic said many patients who come during the first half of that time frame are referred by their own doctors.

Chest pains are a top complaint.

Those patients are observed, tested and checked for other risk factors, such as diabetes and high blood pressure. Some are admitted; others, who check out and have no other risk factors are sent home and told to follow up with their doctors.

Other patients who arrive at the ER with complaints such as cellulitis, swelling or dehydration often need more acute treatment than the doctor can administer in his office. Or they may require immediate testing.

"I can hydrate them, I can get their lab tests back in an hour to find out their electrolyte status and whether there's an infection," said Dr. Ardolic.

As a result, most patients who are admitted come to the ER during the middle of the day, he said. A report issued from the federal Centers for Disease Control and Prevention appears to support Dr. Ardolic and Dr. Miller's assessments.

According to the CDC, just under 8 percent of patients nationwide visited emergency rooms with non-urgent-type complaints in 2007. The figure represented a drop of more than 4 percent from 2006.

Dr. Ardolic said the ERs statistical reports help in trouble-shooting and discerning disease patterns.

For example, if doctors detect a spike in flu-like symptoms, fever or diarrhea, they'll check the patients' ages, and community to see if the bug is hitting a certain age group or neighborhood.

Dr. Ardolic said the findings are reported to the state Health Department.

The state agency can compare the data to a broader band of information to determine if the problem is widespread. Often, the data can indicate an early flu season or the existence of the potentially deadly West Nile virus, he said.

"We usually know it's flu season about two or three days before it gets announced on TV," said Dr. Ardolic.



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