Long emergency department wait times are perilous. Fix this stat! – The Boston Globe

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As Kowalczyk points out, medical patients are also affected, as is anyone experiencing a true emergency in a department with its beds occupied by boarders.

Boarding is visible in emergency departments, but it is not an ER problem. It is a problem of hospital throughput. Emergency physicians look forward to collaborating at all levels of the health care system, from hospitals and insurers to elected officials, to identify immediate and longer-term solutions to the nations urgent boarding crisis.

Dr. Joseph Tennyson

Northborough

The writer is president of the Massachusetts College of Emergency Physicians, director of clinical operations and chief of emergency medicine at the UMass Memorial Health Alliance-Clinton Hospital Emergency Department, and an associate professor of emergency medicine at the UMass Chan Medical School.

As an occupational therapy student at Boston University, I was intrigued by the article Waits longer than ever in area ERs.

The reporter cites how increased wait times in emergency departments are unacceptable for hospital staff and could lead to medical errors for patients but does not mention the potential long-term effects of delayed care and hospital overcrowding on patient health and the overall health care system.

Delayed provision of emergency care for example, for strokes or cardiac events can lead to increased severity of medical events and a greater risk of further hospitalization or rehabilitation. Many rehab facilities and nursing homes are also understaffed and overcrowded, so these increased ER wait times would lead to an increased burden on an already-strained system and decrease the quality of patient care. This in turn could affect the available length of stay for patients as they recover, sending some home sooner than advised.

Bringing more attention to the greater and potentially widespread impact of ER wait times could motivate legislators and heads of hospitals to urgently address this issue.

Natalie Schmidt

Allston

Many of the observers cited in the Globes article focused on process interventions such as improved utilization of observation beds or transfers of patients to inpatient units to shorten emergency department wait times. My colleagues and I published a study in the Journal of Emergency Nursing investigating a range of hospital characteristics associated with how much time it took for a patient to be diagnostically evaluated in 67 Massachusetts emergency departments. Our research demonstrated that this wait significantly increased when emergency nurses cared for higher numbers of patients.

Importantly, while 17 other potential process factors were included in the statistical analysis, such as hospital occupancy, staffed hospital beds, ICU beds, Medicare case mix, observational beds, and profit and loss figures, the most important factor affecting wait times in Massachusetts ERs was nurse-to-patient ratios.

If Massachusetts hospitals want to lower these wait times, the evidence seems clear: Hire and staff more registered nurses.

Judith Shindul-Rothschild

Sherborn

The writer is a registered nurse and is a research professor at William F. Connell School of Nursing at Boston College. She holds a masters degree in psychiatric nursing and a doctoral degree in social economy and social policy.

Liz Kowalczyks story on ER wait times highlighted a distressing reality at a fragile time for American health care. Heres what patients should know as our state addresses these challenges.

First, the root causes: About 19,000 hospital job vacancies in Massachusetts have led to fewer overall care beds. More than 1,000 beds are unavailable on any given day simply because hospitals cannot move patients to lower-level facilities. Patients are experiencing longer stays. Community-based care is constrained. Virus seasons are intensifying. This perfect storm of factors has come together to create the delays many patients are experiencing today.

Second, the solutions: Just as they did throughout the COVID-19 pandemic, health care organizations are working with the state and one another to balance out care demand and share available resources. It is a daily, round-the-clock effort centered around treating the sickest patients immediately. As the pandemic showed, cutting back on planned procedures leads to greater illness and contributes to the capacity crisis we are experiencing now. It would be a mistake to dismiss the importance these procedures have on patients long-term health.

Most of all, patients should know that hospitals have their backs, and they should not hesitate to seek care when they need it. Patients can help local providers by visiting urgent care centers and primary care doctors when they are not in an emergency, keeping up with medical appointments, and treating caregivers with the respect they deserve.

Patricia Noga

Vice president, clinical affairs

Massachusetts Health & Hospital Association

Burlington

The writer is a registered nurse.

One major reason for such overuse of emergency departments is the collapse of outpatient care. Try to get in touch with an outpatient provider. You might get to leave a phone message (after wading through a complicated list of options).

Some people wont, or cant, wait weeks or months to see a provider. Emergency departments are always open, and one can be seen immediately (so to speak) and expect to get good care. So thats what people opt to do rather than see an outpatient provider. Urgent care centers are a good option, but they usually close in the evening.

The care systems are broken. Its helpful to report on pieces of the problem, but Id like to see a report on the fragmented system of health care itself.

Dr. George Sigel

Norwood

The long waits in emergency departments are just another symptom of a much bigger problem. When an industry is led by those without the proper training, the probability of failure is high. The day-to-day workflow of hospitals has increasingly been managed by risk managers, data analysts, and business graduates. However, medicine is a service industry with unanticipated consequences, not a commodity with neatly drawn revenue projections. Corporate models dont apply. Yet it has devolved into a series of billable events governed not by clinical judgment but by insurance company protocols and stakeholder margins. Lets try putting those with a license to practice medicine back in charge of medical care so that we can start to clean up the mess. Its not that complicated to take good care of a patient.

Dr. Paula Muto

Andover

The writer, a practicing surgeon, is the founder and CEO of the technology platform Uberdoc, which promotes access and price transparency.