ER Death Points to Growing Wait-Time Problem

Sept. 25, 2008 — -- With notoriously crowded U.S. emergency rooms, chances are most American families have a story of someone waiting. It could have been half a day for a sore throat or perhaps hours for stitches or a sprained ankle.

But for 58-year-old Michael Herrara of Dallas help never came. He died of a heart attack last week an estimated 19 hours after he arrived at Parkland Memorial Hospital's emergency room waiting room complaining of severe stomach pains, according to reports from WFAA News in Dallas.

Members of the Herrera family said they know they aren't alone in facing dangerously long emergency room waiting times in this country.

Emergency physicians say the problem is getting worse.

"He's not here because they let him die, pretty much," Edward Marquez, Herrara's nephew, told WFAA.

"That's awful to know that people are treated that way," he said. "If someone can be helped by this, I think he would be happy."

Representatives of Parkland Health & Hospital System said they are reviewing the case.

"It's important to also understand that, as with all emergency rooms, patients in Parkland's ER are treated based on the severity of their medical condition rather than the length of time they've waited to ensure that the most urgent cases receive proper attention," Dr. Ron J. Anderson, president and chief executive officer of Parkland Health & Hospital System wrote in a prepared press statement.

Anderson told WFAA he knew the medical team marked Herrara's symptoms as a "level 5" case, rather than the most urgent "level 1."

"This incident is a tragedy and our hearts are with the family," Anderson said. "We always strive to deliver the best care to all our patients."

Members of the American College of Emergency Physicians have long said emergency rooms across the country face a difficult problem: They want to provide the best care, but everybody is swamped.

Doctors Upset About ER Wait Time, Too

"Emergency physicians have been sounding the alarm for years that ER waiting times have been growing," said Dr. Richard O'Brien, spokesman for American College of Emergency Physicians (ACEP) and a doctor at the Moses Taylor Hospital in Scranton, Pa.

In 2006, the Institute of Medicine released a report that approximately 120 million Americans -- roughly one in three Americans -- sought care in an emergency room each year.

According to a U.S. Centers for Disease Control and Prevention report, the number of emergency patient visits rose 32 percent from 1996 to 2006, but the number of hospital emergency departments decreased by 7 percent in that same time.

O'Brien said both trends -- fewer emergency rooms and more patients -- skyrocket wait times.

In 2004, the CDC reported that the average patient spent 3.3 hours in emergency department. Almost 400,000 patients waited 24 hours or more.

"Can you imagine if there was another Katrina or, God forbid, a terrorist action around the time of extraordinary hospital overcrowding," said O'Brien. "They're crowded all the time. If a building goes down, what are they going to do?"

O'Brien said in response to the growing problem, ACEP introduced a bill in both houses of Congress called The Access to Emergency Medical Services Act.

"It forces the government to study the problem ? so that we, as a country, can come to grips with it and deal with it as a country," said O'Brien.

In the meantime, many emergency room physicians are trying to stem the problem.

What Can Be Done for ER Wait Times?

"Anecdotally, there's no question that it's getting worse," said Dr. Sandra Schneider, secretary treasurer for ACEP and professor of emergency medicine at the University of Rochester in New York.

Schneider said out of 1,500 emergency physicians recently surveyed by ACEP, 200 personally knew of a person who had died because of the practice of "boarding."

Boarding means keeping patients in an emergency room bed when they should be in a regular hospital bed. Schneider said the practice eventually creates a backup in the emergency room.

Crowded Emergency Rooms

"If you sort of think of an emergency room as a restaurant where you're waiting to eat, and people sit down at breakfast time and they never leave? Then the line goes out the door," said Schneider. "The inpatients get put into the beds and they never leave."

Schneider said the emergency room is just the start of the clogged "assembly line" of patients in an entirely crowded hospital. But she thinks three solutions may at least help.

First, Schneider said make patients wait on the hospital floors where they need to be admitted rather than in the emergency room, thus spreading the workload among nurses in the whole hospital. Second, speed up the paperwork during hospital discharge to open up beds sooner.

"Many hospitals have such complex procedures that patients don't leave at noon, they're leaving at 5 or 6 o'clock at night," said Schneider.

Finally, Schneider said surgeons and follow-up care providers such as physical or occupational therapists should spread out their work, instead of crunching it in Mondays through Fridays.

Yet, these well-known ideas are easier said than done. Schneider said she knows some of the doctors where Herrera died, and knows them to be dedicated workers.

"I just wanted to say all of us in the emergency medicine community are very concerned and upset and our sympathies go out to the family of Mr. Herrera."

Dr. Corey Slovis, chairman of the Department of Emergency Medicine at Vanderbilt University Medical Center in Nashville, Tenn., said he has only found one way to help emergency room waits: assign a doctor to treat patients in the waiting room before they're technically admitted to the emergency room.

Slovis said the doctor visits people, runs lab tests and checks symptoms like sore throats, abdominal pain or weakness. Should any of this raise concerns, the patient would be sent straight ahead to an emergency room bed.

"Not only have we avoided seeing sick patients still in the waiting room," said Slovis. "We've even begun to be able to [treat and] discharge patients without even admitting them to the emergency room."

"We believe at the present time in this health crisis -- and I know we've got a financial crisis, and an Iraq War crisis -- but in this health crisis, I don't see a simpler, easier or better way to avoid having a mishap in the waiting room," said Slovis.