When an ER is Overcrowded, the Wait Times Get Dangerous

On June 19th, 2008, 49-year-old Esmin Elizabeth Green collapsed onto the floor of the psychiatric emergency room of Kings County Hospital Center in Brooklyn. She had been waiting for more than 24 hours for an inpatient bed. For 20 minutes she writhed on the linoleum floor, and then stopped moving. Forty minutes later, a nurse nudged her. Green was already dead.

The scene caught on security cameras produced outrage and a renewed concern about the state of the nation’s emergency rooms. A study by the Government Accountability Office estimated that there were 119 million ER visits in 2006. A combination of factors has led to serious overcrowding, including an influx of patients with no access to primary care doctors who are forced to use the ER, and competition for inpatient beds between ER patients and patients scheduled for procedures like elective surgery.

For someone in a life-threatening situation, the recommended wait time before receiving medical attention in an ER is less than one minute; in 2006, 1 in 1.35 (74%) of those patients waited longer, sometimes far longer. The average wait was 28 minutes. At the next level of urgency, for patients needing emergent care, the recommended time is 1 to 14 minutes, and 1 in 1.98(51%) waited longer. The average wait for these patients was 37 minutes, up from 23 minutes just three years before.

The consequences of this slowdown can be deadly. A 2009 study showed that patients arriving at the ER with chest pain are significantly more likely to suffer cardiac arrests and heart attacks when the emergency room is crowded. And the prospect of flu victims flocking to already stretched ERs this flu season has many physicians and public health officials across the country concerned. “Our emergency healthcare system suffers from severe crowding on a daily basis,” says Dr. Kristi Koenig, director of public health preparedness for UC Irvine Healthcare. Handling an additional onslaught of flu victims would be “very challenging.”

The emergency room overload in turn taxes fire departments. According to the International Association of Firefighters, emergency calls have increased by 1.2 million in the past year, many of them for medical emergencies. For one Engine Company in Washington, DC, about 80% of calls are health-related.

As emergency rooms, the nation’s ultimate health care safety net, get slower—the odds that a patient requiring urgent treatment will wait longer than an hour are 1 in 4.83—one statistic may come as a surprise: patient satisfaction is on the rise. The state of Florida ranks 37th in emergency room wait times – an average of 266 minutes. However the greater Miami area hospitals rank first in patient satisfaction.

New Yorkers are perhaps less sanguine. On the day after Esmin Elizabeth Green’s death, the hospital fired 3 workers and suspended another 3; and the New York Civil Liberties Union filed a federal lawsuit accusing the county of systematic neglect. And in May of 2009, New York City agreed to pay the family of Esmin Elizabeth Green over 2 million dollars to settle a wrongful death lawsuit.

Leave a Comment