Recently, an area hospital launched a PR campaign, assuring us that ER patients would be "seen" within 30 minutes after arrival. This is certainly a worthy goal, but after spending more than 25 years in emergency departments, I can tell you this will prove to be impossible. It's just the nature of the beast.

While the time taken to initially be seen is important, there is another "wait time" that is probably more critical and that can actually be shortened. It's the amount of time that passes from the point at which the decision is made to admit a patient to the hospital and the actual time that person arrives in his hospital room. Sounds simple and certainly manageable, and you probably think this is only a matter of 30 or 40 minutes, maybe as much as an hour. But you would be wrong. Try 10 or 12 hours, and maybe as much as a day. Shocked? You should be. Worried? You'd better be.

This time interval (we'll call it the "admit time") is so important because it significantly impacts the well-being of all patients being admitted to the hospital. Multiple studies have demonstrated that this interval, if prolonged, exposes the patient to poor care and potential complications. These studies have looked at the lag time in a patient being given needed antibiotics and other medications, sometimes even being given the wrong ones. And they've looked at breathing treatments being ordered for patients with asthma, treatments that were never given. It's not hard to understand when you consider the crowded and frequently chaotic environment of the ER. And remember, once the decision is made to admit a patient to the hospital, they are frequently rolled out into the hallway on their stretcher. Their rooms are needed for other patients still out in the waiting room. The privacy issues during this "admit time" are a separate but significant matter.

Today I want us to consider two recent studies that looked at this issue, and that will shed some interesting light here. The first was published in the Annals of Emergency Medicine in January 2008. These authors looked at ER crowding and poor care of patients with severe pain. Not surprisingly, they found significant delays in the administration of pain medication when there were a lot of people in the waiting room and when there were a lot of people in the emergency department. The greater the numbers, the longer the delay. This shouldn't surprise us, but this objective quantification of the problem should help us monitor the problem and move to correct it. These authors also referred to studies that demonstrated the delay in the delivery of pain medication for those patients with prolonged "admit times". Again, something to address.

The second study came from the same issue of the Annals and asked actual ER patients about their thoughts concerning "admit times". Not surprisingly, the majority of these people didn't want to wait in the ER to be admitted, especially in the hallway. If their bed wasn't ready, they much preferred the idea of being in a hallway upstairs, away from the confusion of the emergency department. And when asked about the length of appropriate "admit times", the clear majority felt that 3 hours would be the absolute limit. That turns out not to be the case. As mentioned earlier, "admit times" are measured in multiple hours and sometimes even days. Sounds crazy, but it's true. If you or a loved one has recently gone through this experience, you know the reality.

So, can anything be done about this? Absolutely. It takes a commitment from the hospital administration and from the staff of the emergency department, but this problem can be fixed. First though, it requires a loud and insistent voicing of the concern. Again, if you have experienced a prolonged "admit time", clearly understand that you or your loved one has been put at unnecessary risk, and let your hospital administrator know. He or she should be willing to talk with you and address the problem. But if you don't voice your concern, don't expect this to be fixed. And the next time you find yourself in the ER, be sure to take a book to read.