Emergency Room Physician Dr. Kerry Forrestal Examines the Lengthy Wait Times Experienced in Area Emergency Departments

Dr. Kerry Forreal: That of course, being the intro song from Rent 525,600 minutes or Seasons of Love. Hello, I’m Dr. Kerry Forreal, and this is 91 7 WHCP Midshore Community Radio, your music discovery and NPR station. Now, today’s topic is going to be wait times and the emergency department one near and dear to my heart as I’m an ER doctor. So that song seemed highly appropriate. I know it feels like you are waiting that long every time you go to the emergency department. So we’re going to look into why er wait times are, what they are, a little bit of history, the problems we face, and then we’re going to go as always in part two into the solutions. And at the very end, I’m going to tell you who’s to blame. Let’s begin. It’s more or less an expectation that if you have to go to an emergency department that you’re going to be doing some waiting.

It’s a frustrating situation because you or your loved one don’t feel well for whatever reason. And then you have to sit in uncomfortable waiting rooms on chairs that were rejected by the Spanish Inquisition as too cruel for hours on end. What gives, well, let’s talk a little bit about the history of emergency departments and some numbers. First, let’s define a few terms here. We’re going to use er, emergency room and ed. Emergency department interchangeably, ER is the old term for when emergency rooms were literally that a designated room in the hospital that had specialized equipment to take care of emergencies. I don’t know when the first emergency room came into existence. I imagine it was back in antiquity when some grumpy old doctor didn’t want to hoof it to get the leches. So he said, set it up over there. The first emergency department was credited to Virginia in 1961 and the American College of Emergency Physicians, the first organization in the field was 1968.

Okay, I hope I’ve got your attention. I need you to hear me on this one. The next term. The media politicians and general public called us ER boarding, ER overcrowding, er, whatever, and it’s not, this is important. Blaming the emergency department for the situation with wait times and overcrowding is a little bit like blaming a roadway for a traffic jam. These things are the result of system-wide processes, and we’re going to look at that and hopefully by the end of this I can convince you of this. And before we go on, this brings up a really important point. I understand if you’re in an emergency department, that it can be very frustrating to wait but unloading on the nurse or the tech or whoever. When you berate or even threaten personnel, you got the wrong person. I’ll tell you who the right person is in a little bit, but they’re just doing a job, so please don’t go after them.

Okay, so wait times in Maryland, unfortunately, they’re among the longest in the nation, and we’re going to focus on medical wait times here. The psychiatric wait times and psychiatric issues are a whole other ball of wax, and we’ll talk about that on another program. But let’s look at the numbers and why these things may be happening. The United States 335 million people, plus 11 million unauthorized individuals, and in 2023 we had 139 million visits. 18 million will need to be admitted. 3 million to critical care beds. That comes out to 42.7 visits per 100 people. And the CDC tells us one fifth of the population will visit the emergency department at least once a year. Maryland has a population of 6.2 million people, plus about a quarter million more undocumented, which includes about 10,000 students. According to the H-S-C-R-C, the Health Services Cost Review Commission, there are 2 million visits to emergency departments every year in order.

Then DC has the longest wait time in the documentation I’ve read it is six hours, 30 minutes, Maryland, four hours and seven minutes. Rhode Island, three hours, 34 minutes, as is Massachusetts, Delaware, a little bit better, three hours, 31 minutes. New York, three hours, 22 minutes, New Jersey, three hours, 14 minutes, Connecticut, three hours and six minutes. The United States average is 2.5 hours. Now here’s an interesting thing. I map this against density of population. Would you like to guess what the top eight places are for population density? No big surprise, those eight places. So how about the opposite of that? North Dakota has the least wait time, one hour 47 minutes. Population density number 47. Nebraska has the second base waiting times in the United States at one hour and 54 minutes. Their population density number 43, South Dakota, one hour 55, that brings ’em. Number three, their population density 46.

But it’s not just population density. We are losing capacity. In 1975, there were 7,156 hospitals and 1.5 million beds for 216 million people or about one bed for every 147 people. In 2022, we’ve decreased the number of hospitals to 6,120. That’s about 14% less. There are now 916,000 beds, a 37% decrease and a 50% increase in population at a time when the baby boomers are coming through, living longer and with more chronic illnesses. Alright, we’re going to dig into the bigger part of this here in just a second while we come back from break. But this is WHCP 91 7 MIDSHORE Community Radio and NPR Station. And I’m Dr. Kerry Forestal.

Comment emailed to WHCP from Ann Robinson:

Dear WHCP–

I am among the local ED nurses in Cambridge’s free standing ED, and have worked in emergency departments for 27 years.
Dr. Forestal’s talk I just listened to is 100% on point! For those who took the time to listen to it in its entirety, I will confirm that everything he said is absolute truth. The level of frustration nurses, techs, docs, and administrative staff is palpable every day, every hour. Patients suffer long waits, ambulances get re-routed to yet another crowded ED, leaving less 911 coverage in areas like ours. The list of the domino effects goes on and on.
Perhaps if enough people listen to his account of this aspect of health care some policy changes would surely follow. America’s citizens need to stand up and say how wrong it is that the profit in health care delivery is grossly misdirected.
Again, kudos to Dr Forestal, and to you at WHCP. We, the people, need to know!
Sincerely,
Ann Robinson, RN