Prolonged emergency room wait times and overcrowding in emergency departments (ED) is a widespread issue worldwide, to the point where some countries have declared it a national crisis. ED overcrowding occurs when an emergency room can no longer function appropriately due to the number of patients outweighing the space, resources, and staff available to provide care for them. Unfortunately, the novel coronavirus (COVID-19) pandemic has only exacerbated this already-growing problem. COVID-19 On The Rise – How You Can Help – FNPWrite.com (fnp-write.com)

Overcrowding can lead to increased emergency room wait times and evident frustrations for patients and their families, who might not always understand the reasons for the delays. Understanding how patients are triaged and how the ED’s flow is managed can help provide some insight as to why you or your loved one might still be sitting in the waiting room, although you arrived before several patients who have already been taken back. There are also options that could be more appropriate for people who need care for certain conditions, which would also assist in alleviating the problem of ED overcrowding.

Triage levels

The Emergency Nurses Association (ENA) maintains the Emergency Severity Index (ESI), a triage tool utilized by most emergency departments within the United States as they work to quickly categorize patients into five groups based on their acuity and resource needs. Emergency Severity Index (ESI): A Triage Tool for Emergency Departments | Agency for Healthcare Research and Quality (ahrq.gov)

ESI Score Description Examples

1 – Immediate, life-saving intervention required without delay: Cardiac arrest, unresponsive child, massive trauma, or severe blood loss

2 – High risk of deterioration or signs of a time-critical problem: Heart attack, stroke, multiple trauma

3 – Stable, with multiple types of resources needed to investigate or treat (such as lab tests or radiology): Abdominal pain, seizure, pneumonia in older adults, dehydration

4 – Stable, with only one type of resource anticipated (such as only an X-ray, sutures, or other resources): Simple laceration, ankle sprain

5 – Stable, with no resources anticipated except oral or topical medications or prescriptions: Toothache, abrasion, medication refill

Putting it in perspective

Imagine a waiting room filled with patients who are all eager to be seen by a provider, and four ambulances are coming in.

It is now up to the emergency room team to decide where to place these patients and who they will see first, determined by the patient’s ESI score. Anyone with an ESI score of 1 or 2 will take precedence, as their condition is likely the most critical and requires immediate or timely life-saving interventions. A patient with an ESI score of 3, such as someone with abdominal pain, pneumonia, or nausea and vomiting with signs of dehydration, would be placed next. Patients presenting with ESI scores of 4 and 5, such as those with ankle sprains or toothaches, would be seen last, as their condition is uncomfortable but not life-threatening.

Please understand: Nurses and providers never want to see patients in pain or discomfort. They don’t want them to wait any longer than necessary, and they are doing everything they can to get them back to a room and treated within a timely manner. COVID-19 has not made this any easier, but they will continue to give everything they have to care for their communities.

How we can all help

There is no magic answer to fixing a long-standing, widespread problem like prolonged emergency room wait times. But community members can help reduce ED overcrowding, and every little bit helps. Chiefly, people can use the ED for urgent and emergent needs only:

• If possible, see your primary care provider or Urgent Care for simple issues such as colds, muscle strains, rashes, etc.
• Suppose you do not have insurance or worry about financial obligations. In that case, there are usually clinics in most areas that offer medical and dental services at reduced or no cost to you.

You should always do what you feel is best for you or your loved one when it comes to healthcare. Always consult your medical provider before starting any new medications or if you have questions or concerns about a particular problem.