Unless you've been shot or suffered another serious injury, chances are you'll have to wait your turn if you go to a hospital emergency room. In fact, people can sit around for hours in an ER before they see a doctor.
That will come as a relief to anyone who has gone through the ER drill: you walk up to the counter and a nurse asks, "What brings you into the emergency room today?" You explain what's wrong, show your insurance card, and fill out some forms. Then the nurse says you will be seen in a little while. Given the room full of people who are already waiting to be seen by a doctor, you realize your wait will be a while.
In an effort to give better care, Scripps Mercy Hospitals in Hillcrest and Chula Vista are trying something new.
When a person checks in, a nurse decides whether their condition is acute or non-acute. Shortly thereafter, the patient is taken into the ER and seen by a doctor and nurse simultaneously.
"So what brings you into the emergency room today?" asks the ER doctor.
"I was running," the patient responds. "And kind of stepped into a pothole, and sprained my ankle pretty badly."
While the doctor examines the patient, a nurse enters all relevant information into a computer. The data is now available throughout the hospital.
Dr. Valerie Norton is the director of Scripps Mercy's ER in Hillcrest. She said the department did an assessment of the way it did things earlier this year.
"And we mapped out all the things we were doing currently," Norton said. "And all the ways in which it was repetitive, and silly, and introducing all these needless waits. And then we mapped out what our ideal system would be, where we got rid of as many waits, and got rid of as many redundant works steps as we could, and what we basically did is we got rid of triage."
Under the old system, a patient would tell their story to the triage nurse, and tell it again to a different nurse once they were brought into the ER. Then they were parked in a bed and waited for a doctor to come by.
Now, once patients are seen by a doctor and nurse, they're put in another room for treatment, and the process repeats.
Dr. Norton said it's a lot more work for the staff.
"You're seeing more patients, faster," she pointed out. "You're changing the beds more frequently. Nurses in one area may hand off care to a nurse in another area. So it is more stressful, and the pace of the workload has picked up."
The hospitals have had to hire more staff. And they've lost a few people who didn't like the new way of doing things.
But the bottom line is, wait times have been cut.
At Scripps Chula Vista, average ER wait times have been slashed by more than an hour, from 92 minutes to 24 minutes.
Greg Knoll directs the Consumer Center for Health Education and Advocacy. His agency helps thousands of San Diegans every year who've been denied health insurance.
Knoll said he applauds efforts to make emergency rooms more efficient. But he said there are two fundamental problems. One is that too many uninsured people use ERs because they don’t have a doctor. And, those who have insurance can't get in to see their doctor right away.
"If someone calls their doctor with what they feel is an urgent matter," Knoll said, "they're usually told he can see you a week from Tuesday. And so they go decide to go to the emergency room."
If doctors were more accommodating to same day appointments, maybe fewer people would go to ERs for care.
A recent study from the Rand Corporation offers more food for thought. According to the report, 27 percent of all ER visits could be handled at a retail clinic or urgent care center.
