FAIRMONT An emergency medical situation means something different to everybody.
Andria Rogers, an RN and director of the emergency room at Fairmont Regional Medical Center, said she and her department see patients check in at the ER for a multitude of reasons and levels of emergency, but the department takes care of them all.
“Something that we may view as a non-urgent case, the public may view it as urgent to them,” Rogers said. “We see anything from chest pain, shortness of breath, and we go to common cold, congestion, things like that.”
Emergency rooms are required to see any patient who checks in, which can mean that individuals with lower health needs may be occupying space needed for a high-acuity patient. When that happens, those who need immediate treatment have to wait longer for care.
“You absolutely have to take anybody that comes through the door,” said John Backus, director of the ER at United Hospital Center in Bridgeport. “That might back up the waiting room, that might back up the availability of beds. A certain percentage of our beds are filled with patients who are lower acuity, that certainly creates delays. That is any emergency room across the country.”
Across the U.S., hospital emergency rooms are experiencing sporadic overcrowding for a number of factors, and in West Virginia, this can be the case in some emergency rooms.
“Crowding in emergency departments is absolutely a problem we see nationwide,” said Peter Griffin, a physician and assistant medical director of the ER at J.W. Ruby Memorial Hospital in Morgantown. “It’s a multi-factorial issue; there are a lot of things that drive it.”
Griffin said West Virginia could see this problem becoming more prevalent as more hospitals close around the state. These closures will lead to a smaller number of emergency rooms and, for that matter, physicians who are available for care.
“We’ve seen a trend of smaller hospitals closing in the past few decades, and that definitely leads to it,” Griffin said. “Other factors that play into this is access to personal care provider offices. Often, nights and weekends it’s hard to get into your family doctor, so people seek care where they can.”
Waid McMillion, a physician and ER trauma director at Fairmont Regional Medical Center, agrees that access to personal doctors can be an issue of volume as well, so a patient may go to the emergency room instead of waiting for their condition to worsen.
“As managed care limits the opportunity for patients to visit their primary care physicians more and more, the community ER has become, by necessity, the patient’s last resort for effective acute care,” McMillion said in a written statement.
Sharon Lansdale, president and CEO of the Hurricane, West Virginia-based Center for Rural Health Development, said that a shortness of staffing, too, can lead to a slower turnaround process in emergency rooms, which causes patients to have to wait longer.
“Here in West Virginia we do see an issue with staffing in hospitals,” Lansdale said. “So we have to be aware of the resources available and the needs of the individual community.”
The measure of wait times in an individual emergency room depends on the circumstances, and can almost never be predictable. Backus estimated that the wait times in UHC’s emergency department hover around 20 to 25 minutes at the longest.
“We certainly see it sporadically,” Backus said. “It’s when our patient volume jumps up quickly and sporadically.”
While visitors can find themselves taking longer in a waiting room than in the actual emergency room, emergency departments have tactics in place to keep crowding to a minimum. And even though other options have become available, from stand alone urgent care centers, patients may be more comfortable at a community emergency room because of its resources.
“Some of the outlying clinics; Urgent Cares, if they have a patient that comes in and they have an emergency situation, they’ll call and report,” Rogers said. “They’ll say ‘We’re sending so-and-so via squad or private vehicle,’ just so we know to expect them.”
In a hospital, too, the system for identifying patients with the most critical needs depends on medical evaluation to make the treatment process efficient, rather than a first-come, first-served basis.
“Our role is to see the patient, evaluate them and determine as quickly as we can whether they have what we call an emergency medical condition,” Backus said. “We’re deciding ‘Does the patient need treating right now, does the patient need admission to the hospital for further treatment, or can the patient be discharged home to take care of themselves whether it’s with a prescription or a followup with a family doctor.”
The process of determining the level of need for every patient in an emergency department is known as triage. When an individual enters an emergency room to be seen, the staff conducts an initial check to assign a level of emergency to that patient.
Rogers said the triage process can be performed in Fairmont Regional’s waiting room. In January, the average wait time in the emergency department was 14-15 minutes.
“If we have every room full, sometimes we’ll have to have people out in the waiting room for a little bit while we discharge somebody,” Rogers said. “But we’re always looking at that list, because registration will put in their chief complaint. So if we see something come up that is high-acuity, meaning shortness of breath, chest pain — we immediately go out and get that patient and bring them back.”
With the resources available at a hospital rather than an urgent care center, some problems can be treated in another department, while others are meant for the emergency room.
“If you know that you’ve broken a limb or you’re having trouble breathing or chest pains, we have the specialist here to treat you right away,” Rogers said. “Sometimes we have to move patients around to accommodate them.”
Griffin also said Ruby Memorial has tools that can help the staff accommodate a large number of patients, which is an advantage of hospital emergency departments.
“We’ve done a great job really developing response tools and resources so when the department does have some crowding, we can respond appropriately,” Griffin said. “We instituted a tool that allows us to level the measure of crowding, and depending on the degree of crowding, reallocate resources around the hospital to meet that need.”
According to Chris Goode, chair of the Department of Emergency Medicine and assistant vice president of Emergency Medicine at WVU Medicine, the wait time for a patient to see a provider at Ruby Memorial in 2019 was an average of 40 minutes. He said the hospital utilizes a split-flow model to treat less acutely ill patients efficiently and utilize its emergency department beds in a way that allows for the critically ill to be seen in a timelier manner.
He also said emergency departments can see increases in volume at this time of year, because of flu cases and other emergency injuries relating to weather.
“This time of the year with the icy conditions, we’ll see slips, trips and falls, also motor vehicle accidents,” Rogers said. “Sometimes they’re walk-in, sometimes they’re by ambulance. We’ll treat them, we’ll stabilize them.”
Each of the doctors said they do not want to discourage anyone from coming to the emergency room.
“There are some things we know you have to come to the emergency room for,” Backus said. “Shortness of breath, stroke-like symptoms, certain injuries, bleeding that you can’t stop; you have to come to the emergency department for that.
“Our motto in this business is ‘It’s the patient’s emergency, not ours.’”