Rick Haston, who suffers from kidney stones, repeatedly has seen evidence of the intense pressures on emergency room staff, including a five-hour wait in the Erlanger ER on a busy January evening.

“There might have been 25 to 30 people (waiting). It was pretty crowded that night,” said Mr. Haston, 59, of Ringgold, Ga. “When I got back in the back, I realized there were certainly people in much worse condition than I was. But I was in a lot of pain.”

Recent studies confirm that emergency departments across the nation increasingly are burdened by overcrowding and a growing number of urgent care cases, resulting in longer wait times.

The average wait time to see an emergency physician nationwide jumped from 38 minutes in 1997 to almost an hour in 2006, said Dr. Stephen Pitts, lead author of a recent report on emergency rooms released by the U.S. Centers for Disease Control and Prevention.

Local hospitals’ efforts to streamline the process of getting patients in and out are showing promise, hospital administrators in Chattanooga said. Emergency physicians and administrators here are focusing on identifying inefficiencies and making incremental changes in processing patients that can have a big impact on time spent in an emergency room, officials said.

Some solutions are as simple as putting medicines and equipment close at hand so medical personnel have instant access to them, while others include shifting personnel and streamlining paperwork processes.

TOO MANY PATIENTS

Administrators say a major factor in wait times is the sheer number of people going to emergency rooms. Some use the ER as their primary physician rather than for injuries, accidents and other traumas, clogging the process, experts say.

Physicians emphasize that those cases make up a small proportion of total ER visits.

Nationally, the number of overall ER visits grew from 90.3 million in 1996 to 119.2 million in 2006, according to the CDC report.

Wait times vary widely among hospitals, and Dr. Pitts emphasized that it is not valid to compare wait times at hospitals that vary in size, type of patients and the severity of cases seen.

“It’s hard to say, ‘My hospital should be using this as a benchmark’ because some are trauma centers, some are little tiny community centers that see very few patients,” said Dr. Pitts, an associate professor of emergency medicine at Emory University in Atlanta.

For example, a Level 1 trauma center such as Erlanger has the added burden of handling this area’s most severe cases, doctors say.

WAIT TIMES FALL

Changes at emergency rooms in local hospitals have begun to pay off, officials say.

At Parkridge Medical Center, the time from arrival at the emergency department to seeing a physician averaged 48 minutes in 2008, compared to 54 minutes the year before, hospital officials said.

Erlanger and Memorial Hospital provided different figures, which measured the total length of stay for a patient, that is, from the time patients enter the emergency room until they are either discharged or admitted to a regular hospital bed. At Erlanger, that time frame has been cut by 23 percent, from 5.52 hours in May 2007 to 4.27 hours in May this year, said Blaine Morris, vice president of clinical services at Erlanger.

After a focused effort in July to reduce wasted time in processing patients in the Memorial ER, the average length of stay there dropped to 4.18 hours, compared to an average of 4.51 before those changes, officials said.

At Erlanger, the addition in January of a staff member devoted entirely to transporting patients from the emergency department to the CT scanner has resulted in significant improvements in the length of stay for those patients, Mr. Morris said.

With the additional manpower, the average time spent between a doctor ordering a CT scan for an ER patient to the completion of that scan is 51 minutes, down from one hour and 10 minutes, Mr. Morris said.

At Memorial, changes in processing patients and paperwork resulted in a decrease in the time it takes for patients with chest pains to make it to the cardiovascular catheterization laboratory for testing.

The time decreased from 59 minutes before changes were implemented in January to a current average of less than 30 minutes, said Jan Woods, director of Memorial’s emergency center and emergency medical services.

ER CHALLENGES

More visitors to emergency departments, combined with fewer ERs nationally, make for a difficult situation for emergency staff, Dr. Pitts said.

Federal statistics show that more patients who are in serious distress and in need of admission to a hospital are showing up in emergency departments, instead of entering the hospital through the front door.

Dr. Pitts said he is unsure why this is occurring but, since patients who eventually are admitted tend to spend more time in the ER, the trend is contributing to the squeeze on those departments.

Another fundamental challenge for emergency departments is the lack of intensive care beds that can take those patients once they’ve already been treated in the ER, Dr. Pitts said.

“Patients in the (emergency department) hallway waiting for the bed upstairs is the real evil behind all this,” Dr. Pitts said.

Local doctors and emergency department administrators agreed.

“We’re trying to look at discharging patients sooner in the morning so we can open up beds. ... We’re looking at ways of sending patients up to the (hospital) floor so they can wait on a hallway floor instead of the emergency department,” said Dr. David Seaberg, dean of the University of Tennessee College of Medicine in Chattanooga and an emergency physician at Erlanger.

A collaborative effort among area hospitals to change the behavior of nonurgent patients — who make up a relatively small portion of ER visitors, anyway — has proven to be a struggle, hospital officials and emergency physicians said.

“It is not successful,” said Jerri Underwood, chief nursing executive for the Chattanooga market at Parkridge. “It’s a problem with community education. Patients continue to use the emergency room as their primary source of care.”

But Dr. Seaberg insisted that nonurgent patients are not the main cause for the backlog in emergency departments.

“What’s really going on is that we have some very sick people that require to be admitted and require extensive testing, and sometimes we have a hard time getting those patients up into the hospital from our emergency department,” he said.

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