Harvard Health Letter

Ask the doctor: Why are waits in the emergency department so long?

Q. I sprained my ankle pretty badly a few weeks ago and was taken to the emergency room. It took three hours before I saw a doctor. Why are emergency rooms so crowded and the waits so long just to be seen?

A. The reasons for emergency department waits are complicated; our entire health care system is implicated. It is impossible to explain every aspect here, but one place to begin thinking about the problem is to separate waiting to be evaluated from waiting to be admitted to the hospital, if an evaluation shows that to be necessary. The reasons for each differ, although there is some overlap.

You waited to be seen, so let's focus on that. Almost every emergency department in this country is overcrowded. About 50 million Americans lack health insurance, and for them, the emergency department may be the only way to get health care: doctors there see all patients who arrive, regardless of their health insurance status. Meanwhile, the number of emergency departments is decreasing. In 1991 there were about 2,500 departments in urban and suburban areas. Now there are about 1,800. Some additional staffing can help, but there's a fundamental problem of too many patients being funneled into too few departments.

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