If This Is the ER, Why Does It Take So Long?

Jun 01, 2023

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By Cassie Stein, BSN, RN, EMT, Emergency Department Manager, William Newton Hospital

You wake in the middle of the night with horrible chest pain, your child running a fever, or you fell earlier in the day, and you’re concerned about a fracture. Your local doctor is fast asleep, as you wish you were, but you need answers. So, you visit your local Emergency Room. You arrive, your information is taken, and you are checked in. What comes next, and why do things play out the way they do?

The Emergency Department (ED) is open 24 hours a day every day, no matter the holiday or the weather. When you have a medical concern, we’re there to try and answer your concerns. Expectations of the ED have changed as people’s perceptions and access to healthcare have changed. However, the base reason for the ED has not: to rule out emergency conditions. After checking in with registration, you will be triaged. Certain conditions or concerns — such as stroke symptoms, chest pain, or trauma — get a higher level of priority and attention. This isn’t to say your concern isn’t important, but you should understand the ED does not operate on a first-come, first-serve basis. Certain situations are more time-sensitive and life-threatening than others. This is where the triage system comes into play.

A triage system helps physicians prioritize by patients’ chief complaints, vital signs, and symptoms provided by the patient and assessment. Depending on the information gathered, this will assist in how quickly you are seen. Those with more life-threatening conditions will be placed at the front of the line while others who have less critical or serious concerns will be addressed secondarily.

At times, you are brought straight back into the ED and placed in a room. Other times you may be triaged and asked to return to the waiting room. The ED staff doesn’t like you to wait to be seen any more than you do. Sometimes, there are multiple critically ill patients already in the back and rooms are limited. The tempo of the ED can change quickly — the ED staff does its best to prepare for the next emergent situation. Understanding and consideration are appreciated if you’re asked to return to the waiting room. If something changes, the staff will ask you to alert registration and you’ll be assessed again for changes.

The nurse and provider take the information collected from your assessment and orders will be placed for staff to complete. This can include medication, lab work, radiology exams, or other items. Lab work usually takes around an hour to return, but some tests can take up to days. Radiology exams may have to wait based on lab results. Once completed, all radiology exams are sent to a radiologist, who will view and send a report back. This usually takes around an hour but may be longer if they have a large number of exams to view. The ED works in tandem with other departments to complete your assessment and decide on a course of treatment.

While you wait, other patients come and go. Medical staff are working hard to assess, reassess, complete orders, and discharge, admit, or transfer patients. As new patients arrive or a current patient has a change of condition, the response of the medical crew can change. A study completed in 2022 found the national average length of stay in the ED is three hours, 28 minutes.

The ED has many working and ever-changing parts. No day, patient, or even shift is ever the same. The staff at William Newton Hospital is working diligently to take the best care of you in the most efficient and timely manner possible. Sometimes after all those tests, questions, and medication, the staff doesn’t have an answer. While that is frustrating, the ED’s job is to rule out life-threatening emergencies. Follow up with your family doctor to continue care and answer questions the ED may be unable to.

Visit the William Newton Hospital emergency care page to find answers to frequently asked questions and learn how you can prepare for a visit to the ED.

Otto, R., Blaschke, S., Schirrmeister, W., Drynda, S., Walcher, F., & Greiner, F. (2022). Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry). Internal and emergency medicine, 17(4), 1199–1209. https://doi.org/10.1007/s11739-021-02919-1