Bothwell working to reduce ED wait times

As a career medical professional, I have worked in emergency medicine and emergency management for many years. I’m proud to have served my country in the Army and the Air Force and now as director of Bothwell Regional Health Center’s Emergency department (ED).

Our ED has 17 beds and our medical team sees an average of 70 patients a day or 24,000 patients a year. People arrive through the doors or by ambulances with conditions ranging from minor illnesses and injuries to life-threatening traumatic injuries, strokes and heart attacks. According to emergency care best practices, we need one ED bed for every 1,000 visits, which means we should have 24 beds.

If you or a family member has visited our ED, you may have experienced a long wait time to be seen or admitted to the hospital. We understand we have challenges in the ED and have recently implemented new processes including having patients seen sooner by a nurse practitioner or physician assistant who sort patients according to their illness or injury. Patients with serious issues are moved to an ED bed while patients with less serious issues may go to a new procedure room for examination and discharge.

Another contributing factor to wait time is an issue called “boarding.” When someone comes to the ED and it’s medically determined they should be admitted to our hospital or transferred to another and there’s no bed available, that patient must stay in an ED bed.

There are three types of boarded patients – those who are waiting for a bed at a hospital that has a higher level or care or services we don’t provide (these patients leave the ED the fastest); those who are waiting for a psychiatric bed elsewhere; and those who need an inpatient bed in our hospital. In the last 12 months, 102 patients have waited in Bothwell’s ED beds from hours to several days.

Despite being landlocked for more ED space and having fewer beds than best practices suggest, boarding is not unique to Bothwell; it has been plaguing hospitals across the nation for years. The American College of Emergency Physicians wrote in a 2022 letter to the White House that “boarding has become its own public health emergency.”

Senior leaders at Bothwell recognize the strain and negative impact boarding has on the patients we serve and on the staff there to help them. To address this issue, we have formed a multi-disciplinary team focused on getting boarded ED patients into one of our hospital beds faster by improving throughput – the efficient and effective movement of patients through the system, from admission to discharge.

We care about this issue because if someone needs to be admitted, it’s safer for the patient to have their hospital care start as soon as possible, and we need the ED bed for the next ill or injured patient. We also know that boarding patients in the ED leads to patient dissatisfaction and higher levels of stress among our providers and staff because more people are waiting to be treated with no place to put them in the ED.

One evidence-based action known to improve throughput is “discharge before noon” or the timely discharge of inpatients from the hospital that can free up beds for ED patients. This involves almost every department in the hospital and will take coordination and standardization.

I am confident our team is up to the task. We know a patient’s length of stay in the hospital or ED wait time is a critical indicator of our performance and quality of care. All of us at Bothwell are actively working to address these measures by reducing the time it takes an ED patient to be seen by a provider and now improving hospital throughput that will impact our ability to function in the ED more effectively.

Mike Shipp is a certified Physician Assistant specializing in Emergency Medicine. Prior to joining the Bothwell team, he worked in the MU Health Care Emergency Department for 13 years. He also has been an emergency medicine instructor in St. Louis and is a Desert Storm and Iraqi Freedom veteran.