WHETHER it is because you have a dire emergency or an unexpected or unexplained illness, or you had to assist a family member or friend with an urgent ailment to the emergency department (ED), most of us have visited the ED. The most common complaint among patients is the long wait in the ED, although most will admit that the treatment received is usually satisfactory.

Why the long wait?

Studies show that only 10-20 per cent of people who visit the ED are actually having an emergency. Therefore, the non-urgent reasons for which people access the ED result in the major problem of overcrowding.

There are several reasons for accessing the ED in Jamaica, among them are: the shortage of primary care physicians; truncated opening hours of health centres; the numerous patients tapping into the free health care system; the confidence of the population in the hospital system; and convenient after-work hours. This results in a spillover of the patients with non-urgent complaints to the ED, which serves as a safety net for these people who are rarely re-routed to other primary care settings.

Patient flow is also another contributor to delays in the ED. Most EDs have a triage system. This sorts the patients into emergent, urgent and ambulatory cases. Patients who are deemed to have emergent and life-threatening pathologies are the primary focus and are treated immediately or soon after arrival. Urgent cases are prioritised based on the most serious problems. However, ambulatory cases, or walk-ins, usually account for the bulk of patients using the waiting area. With staff shortage to deal with the volume of patients, the walk-ins being low acuity suffer significant delays.

The time taken to register, pay fees, the number and level of expertise of the ED doctors and nurses, the availability of the auxiliary staff, as well as the wait for investigations and specialty consultations are also important factors that contribute to waiting times in the ED. If there is a significant patient-number-to-doctor ratio, this will increase the wait in the ED and impact on patient care and satisfaction.

The delay in disposition of ED patients also increase waiting times. Patients who are to be admitted from the ED are delayed by transfer protocols, inadequate staff on the ward to arrange accommodation and the decisions to discharge ward patients to provide available beds. Of course, bed space is a serious limiting factor in any hospital and will affect the number of patients that can be admitted.

The solution?

It lies both in governmental and institutional policy change as well as in educating the public about the use of the ED. Improving the ED with equipment, resources and posts for emergency-trained physicians will result in efficiency in the triage, management and appropriate investigation of patients. Auxiliary services need to be equipped to provide laboratory and radiological results quickly so review of patients can be timely. Boarding patients in the ED should be discouraged and increased staffing and bed number in hospitals must keep pace with the growing patient population.

Dr Romayne Edwards is a consultant emergency physician at the University Hospital of the West Indies and an associate lecturer

at the University of the West Indies.