Q. Why do patients have to wait in emergency departments?

• Critically ill patients are seen first, which means less critically ill patients may wait.
• Thousands of emergency departments have closed in the United States in the past decade. At the same time, the number of emergency department visits increased to 114 million in 2003
• A lack of capacity causes hospitals to "board," or hold patients in the emergency department until beds in other parts of the hospital become available.
• A shortage of on-call medical specialists such as neurosurgeons and cardiologists, caused by skyrocketing medical liability insurance premiums and inadequate reimbursement.
• Local epidemics and disasters can cause many patients needing immediate medical care to arrive at once. This can also happen when multiple motor vehicle crashes occur and during natural disasters or local epidemics, such as the flu.
• Large uninsured populations can, according to a government report, lead to longer waiting times for non-emergency visits.

Q. How much time should you expect to be in an emergency department?

A. If you have a minor illness or injury, and the emergency department isn't crowded, your visit may be 1 to 2 hours. If you require extensive diagnostic tests, your visit may be longer because it will take time to obtain results. If an emergency physician needs to consult with another medical specialist, your wait may be extended. If you need admission to the hospital, you may have to wait until an inpatient bed is available.

Q. Do extensive waiting times affect treatment outcomes?

A. Long waits can affect patient outcomes. Patients may get tired of waiting and leave. Some patients may wait longer than optimal, but emergency departments work hard to make sure the sickest patients are seen first and that all patients are seen in a timely manner.

Q. What steps have been taken to improve customer service in emergency departments?

A. Many hospital emergency departments seek to improve customer service by decreasing waiting times using such measures as registering people at bedsides, streamlining systems that speed specimens to the laboratory, computerizing tracking systems, and developing alternative systems for improving patient flow and processing laboratory tests. Other hospitals are establishing fast-track systems that expedite diagnosis and treatment for patients with less critical conditions.