ERs prioritize on severity, not first-come-first-serve. If you go for stomach pains and while you're waiting, someone else comes in with a severed limb, they will get seen right away and your wait just got longer.

More notably, more serious problems may require more staff. If the nurses are busy cleaning up bio material, you get to wait a little longer too before you get triaged.

The incentive is not to drag your wait out, so much as to have the minimum staff needed to keep patients stable. Stabilizing people in critical condition is literally the one job of the emergency room.

On the other hand, people go to the ER for all kinds of reasons that are more urgent than urgent care, but less than true emergencies. Sometimes, they even go because they can't be denied admittance for lack of ability to pay, when a general practitioner at regular practice would have been a more appropriate physician to see.

All of that said, a 10 hour wait either means there's an absurdly high number of non-emergencies, or they're facing severe shortages (self inflicted or otherwise).

All this is not wrong. Also, there's another huge factor: frankly, most ER triage systems are not very efficient and they don't hire enough RNs or other front-line workers.

I refuse to work day ER shifts because along with just a couple motivated RNs, I can often clear all the patients from the waiting room at night that have been there for many hours. Often, we just need a break from new patients and we need to work as a team and just focus on getting one patient out at a time. OTOH, day shifts often make me powerless as a doc just because there are so many other bodies around, each with competing agendas and pressures.

Yes, a large fraction of ER visits aren't emergencies. Typically they triage new patients, take the actually critical ones immediately and everyone else waits.

I'm not sure wait time is an informative metric, vs something like survival rate for different kinds of conditions.

> I'm not sure wait time is an informative metric

Seems to be a good metric for a dysfunctional triage system. How else does a type 1 diabetic with a known non-functioning insulin pump on the verge of going into coma get labelled as non critical.

They’re not bleeding or have obvious trauma?

I’m not defending the hospital in TFA, per se, but my wife recently had an ER visit on a miscarriage. She was immediately admitted and tended to be a doctor for the fact that she was hemorrhaging.

During the course of our 12 hours I came and went from her room through the waiting room and to my vehicle. Saw folks waiting hours and hours. For all I know they had a faulty pump.

When it came time for dismissal, we waited hours and hours. The attending staff were handing a GSW and a head trauma on a child. While I didn’t go full-Karen I had to drop the “my wife suffered a miscarriage and is having a mental breakdown, are we going to be banned from your hostile system if we just leave?” to receive final clearance to leave.

Triage is just… complicated. You can’t plan and staff accurately for random tragedy.

I'm sorry this happened to you. I don't know what happened, but good ER docs and nurses prioritize getting people out before they get people in. (No beds left = no new patients can be seen... not that hard of a concept!)

Sometimes things happen that we can't control, but I sure do get tired of ER docs/PAs/NPs overlooking common sense stuff like this. Especially since most good ER RNs would have bugged your provider multiple times to just get y'all the hell out of there!

The wait to get you out is, imo, purely due to understaffing.

I assume because DKA usually takes 24-72 hours to develop. So unless said diabetic waited the good majority of that time with their non-functioning pump before showing up at the ER, then that might be their assumption (though if a BGL wasn't done, that's a problem, but not of the triage system).

Also, ER isn't really the place to handle DKA, those patients will cycle quickly through the ER to endocrinology or the ICU. It won't be "give me some insulin manually so I can get on with my day".

As someone who has far more reason to interact with ERs than the normal person, if you have a problem that needs to be seen within the next week by a specialist and not just a GP, you have to go to the ER to actually get it addressed. Otherwise you won't be seen for months.