Emergency room doctors are inclined to see you quickly if you have a simple problem such as an ankle injury or allergic reaction, but they may take longer if you have a complex complaint like numbness or vaginal bleeding, a study at UW Hospital’s ER found.
Residents, or doctors in training, typically take on straightforward cases about four minutes after patients are assigned rooms but wait eight to 11 minutes to pick up cases that are considered more challenging to evaluate and treat, according to the study by UW-Madison researchers.
Even when the severity of the patient’s complaint and the level of crowdedness of the ER were taken into account, a two-fold difference in pickup time remained between easier and more difficult cases.
Residents might be choosing cases they think they can handle quickly, trying to avoid uncomfortable interactions with patients or attempting to treat the most patients overall, the researchers said.
“Perhaps the residents are looking toward having a more efficient day, where they see more patients, if they see some of these patients that they can have a quick disposition on,” said Dr. Brian Patterson, an assistant professor of emergency medicine at UW-Madison and lead author of the study, published online in February in the journal Academic Emergency Medicine.
“Or, are they looking for things they’re better trained in and more comfortable taking care of?” Patterson asked.
The study, part of an effort to improve quality and efficiency in ERs nationwide, is believed to be the first to examine ER pickup time and doctor preference.
It excluded trauma and critically ill patients, who generally are treated immediately.
Patterson said the findings may mean training should be modified to make residents more comfortable with cases they don’t claim quickly. But it’s possible that handling simpler cases first is the most efficient approach, he said.
The pickup time differences have little or no impact on patients’ medical outcomes, the researchers said. Pickup time is a small portion of an overall ER visit, which includes sitting in the waiting room, nurse triage, treatment and discharge or admission to the hospital — a process that typically takes several hours.
“We wouldn’t argue at all that this has a medical or clinical impact,” said Robert Batt, an assistant professor in the UW-Madison School of Business who also worked on the study.
The researchers analyzed about 70 categories of chief complaints made by more than 30,000 patients at UW Hospital’s ER from August 2012 to July 2013. The median time between a patient’s room assignment and a resident accepting the case was six minutes.
For allergic reactions and ankle or wrist injuries, complaints considered relatively easy to treat, the median pickup time was four minutes.
Complaints associated with extensive evaluations had longer median pickup times: eight minutes for abdominal problems, 10 minutes for numbness/tingling and 11 minutes for vaginal bleeding.
When patients initially are evaluated by nurses, they are given severity scores of one to five, with one most severe. Doctors generally see patients with the most severe problems first, regardless of the type of complaint.
But even when the study controlled for severity and other factors, the pickup time for the more challenging complaints was eight to nine minutes compared to four to five minutes for simpler cases.