I work in the busiest ER in my entire home state. We're inner city and we see everyone for everything. Our wait times can be long, but we are constantly striving to shorten them. We have NO incentive to lengthen them, as the article suggests. We see a huge portion of uninsured and public aid patients. Patient through-put is our goal. As far as ER boarding, we have to hold patients in our ER usually for two reasons: 1) our county psychiatric hospital is also unbelievably overburdened, and there is no bed for a patient who needs transfer there (they have tried to alleviate this by using mobile teams to come out and assess our psych patients while they are in the ER if there is no bed for them at the time) and 2) we have no beds available in the hospital and the patient cannot be transferred to another facility for one reason or another.

One of the reasons our wait times can be long at times is simply our volume of patients coming through the door. We see 80,000 per year. Many of our patients are extremely complicated and very sick; many of our patients are not sick and are coming in for primary care complaints: STD screening, faking complaints in order to get pregnancy tests, being seen just because they happen to be there with a friend or a family member, want a day off work, want narcotics, want to use our phone, want to get a refill on their medications, or even have appointments with their doctors (sometimes even later the same day!) but come in because they (think) they can be seen faster in the ER. I can't even tell you how many times a shift I hear, "I don't have insurance so that's why I came here...." (for a pregnancy test, to evaluate a mole, for an uncomplicated mosquito bite, etc.)

So, you may think, shouldn't we build a bigger ER and hire more people? The real truth is money, but not for the reasons the article suggests. We make basically nothing on our self-pay patients. We get a pittance of payment for our state aid patients. We simply don't have many private insured patients. So, our ER operates at a loss every year. By millions. We move patients through as fast as we can, but with so many people turning to ER's for their primary care issues, we can hardly keep up with the demand for care.

The problem is in handling the huge percentage of uninsured and underinsured patients in this nation. Something our government talks about come every election but has failed to initiate real change and reform to address this problem.

Hospitals and certainly not health care providers benefit not at all by suuposedly "ER boarding" patients. We are simply drowning in volume of patients who receive "free" care - free to them, but at a huge cost to government aid programs and hospital systems.

She's exactly right; your article's authors know jack about this problem.

MamaM, you are ABSOLUTELY right! Good job!

The authors of the article, Waiting Doom, How Hospitals are killing E.R. patients. Zachary F. Meisel and Jesse M. Pines, are WAY OFF!!! I can't believe they actually were paid for this!

One point that needs to be made is all these non-emergent patients are not the focus of the article. They are addressing "Boarding Patients" ie. patients who were in fact sick enough to require admission to the hospital. Earache and drug seekers are by and large NOT boarding. They are treated and discharged albeit 20 hours later. A major problem simply is lack of in-patient beds. Our population is aging as the baby boomer's reach retirement age and begin to suffer all those serious problems associated with advancing age. We are not building new hospitals or increasing available beds in existing hospitals. There are many reasons for that, reimbursement being a huge one, however its simplistic to blame the silly notion of insured patient getting priority over unfunded patients.