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In 2022, Ballad reported a median ER time for admitted patients of about six hours. In 2023, it reported the same statistic at seven hours and 40 minutes. In

In 2022, Ballad reported a median ER time for admitted patients of about six hours. In 2023, it reported the same statistic at seven hours and 40 minutes. In the latest report, ER time for admitted patients had reached 10 hours and 45 minutes.

onlyrealcuzzo 3y ago
I imagine ER admission times were steadily increasing prior to the monopoly. How did the rate of increase change?
- choilive 3y ago
  In addition, depending on how you model ER admissions using queueing theory - the wait times very quickly goes exponential with even relatively small changes.
- destroy-2A 3y ago
  I imagine all the signs about don’t abuse the staff and incidents of abuse against hospital workers went up at the same rate as the wait times. Abusing the staff is wrong but you have people that have come there because they think they are about to die without attention, they really don’t have a choice
- roenxi 3y ago
  The fact that this is even a point of investigation is very frustrating. Wait times at local restaurants in my area are basically constant and will remain so, because if there is an observable queue, someone opens a new restaurant or an existing one puts on more staff and finds space for more tables. If people were permitted pay directly for emergency visits, and new hospitals allowed to open then it would be ridiculous for there to be a general problem with trending wait times. Someone would add more emergency capacity somehow. That isn't even in conflict with keeping a public system either, there can still be a public system. Just let people who can afford their own emergency care fund their won care. The problem here is precisely that deliberative bodies trying to work out how much emergency care is required instead of creating an easily-joinable class of people who benefit financially from providing care and leaving decisions up to them. That works well for almost literally every service out there and there is no reason to think it would fail for emergency healthcare. These people attending clearly have hours to shop around.
- hedora 3y ago
  The article is hazy on this point, but the monopoly agreement set an slo of 220 minutes (3 hours 40 minutes), and it was fairly stable, but worsening by tens of minutes per year. Since then, the hospital in question increased to 10 hours 45 minutes. Worse, the federal government stopped tracking this metric, and now, among hospitals that elected to share the number, the median is over 5 hours. So, if you live in the US, you’re probably screwed, regardless of whether you live in appalachia.
  - deleted 3y ago
    [deleted]
antisthenes 3y ago
I'm not sure why at that point it's even considered an ER visit. Clearly if you can wait 10 hours for something, it wasn't an actual emergency. Are hospitals just gambling that these people won't die in the waiting room? What's actually going on? Is there a perverse financial incentive to drag it out?
- ahupp 3y ago
  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.
  - tomxor 3y ago
    > 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.
    - wizerdrobe 3y ago
      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.
      - SamoyedFurFluff 3y ago
_heimdall 3y ago
That's completely ridiculous. The bar is pretty high for me to go to an ER, I'm pretty sure anything on that list would need treatment faster than 6-10 hours. Hell, its not recommended to keep a tourniquet applied for more than two hours and even then there's a specific protocol to follow as there's risk of what will be released back into your system. What are people even going to the ER for when they can wait for 10 hours?
- tibbydudeza 3y ago
  No medical insurance ???.
  - _heimdall 3y ago
    That's a very different discussion. Personally, I think its bullshit if ERs are stuck with 6+ hours wait primarily with non-emergencies only there because they don't have insurance and want free care. Don't get me wrong, its bullshit both because they're clogging up the ER resources and because they're in a position where they may be unable to get or afford insurance. Its also bullshit that insurance is effectively a must-have today. The whole system is very, very broken.
- hundreddaysoff 3y ago
  I'm an ER doc. I work 3 nights a week and see probably 5--10 patients a week who have waited over 3 hours. The basic answer: most people don't go to the ER for emergencies. That is, they go for something like a rash, cough, or fatigue that they know is not an emergency. Many of them just want work notes, although some are convinced they have a legit emergency. We scoop up the real emergencies from the waiting room ASAP. Eg, no one in the waiting room is wearing a tourniquet; if they are, it's my job to either fix the bleed or get them to a vascular surgeon ASAP if I can't. The majority of people who spend hours in the ER waiting room have vastly higher time preference than your or I, and often lower socioeconomic status and higher anxiety as well. Often they can't afford phone service or even a car, so it's hard for them to get places quickly. Others are homeless and want a place to sleep or very anxious and just want to be somewhere with other people in the middle of the night.
orochimaaru 3y ago
This probably correlates to economic conditions of the region, which is most likely the reason for the monopoly hospital system as well.
- ajkjk 3y ago
  How could you possibly know that.

onlyrealcuzzo 3y ago

I imagine ER admission times were steadily increasing prior to the monopoly. How did the rate of increase change?

choilive 3y ago
In addition, depending on how you model ER admissions using queueing theory - the wait times very quickly goes exponential with even relatively small changes.
destroy-2A 3y ago
I imagine all the signs about don’t abuse the staff and incidents of abuse against hospital workers went up at the same rate as the wait times. Abusing the staff is wrong but you have people that have come there because they think they are about to die without attention, they really don’t have a choice
roenxi 3y ago
The fact that this is even a point of investigation is very frustrating. Wait times at local restaurants in my area are basically constant and will remain so, because if there is an observable queue, someone opens a new restaurant or an existing one puts on more staff and finds space for more tables. If people were permitted pay directly for emergency visits, and new hospitals allowed to open then it would be ridiculous for there to be a general problem with trending wait times. Someone would add more emergency capacity somehow. That isn't even in conflict with keeping a public system either, there can still be a public system. Just let people who can afford their own emergency care fund their won care. The problem here is precisely that deliberative bodies trying to work out how much emergency care is required instead of creating an easily-joinable class of people who benefit financially from providing care and leaving decisions up to them. That works well for almost literally every service out there and there is no reason to think it would fail for emergency healthcare. These people attending clearly have hours to shop around.
hedora 3y ago
The article is hazy on this point, but the monopoly agreement set an slo of 220 minutes (3 hours 40 minutes), and it was fairly stable, but worsening by tens of minutes per year. Since then, the hospital in question increased to 10 hours 45 minutes. Worse, the federal government stopped tracking this metric, and now, among hospitals that elected to share the number, the median is over 5 hours. So, if you live in the US, you’re probably screwed, regardless of whether you live in appalachia.
- deleted 3y ago
  [deleted]

antisthenes 3y ago

I'm not sure why at that point it's even considered an ER visit. Clearly if you can wait 10 hours for something, it wasn't an actual emergency. Are hospitals just gambling that these people won't die in the waiting room? What's actually going on? Is there a perverse financial incentive to drag it out?

ahupp 3y ago
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.
- tomxor 3y ago
  > 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.
  - wizerdrobe 3y ago
    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.
    - SamoyedFurFluff 3y ago

_heimdall 3y ago

That's completely ridiculous. The bar is pretty high for me to go to an ER, I'm pretty sure anything on that list would need treatment faster than 6-10 hours. Hell, its not recommended to keep a tourniquet applied for more than two hours and even then there's a specific protocol to follow as there's risk of what will be released back into your system. What are people even going to the ER for when they can wait for 10 hours?

tibbydudeza 3y ago
No medical insurance ???.
- _heimdall 3y ago
  That's a very different discussion. Personally, I think its bullshit if ERs are stuck with 6+ hours wait primarily with non-emergencies only there because they don't have insurance and want free care. Don't get me wrong, its bullshit both because they're clogging up the ER resources and because they're in a position where they may be unable to get or afford insurance. Its also bullshit that insurance is effectively a must-have today. The whole system is very, very broken.
hundreddaysoff 3y ago
I'm an ER doc. I work 3 nights a week and see probably 5--10 patients a week who have waited over 3 hours. The basic answer: most people don't go to the ER for emergencies. That is, they go for something like a rash, cough, or fatigue that they know is not an emergency. Many of them just want work notes, although some are convinced they have a legit emergency. We scoop up the real emergencies from the waiting room ASAP. Eg, no one in the waiting room is wearing a tourniquet; if they are, it's my job to either fix the bleed or get them to a vascular surgeon ASAP if I can't. The majority of people who spend hours in the ER waiting room have vastly higher time preference than your or I, and often lower socioeconomic status and higher anxiety as well. Often they can't afford phone service or even a car, so it's hard for them to get places quickly. Others are homeless and want a place to sleep or very anxious and just want to be somewhere with other people in the middle of the night.

orochimaaru 3y ago

This probably correlates to economic conditions of the region, which is most likely the reason for the monopoly hospital system as well.

ajkjk 3y ago
How could you possibly know that.