Missouri emergency departments face increasing wait times

COLUMBIA, Mo. (KMIZ)

The average time a Missouri resident spends in an emergency department from arriving to leaving is 2 hours and 35 minutes, ranking the state 29th in the longest average wait time.

Emergency department wait times have increased across the country and here in Missouri. According to the CDC, emergency departments in the Midwest in 2019 saw around 28,600 patients a year. That number jumped to around 33,500 patients per year in 2022 -- the middle of the COVID-19 pandemic.

The National Hospital Ambulatory Medical Care Survey defines an emergency department as a 27/7 facility that provides unscheduled outpatient services to patients whose condition requires immediate care.

It's difficult to nail down exactly how long a patient can expect to be in an emergency department, as multiple factors contribute to wait times.

"With most EDs [emergency departments], it kind of follows a bell curve of busyness, so usually in the mornings, if you come in at like 6 a.m., 7 a.m., there might be anywhere between a handful of patients to maybe 10 patients," said Boone Hospital Emergency Department manager Nick Woods. "But then, throughout the day, once you hit like 8 a.m., when people start waking up, getting to work, doing things, you really start seeing that increase in patients."

Most emergency departments are not first-come, first-served; they follow a national standard to triage, or assess. patients called the Emergency Severity Index. The index designates patients in one of five categories based on their symptoms.

ESI Index Level	Condition	Seen time	What could classify	No. of tests or procedures needed
Level 1	Resuscitation	Immediately life-saving intervention	No tests or procedures needed	Needs all resources available
Level 2	Emergency	High risk of becoming life-threatening	chest pain, stroke, fever in an infant, shortness of breath, major fracture/break	Needs all resources available
Level 3	Urgent	Non-life-threatening but requires care	abdominal pain, CT scan, swelling, persisting pain, blood test	Needs two or more resources
Level 4	Semi-urgent	Non-life-threatening, but requires resources	sprained ankle, small cut, simple fracture, UTI, eye irritation	Needs one resource
Level 5	Non-urgent	Non-life-threatening, could need resources	sore throat, cold, minor rash, earache	no tests or procedures needed

"Ones and twos are people who need beds right now," said Boone Hospital Emergency Department clinical educator Jesse Godec. "Those who need a multitude of resources are going to land in that ESI Three, that's our biggest number, these patients that need a few things, but they're not as sick as the ones and twos."

Godec says patients in category levels three, four and five are those who will wait to be seen longer because a nurse or provider has determined their symptoms are not life-threatening.

If a patient finds themselves needing care but it's not life-threatening or immediate, they can visit an urgent care clinic or their primary care provider.

"I think a lot of times, symptoms that go on for a period of time or more chronic stuff probably can be managed by your primary care or by an urgent care in those situations," said Godec.

Doctors say people should visit an urgent care for ailments like cuts or burns, minor allergic reactions, sprains, ear infections, sore throats, dehydration and minor eye and ear infections. However, those clinics can be limited by their resources.

"When they've reached the limit of what they can do, then they call us," said Godec. "Sometimes there are misperceptions about if their doctor told them to come, they get to go to the front of the line."

Health professionals say another way to get care without having to wait is to see your primary care provider for things like preventative care, vaccinations, long-term management of illnesses and mild illnesses.

However, a primary care provider shortage in Mid-Missouri forces some people to use the emergency department as their primary care.

"It is part of the problem with wait times in probably all emergency departments in the area, that they do get inundated with those, 'You don't really need to go to the emergency department, but I have nowhere else to go,' maybe they can't afford urgent care," said executive director of critical care and emergency services at Boone Health Matthew Nusbaum.

Tune in Wednesday on KMIZ 10 p.m. to watch the In-Depth report The ER Waiting Game.