Eight-hour waiting times. Patients leaving before being seen. Mass. hospital emergency departments are beyond the brink.


Cook’s recent experience at Mass General is not isolated. While hospital emergency departments across Massachusetts have dealt with surges in sick patients throughout the pandemic and in years past, doctors say what they’re seeing now is unprecedented. Staffing shortages are at an all-time high — about 19,000 positions are unfilled, according to a report released earlier this week by the Massachusetts Health and Hospital Association — and ERs are continuing to see a the flood of desperately ill patients who delayed care during the pandemic. An early start to the flu and respiratory virus season, and a steady stream of hospitalizations for COVID-19, has further strained the system.

Not only have wait times for patients increased, but doctors are citing an even more alarming statistic: a growing wave of ER patients giving up and leaving before ever seeing a doctor. A recent national study found that the rate at which people leave hospital waiting rooms before receiving care nearly doubled from 1 to about 2 percent between 2017 and the end of 2021, putting yourself at risk for an even more serious illness.

To better understand the toll of overcrowded ERs, the Globe asked readers to share their recent experiences. Some spoke of waiting for hours in pain. A recently retired doctor suffered a stroke in September and had to wait 20 hours in the emergency department before a bed opened up. She spent most of her time on a needle, just feet from a row of patients with antibiotic-resistant infections.

Several people who sought treatment at other hospitals described hearing intimate details of other patients’ medical histories and symptoms while exhausted doctors and nurses tried to handle people in crowded waiting rooms.

“Most caregivers say this is the worst they’ve ever seen,” said Steve Walsh, president of the Massachusetts Health and Hospital Association. “There is great concern about the fragility of the system.”

Dr. Alexander Janke, an emergency medicine physician at the VA Ann Arbor/University of Michigan Health Care System, has studied hospital overcrowding across the country and said it’s as if the levers have been broken in the nation’s health care system.

“It is not that we are on the verge. It’s like we’ve crossed the threshold,” he said.

Janke and colleagues studied emergency department overcrowding — keeping patients admitted to the ER, often in hallways, while waiting for a bed to be made — nationwide between January 2020 and December 2021.

They found that when a hospital was more than 85 percent full, emergency department boarding times often exceeded the national standard of four hours. (Across Massachusetts, hospital beds are 94 percent occupied, according to the most recent state data.)

Health experts say boarding longer than four hours creates patient safety concerns, such as a higher risk of medical errors. as overworked doctors and nurses rush among patients to provide care.

The researchers also found that when hospital occupancy exceeded that 85 percent, the average boarding time was 6.58 hours, compared to 2.42 hours otherwise.

While emergency departments have periodically struggled over the years with overcrowding, the crisis is now far beyond that, Janke said. And the situation continues to decline.

“It’s unprecedented in my career,” said Dr. Michael VanRooyen, chief of emergency medicine at Mass General Brigham, who has worked in emergency medicine for 30 years.

Hospitals can’t free up enough beds in emergency departments because many of the places where patients are discharged, such as nursing homes, are also overwhelmed.

Janke puts it this way: “All of us are at risk of being in a serious car accident and you want the system to be ready for you. And it’s not ready for you now.”

Janke and his colleagues also found that among the worst-performing hospitals, roughly 10 percent of ER patients left before a medical evaluation in late 2021, compared with 4.3 percent in early 2017.

At Mass. General Brigham, the state’s largest health system, an average of 6 percent of patients seeking emergency care from July to October left without being seen — three times higher than a level that used to set off alarms.

“We’ve never seen averages, at this rate, of 6 percent,” VanRooyen said, adding that he has seen peaks above 10 percent during that time period.

VanRooyen is concerned because, he said, people who drop out before getting care aren’t necessarily dropping out because they’re less sick.

“There’s been pretty good evidence that people who leave without being seen are just as sick as those who come into hospital.”

Other health care systems in Massachusetts declined to share data on the percentage of their patients who left before being seen.

Yolette, a Randolph mother, said she saw patients keep coming out of the emergency department waiting room in mid-September when she took her teenage son to South Shore Hospital because he was having trouble breathing. She asked that her last name not be used to protect her family’s privacy.

“It was so packed, and people kept coming in, and this head nurse was making announcements, saying it’s going to be eight hours until you’re seen,” Yolette said. “And every time she made that announcement, people would get up and leave.”

She said they waited about three hours before her son was finally treated with oxygen, steroids and intravenous fluids. He has since recovered.

Yolette was concerned about the delayed care, but she said what prompted her to write a scathing letter to the hospital were patient privacy concerns. During her hours-long wait, she said she overheard intimate details about other patients’ symptoms and test results as doctors were forced to handle so much in the waiting room.

In a statement, South Shore Hospital said the “extremely high” emergency department volumes they and many other health systems face are challenging.

“While we respect privacy at all times, we are also mindful of the importance of initiating care as soon as possible during a patient’s visit, and this may include the need to communicate with a patient and/or a patient’s family.” patient in a lobby or waiting area,” it said.

Baker administration on Tuesday raised the alert level it uses to track the number of staffed hospital beds available, marking an important signal to hospitals that overcrowding was worsening. The action calls for weekly regional meetings of hospital leaders to devise ways to address overcrowding and also consider voluntarily reducing elective, non-emergency procedures and surgeries.

But with no immediate relief in sight, VanRooyen said more patients may spend their entire time in the emergency department being treated in a hospital hallway, or drawing blood and starting IV fluids in a waiting area chair.

The hope is that these “insane shelters” could prevent VanRooyen’s worst nightmare: someone in desperate need of emergency care from walking away and deteriorating.

“There is a very real risk,” he said, “of missing a surgical case, a cardiac problem, a heart attack.”

Jessica Bartlett of the Globe staff contributed to this story.

Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.


Leave a comment

Your email address will not be published. Required fields are marked *