Why build waiting rooms? For patients or providers?

Every emergency department has a waiting room that probably gets used more than any other room in the ED.

Did a patient group meet and declare they wanted waiting rooms?

Of course not.  Patients come to the ED to get help; not sit in a waiting room.

“Well, patients need to be able to wait somewhere before they get inside the ED.”


Why can’t we bring all the patients straight inside the ED?


Only someone painfully unaware of modern ED struggles could ask such a silly question.

“We don’t bring patients inside the ED because we don’t have enough resources to care for them.”

It’s all about stretchers and ratios.  We decide the ED is full when all our stretchers are full.  We decide the number of stretchers by how many nurses we have working based on a ratio of 4 stretchers to 1 nurse.

Stretchers and ratios keep everything neat and orderly inside the ED.

So, to maintain order inside the ED, we build waiting rooms to house all the patients that we don’t feel ready or able to help.  No matter how many patients pile up in the waiting room, we stick to our stretchers and ratios.

Providers want waiting rooms; waiting rooms benefit providers not patients.  Patients want to come straight inside the ED.

Why don’t we bring all patients inside?  What could be worse for patients than leaving them for hours in the waiting room?


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Waiting harms patients – A novel idea?

A room full of unbelieving faces stared back at me.  I had just finished presenting a brief review of the negative clinical impacts of patient waiting.

They didn’t buy it.  My medical colleagues flatly rejected overwhelming evidence.


It’s been said that every idea must pass through 4 stages:

 1. Critics scoff at your new idea because it’s novel and lacks supporting data.

2. After gathering data, critics say it lacks significance or is biased.

3. Eventually, your idea catches public interest.  It gains popular support.

4. Finally, everyone accepts your idea, and the critics tell how your idea was theirs from the start.


Despite hundreds of papers clearly demonstrating harm for patients due to waiting, we will never see improvement without popular support.

We need to engage the public – educate them – on the risks to their health when they wait in crowded emergency departments.  We need hospital leaders and governments to understand that waiting harms patients.

We need to challenge our cherished clinical processes that have been designed to benefit providers, but actually add harmful waiting to patients’ experiences.

We need to share solutions – brave innovations – that strip all the useless, harmful waiting out of our patients’ time in our institutions.

At which stage are you in realizing that waiting harms patients? What needs to be done to recruit you, and others, as champions to help STOP Patient Waiting?


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