How to fix Maryland’s long emergency room wait times

Maryland has had the worst emergency room wait time among 50 states for the past eight years, according to data from the Centers for Medicare and Medicaid Services. While the average ER wait time in Maryland is over four hours, many patients who need emergency care may wait as long as 24 hours to receive care.

Long ER wait times are more than just an inconvenience; they measurably increase risk for patients, especially those who are elderly or vulnerable. Studies published by the British Medical Journal cited an increase in patient mortality of 12.7% for every additional hour spent waiting in the ER.

Patients are suffering life-threatening crises in the ER waiting room due to lack of timely care. The Baltimore Banner reported on a woman who miscarried on the floor of an ER wait room, bleeding and in acute pain, waiting four hours before receiving treatment.

Patients who need medical attention are leaving the ER without treatment, or they are afraid to go to the ER and face a long wait. And, some patients have given up on receiving emergency care in Maryland and are driving to neighboring states, such as Virginia, to get care.

Make no mistake, Maryland emergency patients are in crisis.  However, ER wait times could be reduced in the near term if we promptly address two major problems:

ERs are inadequately staffed

While a patient is spending long hours in the wait room, often an ER staff member will periodically announce: “I’m sorry for the wait, but we’re short-staffed.”

We need to right-size ER staffing, particularly nurses and technicians, to reflect the number of ER patients. It is very predictable that in the winter, the number of ER patients will rise when flu, COVID-19 and RSV — respiratory syncytial virus — are at their peak; clearly, more ER staff will be needed at that time.

Maryland is 36th out of 50 states in the number of nurses per 1,000 population, according to Becker Hospital Review. By my observations, and those of others, the current ratio of nurses to patients in the ER can be as low as 1 nurse to 15 patients. It should be closer to 1:4, which is the target in states like California with mandated nurse-patient ratios.

Short-staffing leads to burnout and retention problems: 39% of nurses who left the profession cited overwork and stress as the reason. According to the Becker Hospital Review, Maryland ranked only 45th out of 50 states for salaries of registered nurses, adjusted for cost of living.

Hospitals should recruit new ER medical staff by offering competitive salaries and livable wages, and support a work environment where workers are not under constant stress from short-staffing.

Chronic short-staffing is a fixable problem.

 Lack of hospital bed availability

Maryland ranks 46th out of 50 states in hospital bed availability. Patients are waiting to be admitted to the hospital from the ER, but there are not enough hospital beds. So, those patients are “boarded” in the ER, tying up resources for emergency patients and putting those waiting for hospital admission at risk. Limited bed availability results in slow throughput for hospital patients seeking care.

Maryland hospitals need more staffed beds.  For example, Montgomery County in Maryland and Fairfax County in Virginia are similar in population size, median household income, and number of hospitals.  A comparison revealed that Fairfax has almost 30% more staffed beds, normalized to population size, and a 106-minute shorter ER wait time.

Inadequate bed availability is a fixable problem.

Moreover, hospitals executives should be held accountable for their inability to provide emergency care to their communities. CEOs should not receive multimillion-dollar salaries and performance bonuses when the hospital is unable to provide high-quality emergency care. Those excessive salaries and bonuses could be repurposed to hire ER staff, including ER nurses, technicians, physicians, case managers and behavioral health specialists.

Other states are taking the initiative with new ideas. According to the Nurse Journal, nine states have current or pending legislation to mandate nurse-patient ratios. Nine states have laws or regulations in place for each hospital to have a safe staffing committee, with over 50% representation of frontline medical staff. Five states promote transparency by mandating publication of nurse-patient ratios by each hospital — important information for health care consumers.

For over eight long years, ER patients have suffered excessive and dangerously long wait times, increasing every year. We urgently need major improvements in two key areas, ER staffing and bed availability, to significantly reduce wait time in the near term.

There is a human cost to inaction.