Megan Ranney: ‘Political will’ is needed to avoid ER disaster as crowding, wait times spiral

Each week, Dr. Megan Ranney fields a handful of calls from family and friends who are looking for emergency care, but finding only frustration and delays. 

In today’s health care system, those complaints have grown increasingly common, according to Ranney, a practicing emergency room physician and academic dean at the Brown University School of Public Health.

The system, she said, “is crumbling at our feet.” 

Breaking point

Last January, at the height of an omicron surge that flooded hospitals with COVID-19 patients, Ranney sounded the alarm in a piece for The Washington Post, likening the emergency department to a disaster zone.

COVID-19 cases have since fallen, but as respiratory virus season, deferred health care, and staffing shortages converge, “emergency departments are at a breaking point,” she said.

“COVID is part of it, flu is part of it, RSV is part of it, but it’s not just because of the pandemic,” she continued. “The system has just reached a breaking point, in a way that in some ways feels reminiscent of last winter, but is worse.”

Across the Northeast, according to Ranney, emergency departments are facing unprecedented numbers of boarding patients — those who require an inpatient bed and spend hours or even days waiting in the ER for one to become available.

The result? Crowded waiting rooms and gridlocked ERs. 

If paying a visit to the emergency room, “expect that you are going to have to wait, unless you are suffering from a gunshot wound or a heart attack — and even then, actually, you may have to wait because there are simply not enough staffed beds available,” Ranney said. 

Some factors driving up crowding include bed closures across the health care system, as well as systemwide staffing shortages — a self-perpetuating problem, as remaining providers are quickly driven to the point of burnout, she explained. 

According to Massachusetts Department of Public health data, 94% of the state’s medical-surgical beds and 85% of its ICU beds were occupied as of Nov. 8, the most recent data available.

Righting the ship

If current trends persist, Ranney predicted that emergency room wait times will worsen. 

“And we know that, actually, quality of care for patients — not just in the ER, but also in the hospital — is worse when there is high boarding in an emergency department,” Ranney added.

She also worries that the U.S. could end up with the sort of two-tiered health care system found in some countries abroad, where public hospitals have “abysmal” wait times, but VIPs can pay out of pocket to get quicker private care. 

“We have to do everything that we can to open up beds in the hospital and in nursing homes,” Ranney said. 

That includes training and supporting nurses, certified nursing assistants, and techs; exploring alternative ways to connect patients with care — tele-triage, for example; and addressing behavioral health needs starting at the community level, according to Ranney. 

She said these fixes will take “political will,” not only from politicians on the state and federal levels, but also from departments of public health, insurance companies, nursing unions, and physician groups, among other stakeholders.

The American College of Emergency Physicians outlined a similar request in a Nov. 7 letter to President Joe Biden, co-signed by dozens of other provider organizations.

The group urged Biden to convene a summit of stakeholders from across the health care system to identify immediate and long-term solutions for the boarding crisis. 

“That would be a great step, if it is followed up with action,” Ranney said of the proposal.

Despite current challenges, patients should still seek emergency care when they need it, she urged. 

“Certainly, if you are having what you worry may be an emergency, call your primary care provider if you can, but otherwise come and get emergency care; that is what we are there for,” Ranney said.