"Our ED has 70+ beds, which we can flex up to even around 100 by putting patients in hall beds. At times we may at worst have 60+ patients waiting for inpatient beds. There are times when we will then have 50-60 patients waiting for ED beds. We try as we might see these patients in triage rooms, attempt to cobble together work-ups and try to reassess them as much as possible. Ultimately many people leave without making it to an ED bed.
It's dangerous, scary, and impossible to practice appropriate medicine.
Many have their entire ED stay completed in the waiting room. Those waiting the longest, sometimes eight, nine, ten hours, generally are so sick they know they can't leave to go elsewhere...finally when they reach a bed, they have already been admitted for a few hours, only to begin a wait for an inpatient bed. It's dangerous, scary, and impossible to practice appropriate medicine. You just go by level of acuity and length of stay and try to find the needle in the haystack that is critically ill and needs intervention as soon as possible."