Waiting at the ER: Altru reports longer than average waits, vows to do better

Federal reports state Grand Forks patients may have to wait longer than others in North Dakota before getting help in the emergency room, but local hospital officials say recent statistics show big improvements.

ER Wait graphic

Federal reports state Grand Forks patients may have to wait longer than others in North Dakota before getting help in the emergency room, but local hospital officials say recent statistics show big improvements.

About 200 Altru Health System patients found they had to wait an average 46 minutes before seeing a doctor, according to data supplied by hospitals nationwide to the Centers for Medicare and Medicaid Services. That's nearly twice as long as what CMS found the state and national average to be.

ProPublica, a nonprofit group involved in investigative news, recently released the statistics in the form of an online app that calculates the average wait time before being seen in emergency rooms. This information does not apply to emergency room visits for serious health problems such as heart attacks or serious injuries, said the organization.

According to the North Dakota Hospital Association, state hospitals aren't required to track that information and no state regulation mandating a specific time for care exists.

Renee Axtman, administrative director of primary care at Altru, said the wait time has reduced in recent months and the goal is to keep it under 30 minutes. In the past year, they've been trying to reduce the wait time and communicate with patients more frequently, she said.


"The emergency room is many times a front door to health care," she said. "We know it's an area that many people had struggled with and we want to make it a better one."

In Fargo, the average wait time for patients before seeing a doctor at Sanford Medical Center is 25 minutes, according to CMS. Emily Bormann, hospital spokeswoman, said last month the average time was 12 minutes.

Wait time varies

ProPublica's news app, called ER Wait Watcher, compares hospitals nationwide on their response time for care. Most of the CMS information for Altru was drawn from April 2012 to March 2013.

For North Dakota, data was available for about a fourth of hospitals listed in the state, including Williston, Devils Lake and Bismarck. Valley City had the lowest average wait time of six minutes before seeing a doctor while Williston had the second highest wait time of 44 minutes.

ProPublica's app includes averages on how long patients have to wait in the emergency room before seeing a doctor, before getting sent home, given pain medication for a broken bone or being admitted to the hospital.

According to CMS, Altru patients waited longer than the state average for all of these services. For instance, it states that someone with broken bones must wait an average 92 minutes before receiving pain medication. This was based on the experience of 122 people.

Altru records from July to September of 2013 show the wait time was an average 74 minutes, hospital officials said.


Axtman said in recent months, people have waited an average of 25 minutes before seeing a doctor. Over a two-day period last week, patients were seen in 17 minutes or less, she said.

"That's when everything's working well, and you have beds that you can admit patients into, and you don't have a high number of trauma patients," she said. "Our goal is the minute we walk in, we take you right back there.

Hospital officials said wait times generally fluctuate based on volume of patients, type of trauma, availability of beds and setting up equipment.

Although people sometimes ask why they can't be seen immediately, hospital staff can't always have everything ready and in place, said Chris Boe, chairman of Altru's department of emergency medicine.

"You can't send somebody to a room where there's not people to take care of them," he said. "Sometimes, we have to get them undressed and certain medications have to be given. There are some things that really need to be done and that takes a couple of minutes. But our goal is to do it extremely quickly."

Staffing challenges

Altru officials say about 62 people staff the emergency room, which sees an average of 81 patients per day.

With 11 physicians on staff and two on call, hospital officials said they feel they're meeting the needs of patients but could always use one more. However, with the increased number of emergency visits nationwide and a decade-or-longer trend of fewer doctors trained for this kind of care, recruiting physicians has been hard, said Boe.


"I believe that's changing now, but it was on hold," he said. "The point is, there will be more in the pipeline going forward, and that will provide some help."

Enticing board-certified physicians to live in Grand Forks rather than a metropolitan city is tough, too, especially as Altru wants physicians who will be committed to the community, he said.

"It's different when you run into a doctor at Hugo's and see him in the stores, and he's taking care of your friends and parents and kids," he said. "It's a tremendous responsibility. We're not just trying to get anyone."


Patient surveys have prompted Altru in the past year to try to shorten time spent in the emergency room by improving some of their processes, officials said.

Access to available hospital beds also saves time. As about 28 percent of emergency room patients need to be admitted to the hospital, transferring patients quickly to beds has also been a goal, hospital officials said.

Right now, Altru is converting double-bed units into single ones and anticipates gaining 65 new rooms by May, officials said. This will offer more privacy and resolve complications that arise from shared rooms, such as trying to pair the same genders together, they said.



Patients also have some alternatives for faster care.

Altru has a pediatric early-morning clinic, a family practice walk-in clinic and an evening walk-in clinic, hospital staff said. Most of the time, people can get a same-day appointment to see a family physician.

"We know our patients need us at different times of the day, and we work hard to increase our access," said Axtman.

She said the hospital system wants to make sure patients have a good experience and have access to care. They're also making an effort to more frequently communicate to patients the reason they might be waiting.

"We just need to keep them informed," she said. "If there's a trauma that comes in, the bad part is that people who aren't critical have to wait. But we do need to talk to them more to keep them comfortable."

On the web: To read ProPublica's report and access ER Wait Watcher, visit

Call Johnson at (701) 787-6736, (800) 477-6572 ext. 1736 or send e-mail to .

What To Read Next
Get Local