Yeah, our ER is already waayy beyond capacity. The whole hospital, in fact, but especially the ER. We need about 50% more beds and twice as much staff on any given day to actually treat all of the patients we're getting these days. Doctors who have privledges here at some point come to the ER to admit patients, so I assume they know this, unless they're just really dumb or think that we set up all these hall beds because we don't feel like cleaning rooms or some shit. So why do they routinely send their patients up here with the big fat lie "they'll have a room waiting for you" when anyone with half a brain knows that we don't have the luxury of saving a room for anything save a STEMI, acute stroke, or CPR? Really?
It's a sad state of affairs, but the fact is that if you are well enough to call your doctor's office and ask what to do and then drive yourself or have someone else drive you by private vehicle to the ER, you're going to spend some time in the waiting room. We're not doing it to disappoint you, or to be dicks, but when other people are coming in dying or have been waiting for 5 hours to be seen for the exact same complaint you have, we can't just give you their bed because your doctor said we would. We don't work for your doctor and he/she hasn't been up here triaging all these other patients and as a result, has no frame of reference.
It sucks, because these people are really just being good patients and doing what their doctors tell them to do, yet we seriously cannot accommodate them and it reflects poorly on us. I used to kind of try to cover these guys assess, but at some point I just started being real with people. Not like "your doctor was bullshitting you and he's a dick", but I just say something like "Unfortunately, unless the doctor goes through the process of getting you admitted directly, a bed can't be guaranteed. With how unpredictable it is down here it's impossible to save a bed in the ER, I'm sorry."
The waits have gotten progressively worse over the last 3 years, and recently people have started calling the doctor's offices back like "WTF dude", which then leads to the doctors calling up the charge nurses and bitching them out over the phone. Now the other stuff could definitely be lost in translation between doctor and patient (although it'd be shocking if it went down that way every time with as often as it happens), but that shit is just ridiculous.
Look here, D-bags. If you really are concerned about your patients, get your shit together and take the necessary steps to direct admit them. If that isn't possible, meet them here and write their damn orders in the lobby if you have to, if it's such a fucking emergency. If it's not, then send them down to the ER with some reasonable expectations like yeah, I think you should be at the hospital for this and your only option right now is to go to the ER, it may take a little bit but I'll let the staff there know why I'm concerned. Really, that's all we ask. But if you can't tear yourself away from you dinner/golf game/re-runs of the Big Bang Theory long enough to come demand a bed and deal with your emergent patient that came in via private vehicle in person, that don't call and scream at us when we can't stop and rearrange the whole ER for them. Freaking primadonas.