Dangerous Increase in Emergency Department Waits

Researchers at the Cambridge Health Alliance at Harvard Medical School (CHA, Boston, MA, USA) analyzed the time between a patient's arrival in the emergency department (ED) and when a doctor first saw them. Using data from the U.S. National Center for Health Statistics (NCHS, Hyattsville, MD, USA), the authors analyzed over ninety thousand ED visits in the United States between 1997 and 2004.

The researchers found that during that time, ED waits increased 36% for all patients (from 22 minutes to 30 minutes, on average). However, for those whom a triage nurse classified as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Waits increased the most for emergency patients suffering heart attacks, who waited only 8 minutes in 1997, but 20 minutes in 2004, a 150% increase. In fact, 25% of heart attack victims in 2004 waited 50 minutes or more before seeing a doctor. While all demographic groups experienced lengthening ED waits, waits were slightly longer for blacks (13% longer than non-Hispanic whites) and Hispanics (14.5% longer). Women also had longer waits (5.6% longer than men), while rural hospitals' patients had the shortest waits. The study was published online on January 15, 2008, in the journal Health Affairs.

EDs close because, in our current payment system, emergency patients are money-losers for hospitals, said lead author Dr. Andrew Wilper, M.D. Our study suggests that these perverse incentives are causing dangerous delays in potentially life-saving emergency care.

The number of ED visits in the United States alone increased from 93.3 million in 1997 to 110.2 million in 2004. During that same time, the number of hospitals operating 24-hour EDs decreased by 12%.


Related Links:
Cambridge Health Alliance at Harvard Medical School