Emergency Department Wait Times Increased By 36% From 1997 To 2004, Study Finds

Main Category: Public Health
Article Date: 16 Jan 2008 - 7:00 PDT

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Wait times for emergency care across the U.S. increased from 1997 to 2004, especially for heart attack patients, according to a study published online on Tuesday in the journal Health Affairs, USA Today reports (Davis, USA Today, 1/15). For the study, lead author Andrew Wilper, a fellow in internal medicine at Harvard Medical School and a physician at Cambridge Health Alliance, and colleagues used patient visit and wait time data collected between 1997 and 2000 and between 2003 and 2004 from the National Hospital Ambulatory Medical Care Survey (Lee, Washington Post, 1/15). The researchers analyzed data on more than 90,000 emergency department visits.

According to the study, the number of ED visits increased during the study period from 93.4 million to 110.2 million, and 12% of 24-hour EDs closed during the study period (USA Today, 1/15).

The study found that:

• The median wait time before seeing a physician for all ED patients was 30 minutes in 2004, a 36% increase from 22 minutes in 1997;
  
  
• Patients whose condition merited treatment within 15 minutes waited 14 minutes or more in 2004, compared with 10 minutes in 1997;
  
  
• The median wait time for heart attack patients was 20 minutes in 2004, up from eight minutes in 1997 (Washington Post, 1/15);
  
  
• About 25% of heart attack patients in 2004 waited 50 minutes or more for emergency care;
  
  
• Women waited 5.6% longer than men for treatment (USA Today, 1/15);
  
  
• Urban hospitals' wait times were twice as long as those in rural hospitals;
  
  
• Not-for-profit hospitals had wait times 13% longer than private hospitals; and
  
  
• The Northeast had the longest wait times of any region in the U.S. (Francis, Wall Street Journal, 1/15).
  

The authors did not determine the cause of the wait time increases (USA Today, 1/15). Wilper said that it is unclear why heart attack patients saw higher increases (Wall Street Journal, 1/15).

Disparities
The study also found disparities in wait times between whites and racial and ethnic minorities. Black patients waited 13% longer than non-Hispanic whites. In addition, Hispanics waited 14.5% longer than whites (USA Today, 1/15). The disparities remained even when researchers adjusted for age and hospital location. Wilper said that the disparity might be caused by "little decisions along the way" by ED staff. He also said that hospitals that serve minority patients might have longer wait times in general (Wall Street Journal, 1/15). According to researchers, minority patients often are treated in urban hospitals, which are more likely to be overcrowded than rural hospitals (Washington Post, 1/15).

Comments
Wilper said, "Patients who present to the emergency room with time-sensitive conditions may be harmed because they're not receiving the care they need in a timely way" (Grant, Houston Chronicle, 1/15). He added, "That means sometimes patients are undoubtedly leaving without seeing a doctor or are discouraged from even coming to the emergency room in the first place."

Matt Rice, a member of the board of directors of the National Patient Safety Foundation, said, "The reality of the emergency department these days is there is more demand than there are resources," adding, "It's a complex problem that doesn't have an easy solution but needs to be addressed."

American College of Emergency Physicians President Linda Lawrence said, "This study supports the findings of the daily experiences of emergency physicians. The number of emergency patients is increasing while the number of hospital beds continues to drop. It is a recipe for disaster." Lawrence added, "National health care reform must strengthen the nation's emergency departments and provide additional resources for hospital emergency departments" (Lopes, Washington Times, 1/15).

An abstract of the study is available online.

NPR's "Morning Edition" on Tuesday reported on the study. The segment includes comments from Art Kellerman, a professor of emergency medicine at the Emory University School of Medicine, and Wilper (Silberner, "Morning Edition," NPR, 1/15). Audio of the segment is available online.

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