25% of heart attack patients have to wait at least 50 minutes before they are seen by a doctor in American emergency rooms (ERs), says a report by the Harvard Medical School. The average wait for a heart attack patient in an ER in 2004 was 20 minutes compared to 8 minutes in 1997 – an increase of 150%. In general, Americans in 2004 had 36% longer ER waits in 2004 compared to 1997. A patient who was seen by a triage nurse and had been classed as one who needed immediate attention had a 40% longer wait in 2004 compared to 1997 (from 10 minutes to 14 minutes).

You can read this report in the medical journal Health Affairs.

Study author, Dr. Andrew Wilper, Harvard Medical School, explains that these longer waits are not surprising as there were more emergency room visits in 2004 while at the same time many emergency rooms closed their doors. Add to this the increasing lack of inpatient bed space and a shortage of specialists available to treat patients and you have an range of factors contributing to bottlenecks. If an ER patient is still in the ER a few hours coming in it can mean that that room, that nurse and that equipment are not available for the next ER patients who has just come in.

In this study the researchers looked at data from for the period 1997-2004, involving 92,173 ER visits (adults). 18,000 of those visits were deemed to need immediate attention at the time of initial evaluation – 987 had a heart attack diagnosis.

The team extrapolated the information to the whole of the USA for the 1997-2004 period. Nationally, there were 332 million ER visits (adult) during that period, of which 67 million needed immediate attention, and 3.7 million had suffered a heart attack.

The figures below illustrate clearly why the waiting times have increased-

— In 1994 there were 93.4 million ER visits (adults)
— In 2004 there were 110.2 million ER visits (adults)
— In 2004 there were 12.4% fewer hospitals offering ERs round-the-clock (24 hours a day) compared to 1997
In other words, demand grew while supply fell.

Each year, from 1997 to 2004 wait times increased 4.1% (from 22 minutes in 1997 to 30 minutes in 2004).

The authors concluded “Emergency departments are the only place where help is offered twenty-four hours a day; like Robert Frost’s conception of home, ‘the place where, when you have to go there, They have to take you in.’ Federal law (the Emergency Medical Treatment and Active Labor Act, or EMTALA) recognizes this important social role, mandating that EDs accept all patients. However, unless resources are reallocated to prevent ED overcrowding, the benefits of early intervention for time-sensitive conditions may be less attainable for all Americans.”

N.B. ER means Emergency Room. ED means Emergency Department. For this article, they both have the same meaning.

“Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997-2004”
Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, Sarah L. Cutrona, David H. Bor, and David U. Himmelstein
Health Affairs 27, no. 2 (2008): w84-w95
published online 15 January 2008; 10.1377/hlthaff.27.2.w84
Click here to view The Article online

Written by – Christian Norqvist