Dramatic increase in ER waiting time for seriously ill patients

Patients of all racial, ethnic, and socioeconomic status are facing ever-increasing waits for care in emergency rooms, according to a study published online today  by the journal Health Affairs. The problem is particularly acute for those who are severely ill, Harvard Medical School researchers at Cambridge Health Alliance found.

The study, which analyzed the time between patients’ arrivals in the  emergency department (ED) and when they were first seen by a doctor, found  that the increasing delays affected everyone, including those with and without  health insurance.

A quarter of heart attack victims in 2004 waited 50 minutes or more 
before seeing a doctor. The authors state that the lengthening delay
for care  of heart attacks is dangerous, because chances of surviving a
heart attack are  known to worsen when treatment is delayed.

Severely ill patients suffered the largest increases in ED  waits. Between 1997 and 2004, 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.

The research provides the first  detailed analysis of national trends in ED waits. Using data from the National  Center for Health Statistics (NCHS), the authors analyzed over ninety thousand  ED visits nationwide between 1997 and 2004.

While all demographic  groups experienced lengthening ED waits, waits were slightly longer for blacks  (13.0% 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 number of ED visits increased from 93.4  million in 1994 to 110.2 million in 2004. Meanwhile, the American Hospital  Association reports that the number of hospitals operating 24-hour EDs  decreased by 12% between 1994 and 2004. ED crowding in the remaining EDs  causes one ambulance to be diverted away from a U.S. ED every minute according  to the National Center for Health Statistics.

Andrew Wilper, lead  author of the study, said, “EDs close because, in our current payment system,  emergency patients are money-losers for hospitals. Planned admissions of  elective patients who need procedures are usually more lucrative for two  reasons.” Wilper, an internist at Cambridge Health Alliance and a Fellow in Internal Medicine at Harvard Medical School, said that “first, elective patients can be scheduled more conveniently and  efficiently, and second, they can be pre-screened for health insurance. Our  study suggests that these perverse incentives are causing dangerous delays in  potentially life-saving emergency care, even for those with  insurance.”

“One contributor to ED crowding,” said David  Himmelstein, Associate Professor of Medicine and senior author of the study,  “is Americans’ poor access to primary and preventive care which could address  medical issues before they become emergencies.”

Robert A. Lowe,  Associate Professor of Emergency Medicine at Oregon Health and Science  University, commented that “this study shows how ED overcrowding affects all of us.  If a loved one has a heart attack, it doesn’t matter whether he is well  insured. He still has a 1-in-4 chance of waiting over 50 minutes, because of  ED overcrowding, and this wait will only increase.”

Steffie  Woolhandler, Associate Professor of Medicine at Harvard and study coauthor,  said: “Some policy makers claim that everyone in America has access to health  care through the ED. Our findings counter this notion. We have insurance  company CEOs making tens of millions of dollars per year, 47 million uninsured  Americans, and worsening access to emergency care for everyone. Something is  wrong here.”

In addition to Wilper, Woolhandler, and Himmelstein, Drs. Karen E. Lasser, Danny McCormick, Sarah L. Cutrona, MD and David H. Bor contributed to the study.

Wilper was  supported by a National Service Research Award.