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.”
Wilper was supported by a National Service Research Award.