ER Wait Times Getting Longer
TUESDAY Jan. 15, 2008 -- The last thing you want to hear in the emergency room when you've got crushing chest pain or can't breathe is that you have to wait before you can get treatment.
Unfortunately, in too many instances, that's exactly what's happening. In fact, new research found that waiting times in emergency rooms have increased by 36 percent for all patients, to an average of 30 minutes per patient. And the sickest sometimes have to wait the longest: As many as one-quarter of all heart attack patients had to wait 50 minutes or longer before seeing a doctor.
Study author Dr. Andrew Wilper, a fellow in general internal medicine at Harvard Medical School and an internist with the Cambridge Health Alliance, reports in the Jan. 15 online issue of Health Affairs that the increasing wait times are the result of a "perfect storm" that has occurred as emergency room visits are on the rise while many ERs are closing their doors.
"It's hard to ignore the fact that several hundred ERs have closed their doors, and we've seen an increase in the number of patients using ERs. Plus, there are a number of internal factors contributing like bottlenecks because of a lack of inpatient bed space and a lack of specialists available to treat patients," Wilper explained.
"The real problem is that patients are backing up in the ER. If a patient is still in the ER six or even 12 hours later, it means that room, that nurse and that equipment just aren't available for the next patient that comes in the door," explained Dr. Art Kellermann, a spokesman for the American College of Emergency Physicians.
Kellermann said a good analogy to this situation would be if controllers at a busy airport started parking planes on the runways. "We'd think they'd lost their minds, but that's what hospital administrations are doing with ERs," said Kellermann. "We've taken the most time-critical portal of care and allowed it to become gridlocked."
For the current study, Wilper and his colleagues reviewed data from 1997 through 2004 and included 92,173 adult ER visits. Of those visits, almost 18,000 were thought to need immediate attention at the time of initial evaluation, and 987 had a diagnosed heart attack.
Using this sample, the researchers extrapolated the data to the U.S. population for the study period, which represented 332 million adult ER visits, 67 million patients needing immediate care and 3.7 million heart attack patients. The number of emergency department visits increased from 93.4 million in 1994 to 110.2 million in 1997, according to the study. At the same time, the number of hospitals operating 24-hour ERs dropped 12 percent between 1997 and 2004.
Not surprisingly, the wait to see an ER physician also increased during that time. In 1997, the average wait was 22 minutes. By 2004, the average wait was up to 30 minutes -- a 4.1 percent increase in wait time each year.
For heart attack patients, even a few minutes of delay in treatment can literally mean the difference between life and death. Yet, the average wait time for a heart attack patient increased from eight minutes to 20 minutes over the study period -- a 150 percent increase.
Those who were assessed as needing immediate care waited 14 minutes in 2004, compared to 10 minutes in 1997. That translated into a 3.6 percent increase.
The study also found that blacks, Hispanics and women had to wait longer for care. Whites waited an average of 24 minutes, while blacks had to wait an average of 31 minutes and Hispanics had to wait 33 minutes on average. Wilper said it's possible that blacks and Hispanics might be more likely to visit hospitals that have longer wait times in general.
While the difference in wait times between men and women was slight -- about 5 percent, or one minute longer, for women -- Kellermann said it may be that women's heart attack symptoms still aren't recognized as quickly as men's symptoms are. "My hunch is while we're doing a better job understanding that women have heart attacks, too, a woman coming in with chest pain may be given a little less credence than a man with chest pain," he noted.
Wilper said because the causes of the increased wait time are multi-factorial, the solution has to be multi-faceted. "Solutions are likely going to be broad-based," he said.
He said there needs to be an expansion of insurance coverage, modified management of inpatient and elective surgeries because so many ER beds have been lost, and an expansion of primary care that might help ease the overflow at the emergency room.
"This is an issue that cuts across insurance status," said Kellermann, who pointed out that even people with insurance are left waiting in ERs, because there just isn't enough space or enough resources.
"Too many hospital administrators think that the hospital begins on the second floor, but ERs need open spaces and open bays. It's what we used to do, and the problem today is that more and more, we just don't have open space for a heart attack patient. We're like a NASCAR pit crew. We're designed to immediately assess, stabilize and move patients [to treatment]," said Kellermann. Without the open space, he said, the ER health-care team wastes valuable time moving patients and equipment around to try to get to the next patient.
Visit the American College of Emergency Physicians to learn when an ER visit is warranted.
Posted: January 2008
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