ED wait times increasing, even for AMIs, other emergent cases

A new study finds little difference between delays for the insured and uninsured.

By Myrle Croasdale — Posted Feb. 4, 2008

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Emergency department waits are up, and for heart attack patients, the delays are dangerously long, Harvard researchers have reported.

From 1997 to 2004, patients waited 36% longer -- a median of 30 minutes -- to see an emergency physician, according to a Health Affairs study published online in January.

Patients triaged with acute myocardial infarction saw their waits jump 150%, for a typical delay of 20 minutes. A quarter of heart attack patients waited 50 minutes or longer before seeing a physician, said the national study that analyzed data of more than 90,000 ED visits from the National Center for Health Statistics.

The American College of Emergency Physicians said the study presents further evidence that major reforms are needed to support EDs and the health care system. Other studies this year have documented a decrease in specialists willing to take ED call, due to declining reimbursements and increased liability risk.

Study lead author Andrew Wilper, MD, said he expected wait time data to show differences across regions of the country, but they did not. There were, however, marked differences between wait times in urban hospitals, which were longer, than in nonurban hospitals. He found that insured and uninsured patients had similar wait times.

Dr. Wilper said 9% to 12% of hospital EDs closed between 1994 and 2004. During the same period, the number of ED visits increased 18%.

Lack of beds a contributing factor

Dr. Wilper and his co-authors suggested longer wait times may be linked to a lack of open hospital beds, the large and aging baby boomer population, an increase in the uninsured and ED staff shortages.

"Longer wait times are an important issue that needs more attention," said Dr. Wilper, an internist with Cambridge Health Alliance in Massachusetts and a Harvard Medical School fellow.

Researchers also found the percentage of ED visits classified as urgent decreased over time, suggesting that nonurgent care contributed to overcrowding.

ACEP President Linda L. Lawrence, MD, said while the study is valuable to document wait-time increases, the ACEP does not agree that nonurgent visits contributed to ED overcrowding.

A bigger problem, she said, is the lack of hospital beds, leaving patients in ED beds, waiting for admission.

"One of the long-lived myths about emergency care is that nonurgent patients are creating a bottleneck," Dr. Lawrence said. "People argue that if we provide insurance for everyone, that this will unclog the ED, but that's far from the truth."

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Waiting for care

It's not news that hospital emergency departments are overburdened. From 1994 to 2004, the total number of ED visits increased about 18%, while the number of EDs dropped by as much as 12%. This translates into longer waits for patients.

A January Health Affairs study found these increases in median wait times after triage:

1997 2004 Increase
All adults 22 min. 30 min. 41%
Acute myocardial infarction 8 min. 20 min. 150%
Emergent* 10 min. 14 min. 40%

* Patients triaged as emergent should be seen within 15 minutes

Source: "Waits to See An Emergency Department Physician: U.S. Trends and Predictors, 1997-2004," Health Affairs, Jan. 15, Web exclusive

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