Emergency Care Waits Found to Be on Rise


By Christopher Lee
Washington Post Staff Writer
Tuesday, January 15, 2008

Patients are waiting longer for care in the nation's emergency rooms, a potentially deadly result of the shrinking number of emergency departments and rising demand for emergency services, according to a new study by researchers at Harvard Medical School.

Half of all emergency room patients waited 30 minutes or more before being examined by a doctor in 2004, a 36 percent increase from a median wait time of 22 minutes in 1997, according to the study, published today in the journal Health Affairs.

Even those experiencing a heart attack are not assured speedy treatment, with half waiting 20 minutes or more to be examined in 2004, up from eight minutes in 1997, the study found. The same was true for those with other serious health problems: By 2004, patients whose conditions warranted treatment within 15 minutes were waiting 14 minutes or more to see a doctor, up from 10 minutes in 1997, the study found.

"We all may need to use the emergency department at one time or another, and it's important for us to be able to rely on it if we need care," said lead author Andrew Wilper, a fellow in internal medicine at Harvard Medical School and a physician at Cambridge Health Alliance, a Harvard teaching affiliate. "The numbers show that the emergency care system in the U.S. is on the ropes."

The researchers analyzed data on patient visits and wait times collected between 1997 and 2000, and from 2003 and 2004, by the National Hospital Ambulatory Medical Care Survey, a nationally representative database. Among other findings, they learned that wait times tended to be longer for African Americans and Hispanics, perhaps because those patients are often treated in urban emergency departments, which are more likely to be overcrowded than their rural counterparts.

In recent years, several expert reports have detailed the strains on emergency room care in the United States. Three reports issued in 2006 by the Institute of Medicine, a branch of the National Academies, concluded that the nation's emergency medical system is "overburdened, underfunded and highly fragmented."

Other factors, experts say, include an aging population, shortages of nurses and primary care doctors, the rising number of patients coming for non-urgent health problems, and the closure of some hospitals (and their emergency rooms) as more procedures are done on an outpatient basis.

"Ever-lengthening waits are a frightening trend because any delays in care can make the difference between life and death for some patients," said Linda Lawrence, president of the American College of Emergency Physicians.

Caroline Steinberg, vice president of trends analysis for the American Hospital Association, said the study raises issues that go beyond the emergency room.

"We need to fix the health-care system," Steinberg said. "We need to ensure that every American has health coverage so that the emergency department isn't their only point of access to care."

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