Senator Eliot Shapleigh - El Paso, Texas

The Harvard researchers found the longest waits in urban areas, which account for 80 percent of ED visits. Even after urban-rural differences were taken into account, median wait times were longer for blacks (31 minutes) and Hispanics (33 minutes) than for whites (24 minutes). (photo courtesy cbcnews)

As patient volumes in hospital emergency departments (EDs) are going up, waiting times to see an ED physician are getting longer, particularly for heart attack patients and those in need of the most immediate attention, according to a study by Harvard Medical School researchers at the Cambridge Health Alliance published today as a Health Affairs Web Exclusive.

The researchers found that the median ED wait time went up from 22 minutes in 1997 to 30 minutes in 2004, a 36 percent increase. For patients diagnosed in the ED with acute myocardial infarction, or heart attack, the median wait time increased a steep 150 percent, from 8 minutes in 1997 to 20 minutes in 2004. And for those identified in ED triage as needing attention “emergently,” wait times increased from 10 minutes in 1997 to 14 minutes in 2004, an increase of 40 percent.

The researchers used 1997-2000 and 2003-2004 data from the National Hospital Ambulatory Medical Care Survey, conducted by the U.S. Census Bureau. (In 2001 and 2002, the NHAMCS did not record wait times.)

“EDs are the only place where every American can go to get help 24 hours a day,” said lead author Andrew Wilper, a fellow in general internal medicine at Harvard Medical School and the Cambridge Health Alliance. “But we found that ED waits are getting longer for everyone, especially for those most in need of quick help. That means that pain and suffering is being prolonged, treatment is being delayed for time-sensitive illnesses, and some patients are undoubtedly leaving without seeing a doctor or are discouraged from even coming to the ED in the first place.”

Wilper and his colleagues say that the increase in ED wait times results from many factors. The most important factor is likely the greater crowding that has resulted from ED closures combined with an increase in ED visits: Between 1994 and 2004, the number of annual ED visits increased from 93.4 million to 110.2 million, while the number of EDs fell 12.4 percent. Moreover, the proportion of ED visits that are emergent has decreased over time, which suggests that compromised access to primary care is driving more Americans to EDs for routine medical needs.

Race And Sex Differences In Wait Times Persist
Despite Efforts To Reduce Disparities

The Harvard researchers found the longest waits in urban areas, which account for 80 percent of ED visits. Even after urban-rural differences were taken into account, median wait times were longer for blacks (31 minutes) and Hispanics (33 minutes) than for whites (24 minutes). Women waited 26 minutes, slightly longer than the 25-minute wait time for men.

“Importantly, the race and sex disparities we detected did not diminish over time, despite widespread efforts to reduce disparities in medical care,” the authors write. They say that biased triage assignments of women and minorities do not seem to cause their longer waits to see a physician. Other factors may be at play, such as greater ED crowding at hospitals serving predominantly minority patients and disparate use of tests such as electrocardiogram and pulse oximetry, which are often performed prior to physician evaluation.

Perhaps surprisingly, self-pay patients waited no longer in EDs than their insured counterparts. This suggests that “in the ED, the uninsured may be treated comparably to the insured,” the authors write.

Wilper and his colleagues say that there is no one easy answer for reducing ED waits. They suggest that multiple reforms are likely to be necessary, including expanding insurance coverage and primary care access to increase alternatives to ED visits; directing hospital resources away from “profitable but unnecessary services” and toward medical needs such as increasing ED space, staff, and specialty consulting services; and modified management of elective surgery scheduling.

You can read the article by Wilper and coauthors below