The Wall Street Journal-20080115-Wait Times Lengthen At Emergency Rooms
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Wait Times Lengthen At Emergency Rooms
Emergency-room patients are waiting ever longer to see a doctor, a potentially dangerous development as rising numbers of uninsured and underinsured Americans turn to ERs for medical care, researchers said.
The median wait for adults rose to about 30 minutes in 2004 -- meaning half waited more and half waited less -- from 22 minutes in 1997, a 36% increase, according to a study scheduled for publication today by the journal Health Affairs. Heart-attack patients, meanwhile, had a median wait time of 20 minutes in 2004, up 150% from eight minutes in 1997.
Black, Hispanic and urban patients can expect to spend more time in waiting rooms than rural or white patients, according to the study, which was conducted by seven doctors affiliated with Harvard University and the Cambridge Health Alliance, a network of nonprofit Massachusetts hospitals.
The study "is not surprising; it's worrisome," said Robert A. Lowe, a physician and director of the Oregon Health & Science University's Center for Policy & Research in Emergency Medicine, who wasn't involved in the research. "What it reflects is that as access to care outside the emergency department deteriorates, the emergency department is one of the few safety nets through which everyone has access to care." An increase in the number of ER visits, plus a decline in the number of emergency rooms, likely has contributed to the wait, researchers said.
The study examined data from a federal survey of ER visits during the years 1997-2000, 2003 and 2004; the survey didn't collect relevant data for the two years in between.
Andrew Wilper, an internist and lead author of the study, said it isn't clear why wait times increased more rapidly for heart-attack patients. As fewer ERs were left to treat very sick patients -- including trauma victims -- "perhaps heart-attack patients became relatively less urgent," he said.
Not all emergency-room waits were equal. While white patients typically waited about 24 minutes to see a doctor during the years studied, black and Hispanic patients could expect to wait slightly more than a half hour. In addition, women could expect to wait about 5% longer than men, even under similar circumstances.
Disparities remained when researchers adjusted for other circumstances, such as a patient's age or a hospital's location. The researchers examined whether race and sex affected triage decisions -- addressing how quickly patients need a doctor's attention -- and found no evidence for it. The disparity could be the result of "little decisions along the way" by other ER staff, Dr. Wilper said, or else hospitals that serve minorities may have longer wait times generally.
Among the study's other findings: Urban hospitals had double the wait times of rural ones; the Northeast's were longer than other regions'; and nonprofit-hospital visitors waited about 13% longer than those at privately owned facilities.
