Study: ER Patients Wait Too Long for Care

Many Hospitals Aren't Meeting Their Own Goals for Limiting Wait Times in Emergency Rooms

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

Oct. 2, 2009 -- Even the sickest patients treated in hospital emergency departments across the U.S. routinely wait longer than they should for medical care, new research suggests.

Just 14% of hospitals met their own target time frame for treating very sick patients at least 90% of the time.

And slightly less than one in three hospitals met target treatment time goals 90% or more of the time for all patients treated in emergency departments.

"In hospitals across the country patients are waiting longer than they should for treatment in ERs," study researcher Leora I. Horwitz, MD, MPH, tells WebMD. "There is also tremendous variation from hospital to hospital, which has more to do with how the facilities choose to practice than the characteristics of the patients they treat."

Triage Targets Not Met

The vast majority of hospital emergency departments across the country now have triage nurses or doctors who assess patients as soon as they arrive and determine target treatment times based on how sick the patients are.

In an effort to examine whether individual hospitals were meeting these triage goals, Horwitz and colleagues from Connecticut's Yale-New Haven Hospital examined data provided annually to the CDC by medical centers across the country.

Their random sample included information on 35,849 patient visits to 364 emergency departments in 2006.

The analysis revealed that:

• When patients were found to be in need of hospitalization, less than half (47.7%) of emergency departments admitted 90% or more within six hours of first being seen.
• Less than a quarter (24.5%) admitted hospitalized patients within four hours.
• One in three patients triaged for treatment within an hour waited longer to see a treating physician.
• The average wait time at the slowest 25% of emergency departments was twice as long as average wait times at the 25% of the fastest hospitals.

The study was published online today in the Annals of Emergency Medicine.

Misuse of Emergency Departments

While there is little disagreement that ER wait times are too long, emergency physician Sandra Schneider, MD, says there is a lot of confusion among the public about the reason for this.

Schneider is vice president of the American College of Emergency Physicians and she practices emergency medicine at Strong Memorial Hospital in Rochester, N.Y.

"When people come to emergency departments [EDs] and have to wait, they assume this is unusual and that people coming to the EDs for primary care are to blame," she tells WebMD. "What they don't realize is that EDs are crowded 24/7 and it has little to do with people using them for primary care."

One problem, she says, is that emergency departments have become dumping grounds for patients waiting to be admitted to the hospital and even those who have already been admitted.

She tells the story of a hospitalized woman whose condition worsened to the point where she needed to be admitted to the intensive care unit (ICU).

The ICU had beds, but no available nurses to take care of her because the hospital limited ICU nurses to two patients each.

"The solution was to send her to the emergency department where her nurse was already taking care of two other ICU patients, three other hospitalized patients and three emergency patients," she says. "I wouldn't say that cases like this are routine, but they aren't rare either."

Emergency department crowding has become so severe that the National Academy of Sciences called it a "national epidemic" in a 2006 report.

Horwitz says her study and others suggest that individual hospitals can do a lot to address the problem.

Improving efficiencies within hospitals has taken center stage in the debate over health care reform, and Horwitz says there is a good reason for this.

"As we look more closely at how hospitals actually work -- how they register and discharge patients, schedule elective surgeries, and things like that -- I think we will find that these things make a huge difference in how effective and efficient hospitals are," she says.

SOURCES: Horwitz, L.I. Annals of Emergency Medicine, Sept. 30, online edition.

Leora I. Horwitz, MD, MHS, assistant professor of internal medicine, Yale University School of Medicine, New Haven, Conn.

Sandra Schneider, MD, vice president, American College of Emergency Physicians; emergency department physician, Strong Memorial Hospital, Rochester, N.Y.

News release, American College of Emergency Physicians, Sept. 30, 2009.

News release, The Dartmouth Atlas of Health Care, Feb. 26, 2009.

Institute of Medicine: "Hospital-Based Emergency Care: At the Breaking Point," 2006.

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