Between Dec. 15, 2000, and May 15, 2001, researchers observed 1,798 randomly selected emergency patients at 30 California hospitals from their first arrival at the emergency department to their first contact with a physician or mid-level provider, such as a physician assistant or nurse practitioner.
The average waiting time for most emergency patients, the study found, is about 56 minutes. However, 42 percent of emergency patients had waiting times exceeding 60 minutes. Emergency department overcrowding has been defined as an acutely ill patient waiting more than 60 minutes to be seen by a physician or mid-level provider, according to surveys of emergency department directors, cited by the authors.
"Emergency departments have a triage process to sort patients by the severity of their illnesses and injuries to ensure the sickest patients are seen first," said Susan Lambe, MD, and lead author of the study. "While our study found many patients wait more than an hour for emergency care, we were not able to look at the severity of their injuries or illnesses."
In poorer neighborhoods, the study found for every $10,000 decline in per capita income within a zip code, patients waited 10 minutes longer, regardless of whether the hospital was public or private. The researchers hypothesize these communities may have a disproportionate number of uninsured patients with more complex medical problems and who may require additional financial, administrative, and social support. Furthermore, an important finding revealed waiting times were shorter at emergency departments with a greater ratio of triage nurses and physicians to emergency patients.
"While our study doesn't fill in all the blanks, it does find people who visit hospitals in low-income areas are more likely to experience long waits, and physician and nurse staffing should be investigated as a means of reducing waiting times," she added.
"We hope policymakers will use this information to begin addressing this supply and demand problem, which has become particularly pressing, considering the nation's emergency departments are vulnerable to threats ranging from bioterrorism to the current economic downturn," said Dr. Lambe.
Annals of Emergency Medicine is the peer-reviewed journal of the Dallas-headquartered American College of Emergency Physicians, a national medical organization with nearly 23,000 members. ACEP is committed to improving the quality of emergency care through continuing education, research, and public education.
The Oakland-based California HealthCare Foundation is an independent philanthropy committed to improving California's health care delivery and financing systems.
Journal
Annals of Emergency Medicine