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Longer ER Waits, Even for Sickest Patients

Jan 16, 2008 | Parker Waichman LLP
U.S. researchers reported Tuesday that patients seeking urgent care in U.S. emergency rooms (ERs) are waiting longer than they had in the 1990s, especially those visiting ERs with heart attacks.   But the waits aren’t necessarily due to negligence on the part of ER staff.  Rather, lack of health insurance is causing more and more people to use ERs as the source of their primary medical care.

The research revealed that in 2004, one-quarter of heart attack victims waited nearly one hour before being seen by a doctor.  Waits for all types of emergency department visits were 36 percent longer between 1997 and 2004, the Harvard Medical School team reported.  Even worse, the study found that those who had seen a triage nurse and had been designated as needing immediate attention waited 40 percent longer, from an average of 10 minutes in 1997 to an average of 14 minutes in 2004, the researchers reported in the journal Health Affairs.  Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004, Dr. Andrew Wilper and colleagues found.  "If a loved one has a heart attack, it doesn't matter whether he is well insured. He still has a one-in-four chance of waiting over 50 minutes, because of ED (emergency department) overcrowding, and this wait will only increase," Dr. Robert Lowe, an emergency medicine expert at Oregon Health and Science University who did not work on the study, said.

Wilper's team used U.S. Census survey and National Center for Health Statistics data for their study, which covered more than 92,000 emergency department visits.  They also used other surveys to calculate that the number of emergency room visits rose from 93.4 million in 1994 to 110.2 million in 2004.  During the same time, 12 percent fewer hospitals operated emergency rooms, according to the American Hospital Association.  "EDs close because, in our current payment system, emergency patients are money-losers for hospitals," Wilper said in a statement.

Dr. David Himmelstein of Harvard who also worked on the study and lobbies for a national health care system said, "One contributor to ED crowding is Americans' poor access to primary and preventive care, which could address medical issues before they become emergencies.”

The American College of Emergency Physicians said the findings were not surprising.  According to ACEP president Dr. Linda Lawrence, "Emergency physicians have said for years that crowding and long wait times are hurting our patients, insured and uninsured equally.”  "Ever-lengthening waits are a frightening trend because any delays in care can make the difference between life and death for some patients. The number of emergency patients is increasing while the number of hospital beds continues to drop. It is a recipe for disaster," she added.

Meanwhile, another study published earlier this year found that nearly one-third of all patients experiencing misfiring or quivering hearts in U.S. hospitals do not receive life-saving defibrillator shocks within the critical first two minutes of cardiac arrest.  The American Heart Association recommends that the stopped hearts be shocked within two minutes.  Researchers from 369 hospitals in the National Registry of Cardiopulmonary Resuscitation found that being black or having a cardiac arrest outside of regular weekday working hours also significantly delayed the time it took for hospital workers to shock the heart.

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