Friday, January 25, 2008

Emergency Department Crowding Dangerous

Emergency Waits Get Dangerously Long in U.S.

WASHINGTON (Reuters) Jan 15, 2008 - Patients seeking urgent care in U.S. emergency rooms are waiting longer than in the 1990s, U.S. researchers reported on Tuesday.

They found a quarter of MI patients waited 50 minutes or more before seeing a doctor in 2004. Waits for all types of emergency department visits became 36% longer between 1997 and 2004, the team at Harvard Medical School reported.

Especially unsettling, people who had seen a triage nurse and been designated as needing immediate attention waited 40% longer -- from an average of 10 minutes in 1997 to an average 14 minutes in 2004, the researchers report in the journal Health Affairs.

Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004, Dr. Andrew Wilper and colleagues found.

Dr. 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 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% 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," Dr. Wilper said in a statement.

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

The American College of Emergency Physicians said the findings were not surprising.

"Emergency physicians have said for years that crowding and long wait times are hurting our patients -- insured and uninsured equally," ACEP president Dr. Linda Lawrence said in a statement.

"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."

See Keith's Letter written in 2001.



Anonymous said...

Dear Dr. Carrol,

Having found your Haiti blog I came by here and this posting makes me wonder what your idea for reforming the US healthcare/health insurance system might look like. I realize you're a very busy guy so just a point or two to orgs with simular ideas would be very helpful. I'm fairly familiar with the subject, or at least I did a bit of reading and activism in the early '90's. I like single-payer but I'm don't want a system like England. More like one risk-pool, indivisible, with liberty and justice for all. But I'd like to get some more concrete details into my brain.

TIA, and thank you for some glimpse at grace.

John A. Carroll said...

Dear Tribalecho,

Unfortunately, I do not have any great ideas regarding reforming the US healthcare/health insurance system. Many smart people are working on this complex problem.

My thoughts are "anecdotal" and I know that the system is broken, and filled with 40 some million uninsured Americans, the cost of medical care in the U.S. is exorbitant, and where the U.S. ranks in medical outcome in the world is not good for the amount of money we spend.

I watch the debates and read what I can. I have more visceral ideas than grey matter ideas. I don't think you need that.

From first hand experience, I do know that ER overcrowding can be very dangerous. The finger is often pointed at the ER's around the country. However, the big problem is moving patients from the ER to another location, like an inpatient bed. That is where the medical center administration needs to be of some help and not let the ER and its patients flounder.

I wish I could give you a much better answer.