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Longer Waits For Emergency Care Coming, Physicians Say

 |  By John Commins  
   July 26, 2010

A report detailing record-long waits at the nation's emergency departments comes as no surprise to emergency physicians, who say waits will lengthen as health coverage expands, emergency departments close, and hospitals fail to improve admitting processes.

Angela Gardner, MD, president of the American College of Emergency Physicians, says the four-hours-and-seven-minutes average wait at the nation's EDs—detailed in Press Ganey's 2010 Emergency Department Pulse Report: Patient Perspectives on American Health Care— threatens patient safety.

"Nobody can possibly call a national average of more than four hours in the emergency department something to cheer about," Gardner says. "Last year the GAO reported that even patients who need to be seen in 1 to 14 minutes are waiting an average of 37 minutes for care. Emergency physicians have become masters of improvisation and troubleshooting under extreme conditions, but the fundamental problems in our emergency departments remain unsolved."

The Press Ganey report is based on evaluations of more than 1.5 million patients treated at 1,893 hospitals in 2009. The 2009 average wait was a four minute increase over 2008 wait times, and a 31-minute increase since reports were made available in 2002.

Gardner said hospitals aren't doing a good job of admitting patients through the ED, which creates a backlog. "Hospitals need to stop boarding admitted patients in the emergency department and get them to the appropriate inpatient floor quickly," Gardner says. "That is what's best for the admitted patients but it's also what's best for the patients suffering in the waiting room."

ACEP has called for hospitals to implement the full-capacity protocol, which Gardner says hospitals have been reluctant to embrace.

Gardner says the problems of long ED waits will worsen with the implementation of federal healthcare reform laws, which will expand health insurance coverage to more than 30 million people.

"Policymakers and the public should also have no illusions that the recently passed healthcare legislation is going to decrease ER use," she says. "Massachusetts, which enacted healthcare reform in 2006, has seen an increase in emergency department visits, with no decrease in patient acuity. It proves that healthcare coverage is no guarantee of healthcare access."

Exacerbating the problem even more, Gardner says, is the number of EDs that have closed in recent years. "More patients plus fewer ERs equals longer wait times," she says. Early one-quarter of hospitals report periods of ambulance diversion because they are over capacity. A longer ride to the hospital is not good medicine."

Utah had the longest wait, with an average emergency department time of 8:17—early an hour and a half longer than the state's average time spent last year. Iowa had the shortest average time spent at just under three hours (2:55), followed by South Dakota (2:59), North Dakota (3:07), Nebraska (3:08) and Minnesota (3:11). More than half the states were able to improve wait times or keep increases to a minimum. Nevada made the biggest improvement in 2009, reducing average wait time by 66 minutes since 2008.

"This report is yet another wake-up call that healthcare reform has yet to address the acute care needs of 123 million emergency patients a year," Gardner said. "They may report being satisfied with the care they are receiving in the ER, but emergency physicians are dissatisfied with an average time in the emergency department that is nearly equal to a coast to coast airplane ride."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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