The Waiting is the Hardest Part: Five Studies on the Effects of Long Wait Times in the Emergency Department and How to Reduce Them

Recent surveys have found that average wait times in US emergency departments are increasing. Several recently published studies have also looked at the effect of long wait times and/or overcrowding on quality of care and patient satisfaction.

Percentage of US Emergency Department Patients Seen Within the Recommended Triage Time From Archives of Internal Medicine (November 2009)

Noting that “wait time to see a physician in US emergency departments (EDs) is increasing and may differentially affect patients with varied insurance status and racial/ethnic backgrounds,” the authors “examined trends in the percentage of patients seen within the triage target time by triage category (emergent, urgent, semiurgent, and nonurgent), payer type, and race/ethnicity.” They found that “percentage of patients in the ED who are seen by a physician within the time recommended at triage has been steadily declining and is at its lowest point in at least 10 years. Of all patients in the ED, the most emergent are the least likely to be seen within the triage target time.”

Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even among High-acuity Patients

From Annals of Emergency Medicine (October 2009)

The authors estimated “the effect of crowding on waiting room time, treatment time, and boarding time separately, using discrete-time survival analysis with time-dependent crowding measures (ie, number waiting, number being treated, number boarding, and inpatient medicine occupancy rate), controlling for patient demographic and clinical characteristics.” They were able to “dynamically measure crowding throughout each patient's ED visit” and “demonstrate its deleterious effect on the timeliness of emergency care, even for high-acuity patients.”

US Emergency Department Performance on Wait Time and Length of Visit

From Annals of Emergency Medicine (October 2009)

The authors measured median wait times and visit lengths, median proportion of patients treated by a physician within the time recommended at triage, and median proportion of patients “dispositioned” within 4 or 6 hours in this retrospective cross-sectional study of a stratified random sampling of 35,849 patient visits to 364 nonfederal US hospital emergency departments. They found that “minority of hospitals consistently achieved recommended wait times for all ED patients, and fewer than half of hospitals consistently admitted their ED patients within 6 hours.”

Emergency Department Crowding and Decreased Quality of Pain Care From Academic Emergency Medicine (October 2009)

The authors studied “predictor emergency department (ED) crowding variables,” including census, number of admitted patients waiting for inpatient beds (“boarders”), and number of boarders divided by ED census (“boarding burden”), to determine the effect on the quality of care delivered to patients “with conditions warranting pain care seen at an academic, urban, tertiary care ED.” They concluded that crowding “negatively impacts patient care,” and that “greater numbers of patients in the ED, whether as total census or number of boarders, were associated with worse pain care.”

Tracking Emergency Department Overcrowding in a Tertiary Care Academic Institution

From Healthcare Quarterly (September 2009)

The authors note that despite the release in Canada of a “national report describing key markers of emergency department (ED) overcrowding, limited linear data using these markers have been published.” Thus, they to “report the degree and trends of ED overcrowding in a typical academic hospital and to highlight some of the key markers of ED patient flow and care.” After studying seven year’s worth of data from a tertiary care teaching hospital that receives approximately 55,000 annual adult ED visits, the authors concluded that “overcrowding in a tertiary care hospital is primarily a result of access block due to boarding admitted patients, and the metrics suggest this problem is increasing exponentially. This is particularly dangerous in the ED environment as the majority of patients have emergent or urgent conditions that cannot be appropriately managed in the waiting room, and these patients are at significant risk of deterioration prior to initial workup.”

What can be done to reduce emergency department wait times? This Los Angeles Times article describes how some hospitals are achieving success by displaying ED wait times on monitors in the waiting rooms and by posting them on websites, blogs, and even Twitter. The practice does have its critics, however, including David C. Seaberg, MD, an American College of Emergency Physicians board member and dean of the University of Tennessee College of Medicine in Chattanooga, who said “It's a very bad idea to put waiting times up on a billboard. When you get seen is a very complex process. . . . To put out a number can be misleading.” Seaberg and others worry that seriously acutely ill patients or patients who underestimate the severity of their symptoms may not understand that they’ll be seen right away, regardless of the posted wait time, and may take extra time to drive to an emergency department with a shorter posted wait time.