Emergency room wait times getting longer

The median amount of time between registering in the emergency department and being examined by a physician was 22 minutes in 1997, according to an analysis of more than 92,000 medical records in the National Hospital Ambulatory Medical Care Survey. By 2004, the median wait time was 30 minutes, the study says. Whether patients had insurance made no difference in how long they waited to see a doctor.

For patients ultimately diagnosed with heart attacks, the wait time rose from 8 minutes in 1997 to 20 minutes in 2004. Patients who needed attention within 15 minutes, according to triage nurses who evaluated them, waited 10 minutes in 1997 but 14 minutes in 2004.

In urban hospitals, the emergency room wait was 30 minutes compared with 15 minutes in nonurban locations.

For black patients, the wait took 31 minutes, for Hispanic patients it was 33 minutes, and for white patients it was 24 minutes. Women waited 26 minutes, one minute longer than men. The longer waits for black and Hispanic patients reflect greater crowding at hospitals serving mostly minority patients, the authors said. They did not find evidence of bias in how patients were triaged.

The longer wait times were tracked during a period when hospital emergency departments were being closed even though patient visits were going up, the authors say. Emergency visits climbed 78 percent from 1995 to 2003 but the number of emergency departments fell 12.4 percent from 1995 to 2003.

Fewer emergency departments could be one explanation for the longer wait times, but Wilper also pointed to a lack of beds for seriously ill patients once they are admitted to the hospital. This Globe story explored efforts in Massachusetts to reduce “boarding,” when admitted patients stay in the emergency department, sometimes for 10 or more hours until a regular hospital bed becomes available.

Other drivers of lengthening wait times could be a shortage of specialists on call to see patients in the emergency department and a lack of access to primary care for people who go to the emergency room for non-urgent needs.

The American College of Emergency Physicians called the study’s findings “alarming, but not surprising,” in a statement issued yesterday.

"The number of emergency patients is increasing while the number of hospital beds continues to drop," Dr. Linda Lawrence, president of the emergency doctors’ group, said. "It is a recipe for disaster."

The group disagreed with the suggestion that nonurgent patients contribute to the delays, saying triage works to make sure the sickest patients are cared for first.