Emergency waits get dangerously long in US -study

[spenac]

http://www.reuters.com/article/health-SP-A...549047220080116

Emergency waits get dangerously long in US -study

Tue Jan 15, 2008

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

They found a quarter of heart attack victims waited 50 minutes or more before seeing a doctor in 2004. Waits for all types of emergency department visits became 36 percent 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 percent 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.

"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 in a statement.

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 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.

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," 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."

The study is available online at content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w84

(Reporting by Maggie Fox, editing by Will Dunham and Philip Barbara)

[Ridryder 911]

Hence the reason I went back into the field full time.

Basically I have seen the rhetorical reasons:

1. Don't have insurance

2. Don't have an assigned Primary care Physician (PCP) or Doc

3. Wants immediate treatment and do not want to schedule preventive care at a clinic.

4. Wants Rx (usually narcotic prescription) to be refilled

5. Don't want to wait

6. Don't want to wait

7.Wants Rx (usually narcotic prescription) to be refilled

8. PCP does not want to see them in the clinic and punts to the ER

The type of patient that was seen in the 80's and early 90's are not the ones we now see in the ER today. Unfortunately, we still attempt to operate emergency departments in the same manner today as we did then.

Majority of ER patients do not require monitors, SpO2 monitoring, or even changing into a gown. (Does the PCP clinic perform this on each patient?)

Many perform bedside triage per portable computers and reduces downtime.

Most ER's are finally addressing that ER patients are really "clinic type" patients and have a fast track system. Some having physician extenders performing triage (PA & NP's) with treatment prescribed right in the triage room. No need for special test for otitis, strep screen can be done at bedside, etc..

Again, this is just the tip of the iceberg. That is the scary part .. the worse is yet to come.

This again will affect EMS and yes our profession will have to adapt to the ever changing methodologies of health care. As I predict EMS will be more used as a screening tool on whom will get to be seen and those that can and will be treated at home.

R/r 911

[Kiwiology]

Oh why oh why is the wait at ED so long? Why are there no ambulances to respond to my heart attack? Why I wonder, same old story, people abusing the system.

If you go to ED here you don't have to pay so while we do get the problem of people who can't pay the $20 (or whatever) to see thier Doc turning up, its mainly people with cut fingers, colds, sore throat etc

I've never waited more than about 30 minutes to be seen in the emergency department (I've waited longer in my Doctor's waiting room reading stale old magazines) and from data our Ministry of Health publishes, it would seem that 100% of people needing immeadiate treatment are treated straight away.

I am not sure what this article means by "heart attack" - I doubt it means somebody who is in VF on the floor not breathing. I would make an educated guess here and it could mean everything from somebody with chest pain to a post resuscitation admission. I'm not saying they should wait longer than they have to, but, I don't see the problem with placing somebody with a massive hemmorage who has lost half his blood volume ahead of somebody who has been resuscitated and thrombolysed who might have to wait 10 minutes longer.

An ER Doc told me "if you are breathing and not bleeding, we don't want to know about you" and I hate to play devil's advocate but that's what the emergency department is for.

Same goes for EMS - people dial up 111 and say "oh I need an ambulance for a cut finger" or "a broken toe" or "my cat is sick". I can't tell you how mad these bullshit calls make me.

The public bitch about wait and response times for ED and EMS, well, its simple, don't abuse the system and you won't have any problems!.

[Don1977]

What I dont understand here is, some hospitals here will put you in the hallway, god knows how long you will wait before anyone sees you, I just dont get how that couunts as a "room" for a patient. So much for confidentiality.