Emergency Room Delays May Put Patient Lives At Risk

New research suggests that about a quarter of patients who need emergency care are not being seen in a safe amount of time due to America’s increasingly crowded hospital emergency rooms. Delays could have a ripple effect, resulting in higher rates of morbidity and mortality in hospitals.

According to a study published in the November 9 issue of the Archives of Internal Medicine, delays in emergency room treatment are worsening across the country, with just over 75% of patients being seen within the recommended time frame. Researchers found that the number of patients being seen in a timely manner is decreasing by about 0.8 percent every year.

The study looked at 151,999 emergency room visits between 1997 and 2006, dividing visits into categories based on the level of severity of the emergency. Overall, the researchers found that 75.9% of all patients were seen within the recommended time. In 1997 that number was 80%.

In an editorial accompanying the study, Dr. Renee Y. Hsia and Dr. Jeffrey A. Tabas from the University of California, San Francisco, noted that there are a number of potentially serious consequences from emergency room delays. Hsia and Tabas described the overcrowding as a worsening problem that could cost lives, calling for a variety of solutions.

“Crowding in the ED (emergency department) has been associated with poorer process measures, including delays in treatment of pain, delays in antibiotic treatment for community-acquired pneumonia and decreases in the satisfaction of patients with their ED stay and hospitalization,” Hsia and Tabas said in the accompanying editorial. “There is also increasing evidence to suggest that ED crowding is associated with poorer clinical outcomes, such as increased in-hospital morbidity and mortality.”

Medical professionals recommend that emergent patients, the patients in the direst need of medical attention, be seen between 0 and 14 minutes of arriving at a hospital seeking treatment. The study found that these patients were the least likely to be seen on time. Only 56.6 percent of patients in the most need of medical attention were seen in less than 14 minutes, compared to 100% of semi-urgent patients being seen in the recommended time of one to two hours.

Researchers said that the increases in emergency room wait time have accompanied increases in the number of people going to hospitals for all manner of ailments, and high bed occupancies have decreased the number of beds available for patients most in the need of care.

Experts have recommended a number of emergency room changes that hospitals can make to decrease wait times, including:

• Condensing the number of questions asked by triage nurses, and having those nurses assign the patient to their next nurse.
• Having patients see the doctor and nurse at the same time after passing through triage, instead of one after the other.
• Equip emergency rooms with bedside supplies that address the most common reasons for emergency room visits.
• Have information such as patient identification and insurance collected at bedside, once the patient is already being seen.