The state of US emergency departments has been called a growing national crisis, and a report out today shows the situation is only getting worse.

Most distressingly, the people who need emergency care the most are the least likely to be getting it in time, Drs. Leora I. Horwitz and Elizabeth H. Bradley of Yale University School of Medicine in New Haven, Connecticut, say.

Over half of patients deemed to need emergency care -- meaning they should see a doctor in 14 minutes or less -- actually saw a physician in this time frame, Horwitz and Bradley found.

To investigate trends in wait times, the researchers looked at data representing nearly 540 million ED visits in the US between 1997 and 2006. They analyzed how often patients in each triage category were seen within the recommended time. Triage, a term borrowed from military medicine, means ranking patients based on how soon they need to receive medical care.

Emergent patients must be seen within 14 minutes, while urgent patients require care in 15 to 60 minutes. Semi-urgent patients should receive care within two hours, while non-urgent patients can wait longer.

In 1997, the researchers found, 59 percent of emergent patients were seen within 14 minutes, compared to 48 percent in 2006. For urgent patients, the likelihood of being seen on time went from 84 percent in 1997 to 76 percent in 2006. Semi-urgent patients also were less likely to be seen in a timely fashion over time; 91 percent were seen within the recommended amount of time in 1997, but 85 percent were in 2006.

Hispanic patients and African-American patients were less likely to be seen in the recommended amount of time than whites, the researchers found, but whether or not a person had health insurance didn't influence their likelihood of getting care on time.

In an editorial accompanying the study, Drs. Renee Y. Hsia and Jeffrey A. Tabas of the University of California, San Francisco, point out that the problem of ED wait times must be seen as a problem of the entire health care system.

Most importantly, the ED is the sole true 'safety net' of the health care system, where patients cannot be denied care, they add. While no one solution will solve the problem, they add, health care reform offers some promise of help, while improving electronic health care information systems could also add efficiency.

The problem is serious and worsening, and we must implement a variety of solutions in the areas of ED input, throughput, and output as well as broader health system reform, the editorialists say. Otherwise our patients will remain waiting, waiting, waiting.

SOURCE: Archives of Internal Medicine, November 9, 2009.

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