Tuesday, January 15, 2008

Hurry Up and Wait: Emergency Care in The US

"I mean, people have access to health care in America. After all, you just go to an emergency room. "
- President George W. Bush Cleveland, OH July 7, 2007
This morning a Harvard study was released that is causing ripples across the media and Internet. Let us begin with the The Boston Globe's medical column:
Between 1997 and 2004, wait times went up an average of 4.1 percent per year for all patients, but for heart attack patients, the waits stretched 11.2 percent per year, researchers from Cambridge Health Alliance report in today’s issue of Health Affairs. Blacks, Hispanics, women, and patients in urban hospitals waited longer than other patients.

"The striking finding is that waits are increasing for all Americans, for people who are insured and for people who are uninsured," lead author Dr. Andrew Wilper, also a fellow in internal medicine at Harvard Medical School, said in an interview. “For patients with severe illnesses, it is troublesome.”
The Houston Chronicle converts those percentages into minutes and also provides this telling quote from Charles Begley, a professor at the University of Texas School of Public Health:
"Because the emergency room has become a source of primary care for a lot of people, it is distracting the emergency room from being able to provide the emergency trauma care that the community needs," Begley said.

For patients across the country identified as needing "emergent" care, wait times increased to 14 minutes in 2004, up from 10 minutes in 1997, study authors reported. And the subset of patients who were diagnosed as suffering from heart attacks saw a significant increase, from eight minutes in 1997 to 20 minutes in 2004.
A twenty minute wait time for a heart attack victim? Think about that for a moment. Think about how long a minute is when suffering chest pains.

The Washington Post also has a piece online today which tells us a bit more about how the data was compiled :
The researchers analyzed data on patient visits and wait times collected between 1997 and 2000, and from 2003 and 2004, by the National Hospital Ambulatory Medical Care Survey, a nationally representative database. Among other findings, they learned that wait times tended to be longer for African Americans and Hispanics, perhaps because those patients are often treated in urban emergency departments, which are more likely to be overcrowded than their rural counterparts.

In recent years, several expert reports have detailed the strains on emergency room care in the United States. Three reports issued in 2006 by the Institute of Medicine, a branch of the National Academies, concluded that the nation's emergency medical system is "overburdened, underfunded and highly fragmented."
It is well documented (in Health Care Reform Now! of course) that for chronic conditions such as asthma, a few hundred dollars a year are required to manage the condition, while a single emergency room visit could skyrocket to over $20,000. This cost factor combined with the wait times present a disturbing portrait of a broken system.

SOURCE: "Emergency room wait times getting longer" 01/15/08
SOURCE: "Wait times at the ER are ticking upward: Researchers say patient care is at risk as crowding causes many to just leave" 01/15/08
SOURCE: "Emergency Care Waits Found to Be on Rise" 01/15/08
photo courtesy of macoggins, used under this Creative Commons license

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