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In The ER, Waiting Is The Hardest Part

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Researchers at Harvard Medical School have handed another inconvenient truth to the politicos -- and I'm thinking specifically of Rudy Giuliani here -- who resist changing how America rations heath care. A study published in the journal Health Affairs found that emergency rooms patients are waiting much longer to see a doctor -- even patients in critical condition.

For patients who suffered a heart attack in 1997, the median wait time was just eight minutes. By 2004 that had more than doubled, to an astounding 20 minutes. Patients so critical that they needed to see a doctor in 15 minutes (called "emergent" in the trade) waited 14 minutes in 2004. (That's the median time, meaning half waited less and half waited more. In 1997, the median was 10 minutes.) For all patients, the wait time in 2006 was 36 percent longer. "Insured, uninsured, it doesn't matter," Dr. Andrew Wilper, the study's leader author, said to NPR's Joanne Silberner. "At one point or another, we all rely on the emergency department for care, and it looks like regardless of who you are, you're gonna wait longer to see the doctor when you go there." To the Washington Post, he added, "The numbers show that the emergency care system in the U.S. is on the ropes."

Wilper told NPR that he attributed the longer wait times to more patients who can't find or afford a family doctor are crowding emergency rooms. The study, which analyzed 92,000 ER cases from 1997 to 2004, found that minorities are likely to wait longer than whites, and women are likely to wait longer than men. Still, not everyone buys this explanation. According to the CDC, the percentage of "non-urgent" visits -- that is, routine cases that a regular doctor could treat -- increased over the same period by 29 percent, but only to an eighth of all ER cases. Dr. Art Kellerman, a professor of emergency medicine at Emory University, contended in the NPR piece that the overcrowding is due to fewer beds available elsewhere in the hospital, either because the hospital's full or it's reserving space for elective patients, a more line of work. The American College of Emergency Physicians agrees, noting that hospitals have cut 100,000 inpatient and 8,000 ICU beds in the last ten years to shave costs. But that's still more evidence that our health care system is broken. "We're gradually becoming the safety net for everyone," ACEP spokeswoman Laura Gore told me.

"People like to criticize the United Kingdom and Canada for long waits for elective surgery, like knee operations," said Kellerman, who contributed to an earlier study that reported the same trend, to NPR. "But these are the waits that matter. The wait for heart attack care, the wait when you have an emergent condition and arrive at an ER -- that can make the difference between life and death."

The audio for the NPR story is available here, while the Post article is here.

Last updated: Jan 15, 2008




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