Patients waiting longer in emergency rooms

WASHINGTON — Patients are waiting longer for care in the nation's emergency rooms, a potentially deadly result of the shrinking number of emergency departments and rising demand for emergency services, according to a new study by researchers at Harvard Medical School.

Half of all emergency-room patients waited 30 minutes or more before being examined by a doctor in 2004, a 36 percent increase from a median wait time of 22 minutes in 1997, according to the study, published Monday in the journal Health Affairs.

Even those suffering from heart attacks are not guaranteed speedy treatment, with half waiting 20 minutes or more to be examined in 2004, up from 8 minutes in 1997, the study found. Ditto for those with other serious health problems: By 2004, patients whose conditions warranted treatment within 15 minutes were waiting 14 minutes or more to see a doctor, up from 10 minutes in 1997, the study found.

"We all may need to use the emergency department at one time or another, and it's important for us to be able to rely on it if we need care," said lead author Andrew Wilper, a fellow in internal medicine at Harvard Medical School and a physician at Cambridge Health Alliance, a Harvard teaching affiliate. "The numbers show that the emergency-care system in the U.S. is on the ropes."

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 they were more likely to be treated in urban emergency departments, which are more likely to be overcrowded than their rural counterparts.

In recent years, several expert reports have detailed how emergency-room care in the United States has been stretched to the breaking point. Between 40 percent and 50 percent of emergency departments experienced overcrowding in 2004, according to a 2006 study by the federal Centers for Disease Control. 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."

Other factors include an aging population, shortages of nurses and primary-care doctors, the rising number of uninsured and patients coming to the emergency room for non-urgent health problems, and the closures of some hospitals (and their emergency rooms) as more procedures are done on outpatient basis, experts say.