Waiting times in California's emergency departments☆☆☆
Presented as an abstract at the Robert Wood Johnson Foundation Clinical Scholars' annual meeting, Fort Lauderdale, FL, November 2001.
Received 13 December 2001; received in revised form 20 May 2002; accepted 1 July 2002.
Abstract
Study objective: Many perceive emergency department crowding as a significant problem that is getting worse. A national survey of ED directors defined crowding, in part, as waiting more than 1 hour to see a physician, a wait considered likely to result in adverse outcomes. Yet few data are available on ED waiting times among a heterogeneous group of hospitals serving a distinct geographic region. Methods: We observed a random sample of 1,798 patients visiting 30 California EDs between December 15, 2000, and May 15, 2001. We defined waiting time as the interval from ED arrival to first contact with a physician or midlevel provider. Results: Patients waited an average of 56 minutes (95% confidence interval [CI] 52 to 61 minutes; median 38 minutes); 42% waited longer than 60 minutes. Ordinary least squares regression analysis revealed that waiting times were significantly longer at hospitals in poorer neighborhoods: For every $10,000 decline in per capita income, patients waited 10.1 minutes longer (95% CI 1.8 to 18.4 minutes; P =.02) after adjusting for hospital ownership, teaching status, trauma status, proximity to a recently closed ED, ED volume, patient severity, and age. Lower ratios of physicians and triage nurses to waiting room patient were also associated with longer waits. Conclusion: Waiting times often exceeded the threshold set by a survey of ED directors. Further study is required to examine factors that lead to longer waiting times at hospitals in low-income areas. Physician and nurse staffing should be investigated as a means of reducing waiting times. [Ann Emerg Med. 2003;41:35-44.]
Robert Wood Johnson Clinical Scholars' Program, University of California, Los Angeles, CA; the Department of Medicine, VA Greater Los Angeles Healthcare System, University of California, Los Angeles, CA; the Department of Medicine and Public Health, University of California, Los Angeles, CA; the California HealthCare Foundation, Oakland, CA; the Division of General Internal Medicine, University of California, Los Angeles, CA; and the Department of Medicine and Health Services, University of California, Los Angeles, CA, and RAND Health, Santa Monica, CA.
☆ This project was commissioned by the California HealthCare Foundation. Dr. Lambe was a Robert Wood Johnson Clinical Scholar when this work was conducted. Dr. Washington had a Robert Wood Johnson Minority Medical Faculty Development Program Career Development award during this project. Dr. Asch is a recipient of a Veterans' Administration Health Services Research and Development Career Development Award.
☆☆Address for reprints: Susan Lambe, MD, Division of Emergency Medicine, University of California, San Francisco, Box 0208, 505 Parnassus Street, San Francisco, CA, 94143; 415-353-1634,fax 415-353-1799; E-mail slambe@itsa.ucsf.edu
ABSTRACT