US Emergency Department Performance on Wait Time and Length of Visit
Received 26 May 2009; received in revised form 10 July 2009; accepted 22 July 2009. published online 05 October 2009.
Study objective
Prolonged emergency department (ED) wait time and length of visit reduce quality of care and increase adverse events. Previous studies have not examined hospital-level performance on ED wait time and visit length in the United States. The purpose of this study is to describe hospital-level performance on ED wait time and visit length.
Methods
We conducted a retrospective cross-sectional study of a stratified random sampling of 35,849 patient visits to 364 nonfederal US hospital EDs in 2006, weighted to represent 119,191,528 visits to 4,654 EDs. Measures included EDs' median wait times and visit lengths, EDs' median proportion of patients treated by a physician within the time recommended at triage, and EDs' median proportion of patients dispositioned within 4 or 6 hours.
Results
In the median ED, 78% (interquartile range [IQR], 63% to 90%) of all patients and 67% (IQR, 52% to 82%) of patients who were triaged to be treated within 1 hour were treated by a physician within the target triage time. A total of 31% of EDs achieved the triage target for more than 90% of their patients; 14% of EDs achieved the triage target for 90% or more of patients triaged to be treated within an hour. In the median ED, 76% (IQR 54% to 94%) of patients were admitted within 6 hours. A total of 48% of EDs admitted more than 90% of their patients within 6 hours, but only 25% of EDs admitted more than 90% of their patients within 4 hours.
Conclusion
A minority of hospitals consistently achieved recommended wait times for all ED patients, and fewer than half of hospitals consistently admitted their ED patients within 6 hours.
aCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CT
bSection of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
cDepartment of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT
dRobert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT
Address for correspondence: Leora I. Horwitz, MD, MHS, Section of General Internal Medicine, P.O. Box 208093, New Haven, CT 06520-8093; 203-688-5678, fax 203-737-3306
Please see page 134 for the Editor's Capsule Summary of this article.
Author contributions: LIH, JG, and EHB conceived and designed the study. LIH and JG obtained the data. LIH, JG, and EHB analyzed and interpreted the data. LIH drafted the article, and all authors contributed substantially to its revision. LIH and JG conducted the statistical analysis. LIH takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This publication was made possible by the Clinical and Translational Science Award grant UL1 RR024139 and KL2 RR024138 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH. Dr. Horwitz is supported by Yale-New Haven Hospital and by the NCRR. No funding source had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review, and approval of the article.
Publication date: Available online September 30, 2009.
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