RENEE MONTAGNE, host:
A disturbing trend in hospital emergency rooms has emerged from a new study - longer wait times even for the very sick. That finding follows a recent report from the Institute of Medicine that describes ERs as being, quote, "at the breaking point."
Here's NPR's Joanne Silberner.
JOANNE SILBERNER: It's hard to find anyone connected with emergency room care who thinks things are working well. Certainly not. Dr. Art Kellermann, professor of emergency medicine at Emory University and a member of the Institute of Medicine Committee that wrote the earlier report. He's seen the increasing wait times firsthand.
Dr. ART KELLERMANN (Department of Emergency Medicine, Emory University School of Medicine): People like to criticize the United Kingdom and Canada for long waits for elective surgery like knee operations. But these are the waits that matter - the wait for heart attack care, the wait when you're having an emergent condition and arrive at an ER. That can make the difference between life and death.
SILBERNER: The new study used data from a federal survey of 92,000 emergency room visits from 1997 to 2004. Andrew Wilper, an internist with the Cambridge Health Alliance, is one of the authors of the study being released online today by the journal, Health Affairs.
Dr. ANDREW WILPER (Internal Medicine, Cambridge Health Alliance): What we found was that the amount of time that patients are waiting to see the doctor is increasing. And not only as the wait increasing, but waits are increasing for patients presenting with what may be severe illness.
SILBERNER: A severe illness like a heart attack. In 1997, heart attack patients got in to see a doctor within just eight minutes. In 2004, they have to wait more than double that time.
When the researchers averaged of the waiting times for everything from strokes to sprained ankles, they discovered that typical ER patient was waiting 36 percent longer to see a doctor in 2004 than in 1997. Wilper also looked at the way times for all sorts of emergency conditions from minorities and women.
Dr. WILPER: We found that blacks and Hispanics wait longer to see the doctor in the emergency room. Blacks waited about 13 percent longer whereas Hispanics waited about 14 percent longer than whites, and that women had a longer wait as well, about five percent difference as compared to men.
SILBERNER: Wilper and the other experts say the longer wait time for blacks and Hispanics was probably because minorities were more likely to wind up in under funded inner city hospitals and those at the ERs that are most likely to be overcrowded. Whether patient could pay the bills, was not a factor.
Dr. WILPER: Insured, uninsured, it doesn't matter. 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 going to wait longer to see the doctor when you go there.
SILBERNER: Wilper thinks patients are waiting longer because those who can't find or afford a family doctor are crowding the emergency room instead. Art Kellermann says, no, the problem is the backup the patients.
Dr. KELLERMANN: Hospitals are not moving the most ill and injured, the ones that we stabilized hours ago, maybe even days ago, out of the ER and upstairs to an intensive care unit or in-patient bed because the hospital is full or because they're holding their beds for elective patients.
SILBERNER: Hospitals make more money on people who come in for elective surgeries. Kellermann says something needs to be done for patients who were waiting, sometimes in pain - now, and for patients in the future.
Dr. KELLERMANN: If you can't get a single heart attack patient to care in time, how are you going to handle hundreds or even thousands of victims of the terrorist strike?
SILBERNER: What got him especially worried is that the federal government has plans to cut payments to the very hospitals that have the busiest ERs, instead of increasing their funding, as expert panels have suggested.
Joanne Silberner, NPR News.
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