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From Reuters Health Information
Shorter Wait Times in the ED Mean More Patients Stay to See a Doctor
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By Marilynn Larkin
NEW YORK (Reuters Health) Oct 06 - Modest decreases in emergency department (ED) waiting times can have a big impact on whether a patient stays to see a doctor or leaves without being seen, investigators said Monday at the annual meeting of the American College of Emergency Physicians in Boston.
The research is based on an analysis of all visits to the George Washington Hospital ED from 2006-2008. Dr. Mehdi Sattarian and colleagues compared wait times for walk-in patients who left without being seen, either before or after nursing triage, to waiting times (from arrival to hospital bed) for people who arrived at the hospital at the same hour and stayed to see a doctor. They also recorded the total number of patients in the ED treatment area and lobby at the hour's end, and illness severity, Dr. Sattarian said at the Boston meeting.
During the study period, 187,663 patients came to the ED, 128,430 of whom were walk-ins. (The rest came by ambulance.) Of those, 5.2% left without being seen.
Further analysis revealed the proportion of walk-in patients who left without being seen fell from 5.5% in July-December 2006 to 3.5% in July-December 2008. During the same period, mean waiting times for walk-ins decreased from 61.4 to 52.6 minutes.
The drop in the number of patients who left without being seen occurred even while the total number of patients coming to the ED in a given hour increased (from 6.9 patients in 2006 to 7.5 patients in 2008), along with the number of patients left in the ED at the end of that hour (36.5 in 2006, 39.5 in 2008).
"We saw highly significant relationships between the number of people who left without being seen and both waiting times and the total number of patients in the emergency department," Dr. Sattarian told meeting attendees. In email to Reuters Health, he attributed improvements in "front-end processes" -- for example, streamlining registration and triage -- to the decreased waiting times and concomitant increase in the number of people who stayed to see a doctor.
Improving "back-end" processes -- what happens from the time a patient is seen by a doctor to the time they're either admitted or discharged -- could have "an even greater effect" on the number of people who stay to be seen by reducing the overall number of people in the ED, Dr. Sattarian observed.
Those strategies would include decreasing the amount of time it takes for seriously ill people to be moved to a hospital bed, and "improving laboratory and radiology turnaround times," he concluded.
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Reuters Health Information © 2009
