Fast Treatment Rare in Emergency Departments, Survey Says

ERs in some states improved; others leave patients waiting eight hours or more.

July 25, 2010— -- A patient waiting in a typical emergency department would have time to watch more than four one-hour long episodes of the iconic television show "ER," according to a survey by a national hospital consulting firm.

The average time a patient spent in the emergency department ticked up by four minutes from 2008 to 2009, which brought the total time to four hours and seven minutes, an increase of 31 minutes since 2002, according to the 2010 Emergency Department Pulse Report by Press Ganey, a hospital consulting firm.

The findings were based on survey results from 1.5 million patients.

The uptick follows a decrease of two minutes reported in last year's report on 2008 ED wait times.

Despite the increase, there were signs of improvement, with 17 states reducing their average wait time and 15 keeping increases to five minutes or less.

Patient satisfaction, which has improved over the past five years, remained high, but stagnated from about October 2008 through the end of 2009, according to Christina Dempsey, Press Ganey's vice president of clinical and operational consulting and a registered nurse.

"One year ago it appeared that this country's emergency care was robust despite the challenges of the current recession," she said on a conference call with reporters. "Perhaps the loss of jobs, loss of insurance, and [emergency department] overcrowding resulting from the recession has finally taken its toll."

Exacerbating the situation was a trend in recent decades of fewer hospitals with EDs trying to care for a greater number of patients.

Press Ganey surveyed 1,501,672 patients treated at 1,893 hospitals in 2009. Only patients who were discharged from the emergency department received a survey.

Although wait times increased, on average, by four minutes, certain states far exceeded that.

The worst performing state was Utah, which had an increase of 89 minutes in its average time spent in the ED. That brought the total time to eight hours and 17 minutes, two hours and 34 minutes longer than the state with the next longest wait time -- Kansas at five hours and 43 minutes.

The state that improved the most was Nevada, which cut its average wait time by 66 minutes. That brought the state's ranking to 37th from 43rd the year before.

Iowa had the shortest average wait time at two hours and 55 minutes, a decrease of seven minutes from 2008.

According to Dempsey, one way to reduce the time patients spend in the ED is to address bottlenecks in other areas of the hospital, particularly the operating rooms.

By smoothing the schedule of elective surgeries by scheduling procedures for non-peak times of day, fewer patients would have to wait in the ED for available beds.

But even with wait times ticking upward, patient satisfaction remained high, with an overall score of 84 on a scale of 100.

About two-thirds (65.7 percent) of patient comments were positive.

In general, satisfaction dipped with longer wait times, but other factors, like communication from hospital staff about delays, mitigated some of the effects.

For example, patients who spent six or more hours in the ED but reported very good communication about delays gave a satisfaction score of 96.6. Patients who were in and out of the ED in less than an hour but reported poor communication about delays gave a satisfaction score of just 41.0.

Improving comfort in the waiting room had a similar effect.

The top three priorities for improvement, according to the patients, were the same in 2009 as in 2008 -- keeping them informed about delays in care, controlling their pain, and improving the degree to which staff members care about patients personally.