Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997–2004

Wilper, Andrew P.; Woolhandler, Steffie; Lasser, Karen E.; McCormick, Danny; Cutrona, Sarah L.; Bor, David H.; Himmelstein, David U.

doi:10.1377/hlthaff.27.2.w84

Cited by 159 publications

(130 citation statements)

References 11 publications

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“…Due to growing demands and reductions in the number of physicians, nurses and beds, EDs are often overcrowded (Burt and Schappert 2004). The overall median wait to see an ED physician increased from 22 minutes in 1997 to 30 minutes by 2004 (Wilper et al 2008). A number of factors can contribute to delays.…”

Section: Delays and The Ed-icu Interfacementioning

confidence: 99%

The Impact of Delays on Service Times in the Intensive Care Unit

Chan¹,

Farias

Escobar

2017

Management Science

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Mainstream queueing models are frequently employed in modeling healthcare delivery in a number of settings, and further used in making operational decisions for the same. The vast majority of these queueing models assume that the service requirements of a job are independent of the state of the queue upon its arrival. In a healthcare setting, this assumption is equivalent to ignoring the effects of delay experienced by a patient awaiting care. However, it is only natural to conjecture that long delays may have adverse effects on patient outcomes and can potentially lead to longer lengths of stay (LOS) when the patient ultimately does receive care. At a very coarse level, prior research confirms these natural conjectures. This work sets out to understand these delay issues from an operational perspective. In particular, using data of nearly 6,000 Emergency Department (ED) visits, we use an instrumental variable approach to empirically measure how congestion in the Intensive Care Unit (ICU) can lead to delays in boarding from the ED to the ICU and measure the impact on the patient's ICU LOS.Capturing these empirically observed effects in a queueing model is challenging as the effect introduces potentially long range correlations in service and inter-arrival times. As such, we consider the problem of how to incorporate these measured delay effects into a queueing model and characterize approximations to various quantities of interest when the service time of a job is adversely impacted by the delay experienced by that job. Our findings suggest that this delay effect can be substantial and ignoring it when using queueing models to model healthcare delivery systems may result in significant under-provisioning.

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Section: Delays and The Ed-icu Interfacementioning

confidence: 99%

The Impact of Delays on Service Times in the Intensive Care Unit

Chan¹,

Farias

Escobar

2017

Management Science

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“…[2] Hospitals increasingly are held accountable for quality performance in terms of public transparency and reimbursement. [13] As a result, hospitals have many incentives to improve ED efficiency to reduce incidents of overcrowding and the subsequent negative influences on both hospital and patient.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department wait time sharing: Do patients contribute to efficiency?

McDougal

OʼConnor

Landry

et al. 2017

JHA

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Objective: Inefficiency commonly results in overcrowding of the Emergency Department (ED) and is a problem for many hospitals. When a condition of overcrowding exists, it is often associated with lower patient satisfaction, lower care quality, and decreased financial position of the hospital. To improve patient throughput efficiency, hospitals use a variety of strategies including posting ED wait times on the hospital website and the use of ED reservation systems. This study investigates these two hospital strategies used to inform patients of anticipated wait times in the ED and their associations with patient throughput efficiency. Methods: The study employs bivariate and Ordinary Least Squares (OLS) regression models to explore the associations between ED efficiency, measured by time spent in the ED, and ED wait times posted on the hospital website (Wait Times on Website) and ED time efficiency and the use of ED reservation systems. The sample includes all 176 acute care hospitals with an ED located in Florida.Results: The results of this study support that posting ED wait times has a statistically significant association with time spent in the ED; however, we did not find an association between the use of a reservation system and time in the ED. Furthermore, the control variables of hospital licensed bed size, metropolitan location, percent of population without health insurance, and percent of population Medicaid eligible were found to have associations with time spent in the ED. Conclusions: This study supports that hospitals should inform patients of anticipated ED wait times. Methods to share wait times should include posting on the hospital website, billboards, or other means to increase the likelihood of informed patients. With anticipated wait time information, the patient has the opportunity to engage in rational decision making that will positively affect ED efficiency. Healthcare leaders, including hospital administrators and ED managers, are encouraged to identify and implement better ways to inform patients of hospital performance metrics to create the opportunity for greater patient decision engagement.

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“…First, demographic shifts have led to increased use of the ED by patients with advanced chronic illness. [29][30][31] Over 75% of older adults visit the ED in their final 6 months of life, and 51% have at least one visit in their last month of life. 32 There is also a high prevalence of unmet PC needs among ED patients.…”

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confidence: 99%

Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

et al. 2015

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Background: The emergency department (ED) is increasingly used by patients with life-limiting illness. These patients are frequently admitted to the hospital, where they suffer from poorly controlled symptoms and are often subjected to marginally effective therapies. Palliative care (PC) has emerged as the specialty that cares for patients with advanced illness. PC has been shown to reduce symptoms, improve quality of life, and decrease resource utilization. Unfortunately, most patients who could benefit from PC are never identified. At present, there exists no validated screening tool to identify significant unmet PC needs among ED patients with life-limiting illness.

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Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997–2004

Cited by 159 publications

References 11 publications

The Impact of Delays on Service Times in the Intensive Care Unit

The Impact of Delays on Service Times in the Intensive Care Unit

Emergency Department wait time sharing: Do patients contribute to efficiency?

Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

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