A new study finds that the longer patients wait for care at emergency departments, the worse their outcomes.
Dr. Astrid Guttmann, a pediatrician at the Hospital for Sick Children and one of the study's authors, says the vast majority of people who show up at hospital emergency rooms are seen by a doctor and then discharged. But little is known about how delays from overcrowding at ERs affects these patients afterwards.
So she and a team from the Institute for Clinical Evaluative Sciences reviewed more than 14 million emergency room visits in Ontario between 2003 and 2008. They found that almost two per cent of the visits were associated with either a death or the need for the patient to be admitted into hospital within seven days of the ER visit.
"The vast majority of patients were those who were seen and discharged, and a small percentage were those who left without being seen," Guttman told CTV News.
The longer that these patients had to wait to see a doctor at the ER the first time, the worse their eventual outcome.
Patients who were seen in shifts during which wait times were six hours or longer were more likely to suffer "an adverse event," such as death or the need for hospital admission.
For patients needing acute care, the risk of death was 79 per cent higher if they arrived at the emergency room during a shift when waits were six hours or more, compared with those with one-hour waits. Their risk for admission into hospital was also 95 per cent higher during such shifts.
Even among less sick patients, the relative increase in risk of death was 71 per cent higher, and 66 per cent higher for admission, during shifts with a length of stay of more than six hours.
Interestingly, patients who left the emergency room after checking in but without being seen by a doctor did not have a higher risk of death or the need for admission, compared with patients who were seen by a doctor and discharged.
The study appears in the online edition of the BMJ.
Guttmann says the findings suggest reducing emergency room wait times needs to remain a priority, while reducing left-without-being-seen rates may be less important.
The researchers suggest that when ERs are overcrowded, usual "processes of care" are sometimes abandoned.
"Examples might include reluctance to order time-consuming tests or consultations and shortened observation periods (both of which could increase missed diagnoses), incomplete treatment, or inadequate planning and communication of care after discharge," they wrote.
Experts say factors ranging from the severity of patients' ailments to strained hospital resources can compromise patient outcomes.
"ER overcrowding is just a symptom of hospital overcrowding," Dr. Peter Toth of the Canadian Association of Emergency Physicians told CTV News.
Some provinces have taken to posting ER wait times online, to tell patients which hospitals have the worst backlogs. There is also an experiment in the United States that involves tracking emergency room patients in real time in the hope of improving care.
"This system allows us to track where the patients are in the process of checking in, going to the lab and seeing their physician and having a procedure done," said Dr. Eric Klein of the Cleveland Clinic.
With a report from CTV's Scott Laurie
