Consequences of queuing for care at a public hospital emergency department.
OBJECTIVE
To determine whether the length of a queue at a public hospital emergency department was associated with increased likelihood of patients' leaving without being seen by a physician and whether leaving adversely affected patients' health or affected their subsequent use of health care services.


METHODS
Observational cohort. Patients were surveyed during 1 week in July 1990 and received a follow-up survey 7 to 14 days later. The responses of patients who left without being seen by a physician were compared with those who were seen by a physician.


METHODS
Emergency department at San Francisco (Calif) General Hospital.


METHODS
All English-, Spanish-, and Cantonese-speaking adults waiting for emergency care were eligible. Of 882 eligible individuals, 700 agreed to participate; 85% of enrolled subjects saw a physician and 15% left without being seen. Demographic characteristics of patients who were and who were not seen were not significantly different.


METHODS
Emergency department waiting time and changes in patients' self-reported health.


RESULTS
Patients were more likely to leave as waiting times increased. At follow-up, patients who left without being seen were twice as likely as those who were seen to report that their pain or the seriousness of their problem was worse. Only 4% of patients who left required subsequent hospitalization, but 27% returned to an emergency department.


CONCLUSIONS
Many patients can appropriately decide whether their problem is truly urgent and make alternative plans in the face of long waits, but the health of some patients may be jeopardized by long queues for emergency care.
Bindman
A B
AB
Department of Medicine, San Francisco General Hospital, CA 94110.
Grumbach
K
K
Keane
D
D
Rauch
L
L
Luce
J M
JM
D000208:Acute Disease / Q000145:classification; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006745:Hospital Bed Capacity, 300 to 499; D006773:Hospitals, Municipal / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012495:San Francisco; D012959:Socioeconomic Factors; D013997:Time Factors; D014218:Triage; D014850:Waiting Lists