Waiting times in California's emergency departments.
OBJECTIVE
Many perceive emergency department crowding as a significant problem that is getting worse. A national survey of ED directors defined crowding, in part, as waiting more than 1 hour to see a physician, a wait considered likely to result in adverse outcomes. Yet few data are available on ED waiting times among a heterogeneous group of hospitals serving a distinct geographic region.


METHODS
We observed a random sample of 1,798 patients visiting 30 California EDs between December 15, 2000, and May 15, 2001. We defined waiting time as the interval from ED arrival to first contact with a physician or midlevel provider.


RESULTS
Patients waited an average of 56 minutes (95% confidence interval [CI] 52 to 61 minutes; median 38 minutes); 42% waited longer than 60 minutes. Ordinary least squares regression analysis revealed that waiting times were significantly longer at hospitals in poorer neighborhoods: For every 10,000 dollars decline in per capita income, patients waited 10.1 minutes longer (95% CI 1.8 to 18.4 minutes; P=.02) after adjusting for hospital ownership, teaching status, trauma status, proximity to a recently closed ED, ED volume, patient severity, and age. Lower ratios of physicians and triage nurses to waiting room patient were also associated with longer waits.


CONCLUSIONS
Waiting times often exceeded the threshold set by a survey of ED directors. Further study is required to examine factors that lead to longer waiting times at hospitals in low-income areas. Physician and nurse staffing should be investigated as a means of reducing waiting times.
Lambe
Susan
S
Robert Wood Johnson Clinical Scholars' Program, University of California, Los Angeles, CA 94143, USA. slambs@itsa.ucsf.edu
Washington
Donna L
DL
Fink
Arlene
A
Laouri
Marianne
M
Liu
Honghu
H
Scura Fosse
Jessica
J
Brook
Robert H
RH
Asch
Steven M
SM
D000367:Age Factors; D000368:Aged; D000465:Algorithms; D002140:California; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D007182:Income; D017060:Patient Satisfaction; D011897:Random Allocation; D012044:Regression Analysis; D012494:Sampling Studies; D013997:Time Factors; D017748:Time Management; D013996:Time and Motion Studies; D014193:Trauma Centers / Q000592:standards; D014218:Triage; D000078329:Workforce