Emergency room wait times in Massachusetts are longer than national average

Printed from: https://newbostonpost.com/2016/06/27/emergency-room-wait-times-in-massachusetts-are-longer-than-national-average/

Despite a national reputation for excellence, Massachusetts hospitals lag behind the rest of the nation in emergency room wait times – by as much as 10 minutes in some instances, according to federal data for 2015 reviewed by the NewBostonPost.

The greatest discrepancy is among local hospitals with high-volume ERs – between 40,000 and 60,000 patients a year. The average wait time in these hospitals is 42 minutes, compared with a national average of 29 minutes. The gap narrows slightly for medium-volume emergency departments – 20,000 to 40,000 patients annually – where the state average is 36 minutes, compared to 25 minutes nationally, according to the Centers for Medicare and Medicaid Services.

It is a given in the world of health care that in emergency situations, minutes matter a great deal. For patients with mild symptoms masking underlying serious conditions – such as a heart attack or a stroke – minutes can mean the difference between life and death.

About half of the 64 Massachusetts hospitals that have emergency rooms reported wait times between 20 and 50 minutes for the fiscal year that ended June 30, 2015. But in some hospitals the delay can be more than an hour. (“Wait time” is defined as the time it takes for a patient who arrives at an emergency room to see a doctor or physician assistant.)

The longest wait times in the state for 2015 are found at the Massachusetts Eye and Ear Infirmary in Boston, at 92 minutes, followed by Boston Medical Center, where the median wait time was 91 minutes. The Massachusetts Eye and Ear Infirmary emergency room handles only specialized eye, ear, nose and throat (ENT) care, making comparison to general-service ERs somewhat less meaningful. Delays at the infirmary stem in part from specialized tests run on ER patients as well as patients who are referred to the infirmary from other hospitals, according to a Massachusetts Eye and Ear Infirmary spokeswoman.

A spokeswoman at Boston Medical Center said the center’s longer wait times are due in part to the hospital taking a large portion of the city’s trauma victims as well as city residents who have chronic diseases, complicating and prolonging their care. The hospital, which has 60,000 emergency room visits a year, has seen a significant rise in both patients who bring themselves to the emergency room and those who are taken there, according to the spokeswoman, Ellen Slingsby.

Wait times do matter – but Slingsby insisted that patients with serious life-threatening conditions are not affected. “This measure absolutely matters. ED [Emergency Department] wait times have an impact on the patient experience, which we take very seriously,” she said. “While we are confident that longer wait times are not impacting patient care as all patients are triaged upon arrival and life-threatening issues are addressed immediately, longer waits do affect a patient’s overall satisfaction with their hospital experience.”

In fact, since the release of the new Medicare data, she noted that the wait time has been cut nearly in half – 45 percent to be precise – though final numbers for the 2016 fiscal year are not yet available.

Slingsby said Boston Medical Center has taken a number of steps to shorten wait times – including assigning a doctor or physician assistant to triage patients, moving the check-in desk to a more convenient location and increasing staffing.

“Currently, BMC is undergoing a clinical campus redesign, including a new, larger Emergency Department, and we are confident that this new ED, along with various processes and policies that we have put in place in the past year to improve inpatient and ED patient flow, will help us further reduce wait times,” Slingsby said.

At the other end of the spectrum, some Bay State hospitals have far shorter wait times than the national average. Tied for the shortest wait times are the Cambridge Health Alliance in Cambridge and Harrington Memorial Hospital in Southbridge, at 7 minutes – and that’s despite having very high and medium patient volumes, respectively.

Not all Massachusetts hospitals lag national averages as badly as the higher volume ERs. The average for Bay State hospitals with low-traffic ERs is 22 minutes, just one minute longer than the national average. Roughly half a dozen hospitals in the state are classified as low traffic.

Hospital wait times are driven less by demographics and other factors than the internal dynamics of the local health-care system, said Dr. Howard Mell, a spokesman for the American College of Emergency Physicians.

Mell said the biggest cause of delays is patients who are awaiting transfer to a larger hospital or other facility that offers the specialized care those patients need. “The problem is not getting them in – it’s getting them out,” Mell said in an interview with the NewBostonPost.

As long as the receiving hospital cannot accept that patient, he or she remains in the emergency room, reducing the number of beds and the availability of nurses and doctors to tend to other patients. Among those transfers, psychiatric patients are the biggest burden, said Mell, who is a practicing emergency physician in North Carolina. The delays can stretch from many hours to even several days, he said.

“There’s nothing you can do,” Mell said. “You just hunker down. You try to be creative.”

Transfer delays can also affect the care of patients waiting to be taken to the specialized facility. For example, a 2011 study by researchers at Duke University found that heart attack patients awaiting transfer for surgery or other treatment had a 5.9 percent mortality rate if delays lasted longer than 30 minutes. Those transferred in less than 30 minutes had a 2.7 percent mortality rate.

Because the sending hospital does not have control over transfer delay, Mell said, a better measure of its effectiveness may not be ER wait time as much as the total time it takes for someone in an emergency room to be admitted at that hospital as a patient – a measure that reflects factors such as, for example, how coordinated housekeeping and nursing staff are.

Medicare recommends four hours from arrival to patient admission. At Boston Medical Center, the average time is 6.8 hours. The statewide the average is 6.4 hours, compared with a nationwide average of 5.7 hours for hospitals with comparable emergency rooms, according to the Medicare data.

Other factors that affect both wait times and admission time include the number of beds available, nursing staffing levels, and the efficiency of the electronic medical records system in use by the hospital, Mell said. Local demographics are not a factor in delays because they do not change dramatically from year to year and so are something for which emergency department managers can plan ahead, he said.

Er Wait Times Public Alt2 by Abigail Adams