ER Waiting Times

Here is an interesting Baltimore Sun web blog piece that picked up on an article in the Archives of Internal Medicine.  The key point is that ER waiting times are getting longer.  Many people who present to ERs are not seen in the recommended time from when the present.  People are receiving poor quality of care as a result.

Is this news?  Not particularly.

Is this all the fault of the hospitals?  No.  Many patients are using the ER for reasons that may not be truly emergency situations.  The incentives for them to go elsewhere (from limited medical care provider office hours, to a lack of insurance for medical care provider office visits, to a lack of time off from work) are limited.  Perhaps we could do things to change the incentives as part of health care reform--covering urgent care clinics would help.

However, let us also consider the supply side.  With a relatively fixed physical plant, what we may be seeing are diseconomies of scale.  In other words, as the output grows, the efficiency with which the visits are being produced decreases.  As the ER's operate within a fixed space to serve a growing number of patients, the providers who are attempting to provide the care find themselves unable to provide the care as efficiently.  Sometimes having more patients come through can actually be associated with a decreased average cost per patient.  At some levels this can lead to greater specialization and provide opportunities for useful coordination.  However, we are seeing the costs increase as the individuals stay longer and the coordination of skills and personnel needed is more difficult when the organization is basically at capacity.

We will likely continue to see the time for and cost of ER visits increase until we provide greater incentives for patients to obtain  non-emergency care elsewhere.