Improve Emergency Care? Pandemic Helps Point the Way

This crowding and its adverse consequences are problems in other countries, too. A 2018 National

This crowding and its adverse consequences are problems in other countries, too. A 2018 National Bureau of Economic Research working paper examined emergency department wait times in England. Beginning in 2004, a policy penalized hospitals if their emergency departments did not complete treatment for the vast majority of patients within four hours, admitting them to the hospital if necessary for subsequent care. Large fines were imposed for failing to meet this target and, in some cases, hospital managers lost their jobs.

The study found that the policy reduced the time a patient spent in the emergency department by 19 minutes, on average, or about 8 percent. It also found a reduction in 30-day mortality of 14 percent and in one-year mortality of 3 percent.

Longer waits can also increase costs, according to a study published last year in Economic Inquiry. A 10-minute-longer wait increases the cost to care for patients with true emergencies by an average of 6 percent. The study took advantage of the fact that emergency department triage nurses make different decisions about how quickly to treat similar patients, which inserts a degree of randomness into their waiting times.

“The longer patients wait, the more their conditions can deteriorate,” said the study author, Lindsey Woodworth, an economist with the University of South Carolina. “Sicker patients cost more to treat.”

A big contributor to crowding, Dr. Burke said, is that some types of patients — in particular those needing behavioral health care — are hard to move out of the emergency department, even when they no longer need to be there. “Many hospitals do not reserve enough beds for behavioral health patients,” she said. “These patients often wait days in the E.D. for definitive care and, by taking up space in the E.D., they delay the E.D. care for other patients.”

Because the bottleneck in this case is the need for more hospital beds for patients with mental health conditions, this is not necessarily a problem that telemedicine can address.

Additionally, many people end up waiting in the emergency department on the advice of other medical providers, though they may not need to. Their problems could be handled elsewhere. Although estimates vary, some studies suggest up to a third of E.D. visits are avoidable.

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