Astrid Guttman, M.D., M.Sc., Michael J. Schull, Dr.Med., Marian J. Vermeulen, M.H.Sc., and Therese A. Stukel, Ph.D.
Long emergency department (ED) waiting times, research shows, can have an adverse impact on outcomes for high-acuity patients—those who require active monitoring and intervention. However, less is known about the impact of long waits on patients who are less seriously ill, including those who are discharged from the ED without being admitted and those who leave without being seen. In a study that linked records of ED visits to hospitals in Ontario, Canada, with subsequent ED visits, hospitalizations, and deaths, researchers sought to determine if these lower-acuity patients suffer adverse consequences within seven days of ED discharge.
Patients who visited EDs during shifts with longer waiting times were at increased risk of death and admission in the subsequent seven days, regardless of their health status at the time of the initial visit. In contrast, patients who were well enough to leave without being seen were not at higher risk of short-term adverse events. Reducing mean length-of-stay by an average of one hour could have potentially decreased the number of deaths in the study by 6.5 percent among the higher-acuity patients and by 12.7 percent among the lower-acuity patients.
Long wait times delay every stage of treatment, from initial assessment to final decision-making to admission or discharge. Emergency departments should implement interventions that reduce wait times, such as fast-track units for patients with minor complaints and improved access to inpatient beds.