Consequences of Queuing for Care at a Public Hospital Emergency Department

TLDR

The study aimed to determine whether longer emergency department queues increase the likelihood that patients leave without being seen and whether such departures adversely affect health or subsequent health‑care use. Researchers conducted an observational cohort study at San Francisco General Hospital, surveying all adult patients in English, Spanish, or Cantonese who were waiting for emergency care over one week in July 1990 and following up 7–14 days later to compare those who left without being seen to those who were seen. Among 700 participants, 15 % left without being seen; longer wait times were associated with a higher likelihood of leaving, and those who left were twice as likely to report worsening pain or seriousness at follow‑up, with 27 % returning to an ED and only 4 % requiring hospitalization, indicating that long queues can jeopardize some patients’ health.

Abstract

To determine whether the length of a queue at a public hospital emergency department was associated with increased likelihood of patients' leaving without being seen by a physician and whether leaving adversely affected patients' health or affected their subsequent use of health care services.Observational cohort. Patients were surveyed during 1 week in July 1990 and received a follow-up survey 7 to 14 days later. The responses of patients who left without being seen by a physician were compared with those who were seen by a physician.Emergency department at San Francisco (Calif) General Hospital.All English-, Spanish-, and Cantonese-speaking adults waiting for emergency care were eligible. Of 882 eligible individuals, 700 agreed to participate; 85% of enrolled subjects saw a physician and 15% left without being seen. Demographic characteristics of patients who were and who were not seen were not significantly different.Emergency department waiting time and changes in patients' self-reported health.Patients were more likely to leave as waiting times increased. At follow-up, patients who left without being seen were twice as likely as those who were seen to report that their pain or the seriousness of their problem was worse. Only 4% of patients who left required subsequent hospitalization, but 27% returned to an emergency department.Many patients can appropriately decide whether their problem is truly urgent and make alternative plans in the face of long waits, but the health of some patients may be jeopardized by long queues for emergency care.