"Emergency Department"

Potential for Improvement in Emergency Department Timeliness

Bottom Line:

Variability exists in emergency department (ED) timeliness based on four variables (hospital size, rural vs. urban, ownership and teaching status) reported to the Centers for Medicare & Medicaid Services for patients discharged from the ED or admitted for inpatient services.


Sidney T. Le, B.A., and Renee Y. Hsia, M.D., M.Sc., of the University of California, San Francisco.


The Centers for Medicare & Medicaid Services made several quality measures of ED timeliness available online to provide a national look at the ability of EDs to provide timely care.

How the Study Was Conducted:

The authors examined ED measurements of timely care and looked at whether hospital characteristics or patient populations were associated with poor timeliness of ED care. Their study, which was reported in a research letter, included a sample of 3,692 hospitals, most of them nonteaching, private nonprofit hospitals in urban areas.

"Emergency Department"
Emergency Department


For patients ultimately discharged from the ED, the median wait time to see a health care professional was about 30 minutes and the length of stay just over two hours. For patients who were admitted, the median length of stay in the ED was more than four hours, approximately one-third of which was “boarding” (waiting for an inpatient bed). Lengths of stay for patients discharged from the ED were longer at large hospitals (158.2 minutes) than hospitals of other sizes and urban hospitals (149.2 minutes) compared with those in other areas. Public hospitals (149.5 minutes) and major teaching hospitals (172.6 minutes) had the longest length of stays compared with other hospitals based on ownership and teaching status.


“Given the variation in hospital ED performance, our results suggest a potential for improvement in ED timelines. However, if these measures are translated into pay-for-performance incentives, the financial pressures faced by larger, urban, major teaching, public hospitals may be exacerbated.”


JAMA Intern Med. Published online September 15, 2014. doi:10.1001/jamainternmed.2014.3431.

Editor’s Note:

This study was supported by an American Heart Association National Clinical Research Program Award. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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