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Article
August 28, 1991

Consequences of Queuing for Care at a Public Hospital Emergency Department

Author Affiliations

From the Division of General Internal Medicine (Dr Bindman and Mr Keane) and the Quality Assurance Department (Dr Luce), San Francisco (Calif) General Hospital; and the Departments of Medicine (Drs Bindman and Luce) and Family and Community Medicine (Dr Grumbach), the Institute for Health Policy Studies (Drs Bindman, Grumbach, and Luce), and the Joint Medical Program (Mr Rauch), University of California, San Francisco. Dr Grumbach was a Pew Health Policy Fellow at the time this study was performed

From the Division of General Internal Medicine (Dr Bindman and Mr Keane) and the Quality Assurance Department (Dr Luce), San Francisco (Calif) General Hospital; and the Departments of Medicine (Drs Bindman and Luce) and Family and Community Medicine (Dr Grumbach), the Institute for Health Policy Studies (Drs Bindman, Grumbach, and Luce), and the Joint Medical Program (Mr Rauch), University of California, San Francisco. Dr Grumbach was a Pew Health Policy Fellow at the time this study was performed

JAMA. 1991;266(8):1091-1096. doi:10.1001/jama.1991.03470080061030
Abstract

Objective.  —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.

Design.  —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.

Setting.  —Emergency department at San Francisco (Calif) General Hospital.

Patients.  —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.

Main Outcome Measures.  —Emergency department waiting time and changes in patients' self-reported health.

Results.  —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.

Conclusion.  —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.(JAMA. 1991;266:1091-1096)

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