ABSTRACT
At the turn of the millennium, the World Health Organization ranked the U.S. health system’s performance at 37 out of 191 countries (WHO 2000). Six years later, the United States was number one in terms of health care spending per capita, but it ranked 43rd for adult female mortality and 42nd for adult male mortality (Doe 2009). In general, the performance of health care service can be assessed by overall responsiveness, measured in terms of patient waiting time and the quality of service. The longer the waiting time for medical intervention, the poorer the service is-a factor that can mean life or death in an emergency department (ED). EDs are considered to be vital components of the nation’s health care safety net (Richardson and Hwang 2001a, 2001b; Weinick and Burstin 2001), and are responsible for 45% to 65% of all hospital admissions (Mahapatra et al. 2003). Most EDs in major areas are overcrowded; there were 119.2 million ED visits in 2006 (Pitts et al. 2008). Accordingly, the potential for performance problems in EDs is critical.
