Opinion: Our view on medical treatment: Ailing ERs threaten patients, leave communities vulnerable


EmergencyOn the night of her baby’s seizure in February, Brandy Nannini discovered a harsh reality of today’s overtaxed medical system. The ambulance crew that responded to her 911 call refused to take 23-month-old Bella to a nearby Washington, D.C., hospital where her doctor was waiting. The emergency room was so crowded it was closed to new patients. Despite Nannini’s pleas, the ambulance was diverted to suburban Virginia.

Bella got to a hospital in time. But Nannini, who has insurance but goes to the ER often because of her child’s seizures, was shocked that emergency rooms could simply close.

They can, and they do. In fact, they have little choice. Once a rare safety valve, “diversions” to other hospitals have become routine. And they are just one symptom of an emergency system that is sick.

Rising health care costs have forced hundreds of hospitals out of business, mostly in poorer areas, putting pressure on those that remain. They, too, are racing to trim costs, and there’s little incentive to focus on ERs, which are not money-makers. So the sickest patients are endangered, and communities are left unprepared for disasters, whether a bus crash, a hurricane or a terror attack.

You don’t need a medical degree to identify the symptoms: Waiting rooms are often standing-room-only, corridors clogged with patients on gurneys. Waiting times are longer, even for heart attack patients: One in four waits nearly an hour to be seen by a doctor. ER patients so sick they’re already admitted to the hospital still could wait hours parked in emergency room corridors for inpatient beds to open up. In a survey last year by the American College of Emergency Physicians (ACEP), 13% of ER doctors said they knew of a patient who died because of that practice.

In a report last month, ACEP called on hospitals to make several common-sense changes to fix the ER mess:

Move admitted patients from the ER to other departments, even when beds aren’t available. That has been standard practice at Stony Brook University Medical Center in New York since 2001 and it benefits everyone, says Peter Viccellio, director of the emergency department. It takes the heat off the ER so doctors there can do their jobs, and patients get the specialized care they need.

Spread the scheduling of elective surgeries through the week, instead of stacking most on Monday through Wednesday. That might annoy surgeons, but it has opened more inpatient beds and alleviated congestion at Boston Medical Center, home to one of the most crowded ERs in the nation.

Coordinate the discharge of hospital patients by noon, which helps to open beds.

Too few hospitals have followed the leaders in making these changes. It’s easier to leave the burden in one spot, the ER, rather than spread the pain around the hospital.

The American Hospital Association prefers to suggest that the crisis is about the uninsured using ERs for primary care and that only “fundamental reform” will help.

That aspect of the problem, while real, is overstated. According to the National Center for Health Statistics, less than 14% of ER patients come for non-urgent needs, while 70% require immediate or semi-urgent care. (The other 16% were not tracked.) Yes, major health care reform is needed, but the ER crisis is one hospitals could ease themselves.

ERs have been at the breaking point for several years, an Institute of Medicine study found in 2006. Bella Nannini, now 2 years old, and millions of others are waiting for hospitals to do something about it.

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