ED's bursting at seams?

[Wichitan]

With mandates forcing the hospital to 'treat' all patients, we have seen an increase in people seeking services in the ED. Number of ED visits has gone by almost by 25% while the ED's have decreased by 15%:

http://www.cdc.gov/nchs/data/ad/ad340.pdf

Not only the uninsured but also the insured are increasingly relying on the ED.

Do you feel that this situation shall ultimately lead to a collapse of our system? How do your hospitals deal with such challenging situations?

What do y'all feel?

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[typeB-md]

the quicker the **** hits the fan the better. i'm just waiting for the moment that EDs will collectively strike for one weekend just to show how screwed up this **** has gotten.

 

[docB]

Do you feel that this situation shall ultimately lead to a collapse of our system? How do your hospitals deal with such challenging situations?

What do y'all feel?

That's an excellent question. I don't think that the system will fail any time soon. ER overcrowding is protected and worsened by the malpractice system. Whenever someone dies sitting in a waiting room or on an ambi gurney waiting for an ER bed the system as a whole and the malpractice system don't look at the problem nationally. They find a local scapegoat, often the ED doc who was on duty, and sue them. Thus the money changes hands and the families are happy but the problem goes on. Remember that the government doesn't care about ED overcrowding. They created the problem with EMTALA. How you deal with that unfunded mandate at the local level is our problem. Rest assured that the OIG and CMS will feel free to rip your guts out if at anytime they think you're not giving out as much free care as they think you should.

 

[NinerNiner999]

Perhaps the installaion of an MD-run triage "EMTALA MSE" booth for the local drunk, high, homeless people with chronic back pain, lower extremity edema, tooth pain, etc could help clear out the waiting room, and make way for the first timers to the ED with chest pain or vomiting blood...

 

[docB]

Perhaps the installaion of an MD-run triage "EMTALA MSE" booth for the local drunk, high, homeless people with chronic back pain, lower extremity edema, tooth pain, etc could help clear out the waiting room, and make way for the first timers to the ED with chest pain or vomiting blood...

My group is being asked (read as forced) to do this by the hospital corporation. This sounds great but it's actually a huge pain and a liability risk. It takes just as long to deal with them as it did before. Since it's an MSE only it doesn't bill for anything. It pisses the pts off and makes them more likely to sue. It looks bad to the jury that you've done an exam to determine that no emergency exists for the purpose of booting the pt out. And as always if something bad happens it's the docs malpractice insurance that gets hit.

 

[NinerNiner999]

It looks bad to the jury that you've done an exam to determine that no emergency exists.

This would be the entire purpose for an MSE according to EMTALA. There is no provision that ALL patients are entitled to treatment, only to a screening exam in an Emergency Department setting to. I would think EMTALA rules would protect this practice from seeing the court.

 

[docB]

This would be the entire purpose for an MSE according to EMTALA. There is no provision that ALL patients are entitled to treatment, only to a screening exam in an Emergency Department setting to. I would think EMTALA rules would protect this practice from seeing the court.

EMTALA doesn't protect you. It's goal is to mandate free care and to stop pt dumping. If you do an MSE and decide there's no emergent condition and the pt goes out and has a bad outcome several things could happen. You could be sued for malpractice for not diagnosing whatever the problem was. This is a completely separate issue from EMTALA. In terms of EMTALA the OIG (Office of Inspector General who investigates EMTALA violations) could say that you did the MSE and decided there was no emergency so even though you were wrong you're good under EMTALA. They could also hose you and it's totally up to them. Due process with the OIG is not like it is in courts. They can do what they want to you and you have to take it.

The bottom line is that if you MSE someone out of your ER you might be OK on EMTALA or you might not. You can definitely be sued for malpractice although you might win your case.