Hospital Emergency Rooms Overcrowded

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

lpressley130

*** Angel
10+ Year Member
5+ Year Member
15+ Year Member
Joined
Jul 5, 2004
Messages
115
Reaction score
3
Interesting article...
http://news.yahoo.com/s/nm/20060928/hl_nm/hospitals_dc

Hospital emergency rooms overcrowded


Emergency rooms at U.S. hospitals are becoming stretched as patient visits increase while the number of emergency facilities declines, a new report said.

Almost two-thirds of hospital emergency rooms in U.S. cities are sometimes crowded, according to the report released Wednesday by the U.S. Centers for Disease Control and Prevention.

"In recent years, growth in the use of hospital emergency medical services (ED's) has coincided with a decline in the number of EDs, leading to concerns about the capacity of EDs that continue to operate," said the report.

The annual number of visits to an emergency service rose by 18 percent in the 10 years from 1994, but the number of hospitals operating 24 hours a day decreased by 12 percent over the same time period, it said.

Between 1995 and 2003, the average caseload among operating emergency rooms rose by 78 percent, according to the report.

"Although most of the increase in visits can be explained by growth in the U.S. population, over one-third is accounted for by the growth in per capita use during the last 11 years," it said.

Nursing vacancies up to 5 percent of staff required, higher patient volume and longer patient waiting and treatment times accounted for the crowding, said the report by the CDC's National Center for Health Statistics.

Overall, between 40 percent and 50 percent of U.S. hospitals were sometimes crowded, according to the report, which was based on 2003-2004 data.

As a result, almost one-third of U.S. hospitals reported having to divert an ambulance to another emergency department due to overcrowding or staff shortages, the report said.

An average of 4,500 emergency rooms were operating during that period. More than half saw fewer than 20,000 patients annually, but one in 10 had an annual visit volume of more than 50,000 patients, the report said.
 
I feel like a broken record on this sometimes, but everytime I see one of these threads I'm forced to point out how heavily all of the hospitals in my area advertise their ER services to the public. This is the case in many cities and metropolitan areas. They promise prompt caring service to all comers, and they are terribly overcrowded. If you advertise, they will come. What do you expect?
 
I feel like a broken record on this sometimes, but everytime I see one of these threads I'm forced to point out how heavily all of the hospitals in my area advertise their ER services to the public. This is the case in many cities and metropolitan areas. They promise prompt caring service to all comers, and they are terribly overcrowded. If you advertise, they will come. What do you expect?

The problem is that, because of EMTALA, the ED has to treat all comers. Now, if you are in an area with a "bad payor mix", that is a high percentage of medicare / medicaid and uninsured, you have to advertise to bring in more "customers" with insurance just to pay the bills. Of course, you can not advertise directly for "insured people", so you just have to become a volume business (since a fair amount of the costs are fixed anyway e.g., med mal insurance, physical plant overhead, nursing and physician salaries, etc.).

Downstream ramifications of EMTALA...

- H
 
I try to tell patients, gently and professionally, that "emergency" does not always mean "fast." We have an Urgent Care two blocks away, and it's open from 9am to 7pm every day. They're about seeing people quickly and efficiently. We're about taking care of life-threatening situations... so if you are at the top of our priority list, it means there is something very, very bad happening to you.

I can't be that blunt about it, of course. And I don't really blame most patients; they do not get enough news stories like this one, and for all I know there is advertising in my area too that encourages the idea that the ED is a big walk-in clinic.

I do feel bad for people who say, "man, I've been here for six hours." I've been an ED patient. It sucks. But knowing what I know, I'm happy to be the guy reading a book he brought along, waiting for lab results. I never say, "you're here for hours because the place is clogged with people who should be at Urgent Care or their PMD instead." And I never, ever say, "...and you might be one of them!"

The whole situation stinks, basically.
 
I never say, "you're here for hours because the place is clogged with people who should be at Urgent Care or their PMD instead." And I never, ever say, "...and you might be one of them!"
I frequently tell people that they are using the ER inappropriately for primary care. I explain that they should see their PMD or go to an urgent care. If they are truly silly there is a process at my hospitals where I designate them as "non emergent" and they are required to provide proof of insurance or make a deposit ($200) prior to treatment. Without any education these people can't learn and have no incentive to seek a more appropriate level of care.
 
They know it will be free.

some may not be able to afford the care. I understand that.
but if you pull up to the ED in your suv or your pack of smokes, you should not be there unless it is a real emergency.
 
problem #1 there is no money to be made in running a hospital

I read alot about how people think EMTALA is a problem so if it is how would it be rewritten to fix the problem?
 
It can be fixed EXACTLY as someone said above.

1) Tell them they are none emergent and that they need to go to an Urgent Care center or their PMD.

2) If they insist on being treated there they will need to show proof of insurance and pay $200 upfront for utilizing an emergency department for a none emergency..

When someone calls 911 for a none emergency, they get fined or arrested (don't know the exact rules for calling 911 as a prank).... so why shouldn't hospitals penalize people who come to the ER for a none ER. Heck, you might see it in the future... the government stops refunding ERs for none ERs because they want to see patients go to their PMD or Urgent Care which is cheaper to recompensate.
 
That will be the day when EMS can do a reverse refusal on a patient. I'm no fool but it does exsist in some places but wide spread, never. Not to mention we now and probaby not within the next 10 years will have means to be able to judge people "non-emergent" enough to turf to Urgent Care, or PMD.

Anyone recall the first National Scope of EMS that came out about a year ago? Had an Advanced Paramedic level that would have really helped ED overcrowding. Imagine having a unit that could respond to these "non-emergent" calls and do the turfing. To bad the nursing lobby put the sqeeze on it and its all but gone on the rewrite. Mabye the answer would be field doc's and PA's that would do this. Regardless there will always be the 80% of patients that are BS and its all a matter of how we respond to them, and clearly the current system isn't working.
 
That will be the day when EMS can do a reverse refusal on a patient. I'm no fool but it does exsist in some places but wide spread, never. Not to mention we now and probaby not within the next 10 years will have means to be able to judge people "non-emergent" enough to turf to Urgent Care, or PMD.

Anyone recall the first National Scope of EMS that came out about a year ago? Had an Advanced Paramedic level that would have really helped ED overcrowding. Imagine having a unit that could respond to these "non-emergent" calls and do the turfing. To bad the nursing lobby put the sqeeze on it and its all but gone on the rewrite. Mabye the answer would be field doc's and PA's that would do this. Regardless there will always be the 80% of patients that are BS and its all a matter of how we respond to them, and clearly the current system isn't working.


The highlight story of my life was a pediatric ER attending whom I asked what was the most stupid 911 ambulance arrival that he had and he said "a woman whose kid might have TB, the kid needed the test. So when she saw the pediatrician, the doctor told her that she needs to come back in two days for them to measure the result of the TB test... If she doesn't come back then the doctor will call the authorities because she has been delaying this. So two days later, she called 911 and had the ambulance drive her to the hospital to get the test measured. When she arrived, they asked her why didn't she just drive over to the doctor and get it checked. She said she couldn't afford a cab." the hospital of course billed her for the ambulance etc and I am sure she didn't pay (which btw is something like 900 dollars only for the ambulance trip only).

Moral of the story.... to some people out there... it's cheaper to call 911 for an ambulance and going to the ER than getting a cab and paying a PMD 40 dollars for the visit.
 
Not to mention people coming to the ED for sports or school physicals, immunizations, and other routine things (none of which we do, the patients being politely ATFO.)
 
I wonder what it would take to change the emtala laws.
 
I wonder what it would take to change the emtala laws.

It would never happen. The reality is that, despite the media attention given to the "uninsured americans", EMTALA prevents hospitals from turning away the poor for lack of payment. Everyone in this country, legal or not, insured or not, has access to emergency care. It is the final safety net. Without it there would be a HUGE problem...

- H
 
It would never happen. The reality is that, despite the media attention given to the "uninsured americans", EMTALA prevents hospitals from turning away the poor for lack of payment. Everyone in this country, legal or not, insured or not, has access to emergency care. It is the final safety net. Without it there would be a HUGE problem...

- H
EMTALA was a way for politicians to grant free care to the uninsured without raising taxes. Everyone's medical costs went way up but the politicians just blame doctors, hospitals, managed care or anyone else for that. It's not going away unless we socialize the whole system (which I do not advocate).
 
I would love to say get rid fo EMTALA but you know all my colleagues who still have some 'ideal' views of the medical world would jump my throat in a heartbeat.

Fact is, you can't cure poverty.....and they just dont understand that. At a certain point... someone with money will afford to live longer with better healthcare... it's a fact of life... it sucks but I am not God nor is the US a communist country where the rich and poor get equal health.
 
Well I did not say get RID of emtala. I asked if it could be changed.

For example if someone walks into the ER for a cold or some other non-emergency then maybe we can turn them away.

But in order for emtala to be changed the total healthcare system has to be revised.

emtala was a band aid. The law makers would rather spend millions on killing people than on saving lives.
 
Top