The Columbus Dispatch (Ohio)
Copyright 2006 The Columbus Dispatch
When there’s a medical crisis, people go to the emergency room. But where do they go when the emergency room is in crisis?
Never mind the flood of victims from a terrorist attack or a flu pandemic. Many emergency departments are gasping for breath just trying to get through a normal day, according to a series of reports from the Institute of Medicine of the National Academies. From 1993 to 2003, the number of ERs fell by 425, a 9 percent decrease. At the same time, the population grew by 12 percent and the number of ER visits grew by more than twice that, 26 percent.
Part of the reason for that increase is that the number of uninsured patients continues to rise. It now stands just shy of 46 million. Many of these uninsured people use emergency rooms for their primary care; others get no primary care and end up in the emergency room after their condition has deteriorated to the point that it requires expensive care or is life-threatening.
All of that hinders the true purpose of the emergency room, which is to handle medical emergencies. Primary care administered in an emergency room costs up to five times more and ties up space and personnel. The same is true for the care of those whose health has deteriorated until they cannot avoid the emergency room. All of those resources could be better utilized.
One of the results of such poor resource management is that emergency rooms are overcrowded. This strains the doctors and nurses. It can lead to mistakes. It also results in longer waits for all patients. And backups in the ER can cause ambulances to be diverted to other hospitals. More than half a million ambulances were diverted in 2003, or about one every minute somewhere in the nation. For people who are seriously ill, a diversion can be the difference between life and death.
That hit home five years ago when a 5-year-old Upper Arlington boy died after his ambulance was diverted because an emergency room was full.
Another result of the ER crunch is bigger hospital bills and higher insurance premiums for everyone.
The Institute of Medicine offered several recommendations for helping to shore up emergency medical care. Those include coordinating ambulance traffic so patients are taken to the most appropriate hospital in the shortest amount of time; reimbursing hospitals for uncompensated care; creating guidelines to address hospital overcrowding and ambulance diversion; developing regional networks to share on-call specialists; improving the use of technology to make hospitals more efficient; and developing a national categorization system for emergency rooms, trauma centers and emergency squads, based on their capabilities.
The Institute also wants Congress to appropriate more disaster-preparedness money to hospitals.
One of the most important recommendations is to develop a system of evaluating the performance of emergency medical services, and to make that data public. Such transparency likely would spur improvements.
Some of these recommendations will cost money. But the cost of doing nothing is steeper.
Americans depend on emergency rooms. In the event of a pandemic or a terrorist attack, emergency rooms will be crucial in the struggle to save lives. As the priorities are set for spending Homeland Security money, emergency rooms shouldn’t be forgotten. These reports should nudge Congress and the medical community into action.