ER overcrowding solutions continue to fall short

Emergency departments around the country continue to struggle with overcrowding and, in some cases, come up with options for delivering care in different ways.

For example, in Boston, Massachusetts General Hospital's ED is at capacity less than five years after opening a $500 million expansion, The Boston Globe reported. Eight out of 10 ED patients have to wait for care, in part because more patients require complex, time-consuming care, according to the article.

It's not that all of the beds are always full, according to the Globe. The problem is that 30 to 45 beds in shared rooms go unused because staff can't match patient gender or don't want to put someone in a room with disruptive patients.

 "One of the clear lessons learned is the value of single rooms," Sally Mason Boemer, senior vice president of finance, told the newspaper. "There were more demands than we anticipated."

In Syracuse, New York, a new program called Upstate at Home is using house calls to treat patients whose conditions require treatment, but not emergency transport and care, according to a blog post on Syracuse.com. Right now, though, the program's medical director is the only doctor making house calls, limiting the program's reach.

Some cities and hospitals are trying out community paramedicine or mobile integrated healthcare-community paramedicine, in which paramedics respond to nonemergency calls to provide preventive and interventional care for people not sick enough for emergency treatment. They also respond to possible emergencies to determine whether the patient needs transport, FierceHealthcare previously reported.

In San Diego, officials said emergency room visits swelled by 40 percent between 2004 and 2014, with more than half of ED visits in that time for non-emergencies. Too few people understand when to use emergency services, and many don't have primary care doctors they can visit, Wilma Wooten, M.D., county public health officer, told The San Diego Union-Tribune. She also noted the county's population of older patients with chronic conditions has grown, putting more strain on the ED.

Another problem, according to the local hospital association: Too few primary care doctors accept Medi-Cal, the state's Medicaid program, because reimbursements rank 49^th in the nation. More than 40 percent of patients surveyed by the hospital association didn't have a primary care doctor, and 56 percent didn't know when to use an ED versus urgent care or a clinic, according to the article.

The expansion of health insurance coverage under the Affordable Care Act also appears to be driving more patients to the ED, officials told the newspaper.

While outside factors at play, hospitals themselves also are to blame. Hospitals with the busiest EDs haven't adopted proven interventions such as bedside registration that can reduce overcrowding, FierceHealthcare previously reported. It's not a high enough priority, researchers said.