overcrowding

A recent poll among northeastern Illinois emergency physicians suggests that the region, like many others across the U.S., faces a serious overcrowding problem. The study, conducted by the American College of Emergency Physicians, found that 99 percent of the region's doctors consider their ED to be overcrowded "frequently" or "almost always." What's more, almost nine out of 10 said that conditions had gotten worst over the last year. 

With emergency physicians around the …

Taking on a very tough problem, two federal legislators have re-introduced a bill which would reward doctors who provide ED- or other emergency-related care with 10 percent Medicare pay increases. The bill also establishes a commission which would look at related issues such as overcrowding in the ED, med mal issues in providing ED-based care, and the shrinking availability of specialists willing to take call. Right now, ED physicians end up with $140,000 in uncompensated care annually, …

Seven out of every eight hospital administrators believe that the problem of overcrowding has not subsided in the past year, and in many cases has gotten worse, according to a survey by the American College of Emergency Physicians and by patient-flow software vendor TeleTracking. A full 60 percent report that the overcrowding has forced their facilities to divert patients in need of urgent or emergent care. And although more than 70 percent of hospitals responding to the survey have a …

In the high-intensity atmosphere of the ER, nurses and physicians must make quick decisions often without patient's medical history. This can lead to mistakes, such as misdosing and miscalculation of the amount of drug needed. In Pasadena, however, several hospitals have brought pharmacists into the ER to cut down on these mistakes. Having a pharmacist on board can help hospitals cut down on errors and streamline the way drugs are distributed. "There is a lot of evidence in the literature …

The Maryland Health Care Commission has found that a third of all Maryland's emergency room visits are for non-emergency conditions that could be treated in another setting. Over a one-year period, 2.3 million patients visited Maryland ERs. "Of those visits...18 percent were for conditions that weren't emergencies at all, and 17 percent required rapid treatment but could have been dealt with in primary care doctors' offices." State legislatures are concerned by this over-use because …

If you're not ready to pay a $100 surcharge, don't bring minor issues to the emergency department at Jacksonville, FL-based Memorial Hospital or Orange Park Medical Center. In August, the two HCA facilities began charging less-sick patients extra as a means of minimizing overcrowding. Since October, about 500 of the 5,500 patients treated at Memorial's ED were encouraged to seek primary care after being triaged. If they still wish to be treated in the ED, they can be, as long as they're …

When chronically ill patients are discharged from the emergency department, chances are they'll be back soon without further help. In response, health plans have increasingly been assigning "health coaches" to such patients, tasked with making sure patients are doing what they can to stay well. The health coaches, typically registered nurses, stay in regular touch with the patients, sometimes with home visits and sometimes over the phone, helping them schedule appointments, decipher …

Administrators at inner city-based St. Louis University Hospital were troubled by their rate of ambulance diversion. For 2003, St. Louis University ranked third among 22 area hospitals for diversions, rerouting ambulances 660 hours due to ER overcrowding and resources drained by its status as a Level One trauma center. But after instituting some process changes designed to assess ER conditions and free up beds, the hospital has been able to cut that figure dramatically.

The …

All this talk about ER overcrowding has caught Congress's attention. The Senate Health subcommittee on bioterrorism and public health preparedness heard testimony about the growing problem in ERs and the impact that a disaster could have on the nation's emergency departments. In the ten years from 1994 to 2004, the number of ER visits rose 18 percent, to 110 million. But over that same time …

Wonderful topic, and forgive me for tossing in my two cents: Isn't the basis for the plight of the ER primarily linked to the catastrophic and wholesale abandonment of primary care in this country? While some of the lengths undertaken to fix the symptoms of overcrowding, some nearly heroic, I think the fundamental issue is associated with access, coverage, and availability and utilization of primary care. As you mention in the case of the HCA hospitals in Florida, redirecting patients to clinics can save costs. But this kind of shift also comes much too late. Providing a global (national) accessibility to primary care could keep the 85 percent of the patients out of the ER who do not have genuine need of emergency services. It would also allow the most costly care in the system to be used appropriately and would shore up the primary care docs, who are soon to be found only in museums.