overcrowding

Study: Parents take kids to ER to avoid primary care physician

Anne Zieger — Tue, 25 Nov 2008 09:10:36 -0500

A new study looked at why parents take their children to the emergency department for non-urgent care, and found some surprising results: they aren't doing it to abuse the system, and in some cases the primary care physician has actually referred them to the ER. Children account for 25 percent of visits to the emergency department, and somewhere between 58 to 82 percent of these visits are for non-urgent conditions.

The study, published in Academic Pediatrics, interviewed parents who were bringing children in to find out their reasons for doing so. Some parents had problems with their primary care physicians, such as not being able to get in soon enough, or just not feeling like they were getting the attention they deserved.

Meanwhile, some were actually referred by the child's primary care physician, and a third group found advantages in going to the ER. The study's authors were surprised to find that many parents found the ER to be a more efficient alternative.

To learn more about the study:
- read this Washington Post piece

Case study: MA hospital creates $1M quick-care unit

Anne Zieger — Fri, 22 Aug 2008 05:41:39 -0400

These days, virtually any emergency department can say it's overloaded--but the staff at Wareham, MA-based Tobey Hospital had a particularly difficult problem on their hands. The hospital, which serves flocks of vacationers from nearby Buzzards Bay during the summer, gets 35 percent of its yearly ED visits between June and August. Often, that meant a longer wait for patients with minor ailments like ear infections or the flu.

Today, however, things are different. Tobey has opened a $1 million unit, dubbed ExpressCare, designed to move non-critical patients quickly and safely through the care process. It will include 21 staff members, and will be open from 11 AM to 9 PM seven days a week. ExpressCare's goal is to get such patients in and out within an hour. Staff will automatically route children with high fevers and people 75 and older to the traditional ED, since both types of patient can have complex problems that can be passed over in a quick-care setting.

Hospital managers expect that ExpressCare will help the 70-bed facility cope with its rapidly-growing ED load, which has grown 40 percent over the past 10 years to 28,000 visits last year. Interestingly, donations covered much of the cost of the ExpressCare facility, suggesting that the community saw the need for the facility, not just administrators.

To learn more about ExpressCare:
- read this piece from The Boston Globe

SPOTLIGHT: Hospital EDs not ready for mass casualties

Tue, 06 May 2008 06:59:52 -0400

While they may be managing to deal with overcrowding right now, there's no way that the nation's hospital EDs will be ready for mass casualty events such as a natural disaster or terrorist attacks using conventional explosives. That's the verdict of the House Committee on Oversight and Government Reform, which says that current Medicaid regulations have only made things worse. Article

Case study: AZ hospital posts ED wait times on website

Thu, 17 Apr 2008 06:59:54 -0400

Scottsdale, AZ-based Scottsdale Healthcare has taken an approach more common in the travel industry and put it to use in its emergency department. The health system has begun to post emergency department wait times on the front page of its website, which it defines as the time it will take a patient to get from the ED's front desk to an exam room. The system posts wait times for each of its three facilities, and wait times are updated every 10 minutes. Looking at the site today, visitors could see that one of its facilities has a seven-minute wait, and the other two no wait at all. This is a nifty marketing trick; I wonder if it helps reduce ED congestion as well?

To learn more about the hospital's ED wait time postings:
- read this press release

Related Articles:
Hospitals slash ED wait times
CDC report backs emergency department overcrowding charges
Hospitals develop strategies to cope with ED overloads
Hospitals charge fee for non-emergency ED visits

EDs seeing more affluent patients, less uninsured

Wed, 09 Apr 2008 06:59:58 -0400

Here's a study that flies in the face of what we've been reading elsewhere. According to new research published in the Annals of Emergency Medicine, emergency departments are actually seeing a growing percentage of affluent patients, while the number of uninsured patients is falling. Researchers found that uninsured patients accounted for 15.5 percent of visits in 1996-97, but only 14.5 percent of visits in 2003-04. Meanwhile, the number of visits by higher-earning people with incomes of more than 400 percent of the poverty level grew from 21.9 percent to 29 percent during the comparable period. Wow. That is a stunning reversal from the conventional wisdom. So, if the uninsured aren't the biggest cash drain on EDs, what's really going on?

To learn more from the study:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
CDC report backs emergency department overcrowding charges. ED report
Case study: California hospitals help emergency department "frequent fliers." ED report
Hospitals charge fee for non-emergency ED visits. ED report
CMS faces ED overcrowding scrutiny. ED report

WA hospitals struggle with extreme ED overloads

Mon, 24 Mar 2008 07:59:56 -0400

While emergency departments are overloaded across the U.S., few regions are struggling quite as hard as Washington state's King County area, where overflowing facilities are closing EDs as often as six times a month, according to area officials. The problem seems to be a more-intense version of issues that are cropping up nationally, including a flood of uninsured patients, a primary-care physician shortage and an aging population, and an unusual influx of patients with winter illnesses like the flu. No one is sure why things are quite so bad now, but this is about the worst even the most experienced veterans in the region have seen, according to a report in the Seattle Times. This summer, hospitals hope to get some help in the form of a new system that routes ambulances around the county more efficiently. Also, one of the area's trauma hospitals plans to open 50 beds. However, it seems the region will remain in crisis for while unless bed supply increases further--or patient influx slows down.

To learn more about the Puget Sound area's hospital crisis:
- read this Seattle Times piece

Related Articles:
CDC report backs emergency department overcrowding charges. Report
Hospitals develop strategies to cope with ED overloads. Editorial
Overcrowding worsens at nation's EDs. Report
Congress takes on ER overcrowding. Report
Less ambulance diversion means more profit. Report

CMS: Harbor-UCLA places patients in jeopardy

Wed, 06 Feb 2008 06:59:55 -0500

Another Los Angeles county hospital emergency department appears to be facing serious care problems, in an unfortunate echo the problems faced the now-deceased Martin Luther King Jr.-Harbor hospital. Inspectors working on behalf of CMS have concluded that overcrowding in the emergency department at Harbor-UCLA Medical Center is placing patients in immediate jeopardy. The hospital, which is expected to receive a formal citation, was investigated after the December death of a patient who left the ED before treatment was finished and was found dead in a parking lot across the street from the facility. The Los Angeles County health services director has said that it's already working on a plan of correction to submit to the inspectors.

The citation follows well-publicized problems at the county's King-Harbor facility, where a woman died in the ED after waiting for 45 minutes in pain on the floor. The county's Olive View-UCLA hospital is also under scrutiny after a patient complaining of chest pains died without being given a test to determine if he was having a heart attack.

To learn more about the citation:
- read this Los Angeles Times article

Related Articles:
Untreated patient dies of heart attack in Olive View-UCLA ED. Report
King-Harbor state license may be pulled. Report
LA officials grapple with King-Harbor hospital death. Report

Survey: ED overcrowding getting worse

Wed, 10 Oct 2007 06:59:56 -0400

Is overcrowding getting worse in your emergency department? Probably, if this survey is any indication. A new poll from the American College of Emergency Physicians found that of almost 1,500 practicing emergency physicians surveyed, 80 percent felt that crowding in their ED had increased. Worse, 200 physicians said they'd experienced a patient death due to overcrowding.

When asked about their patient care concerns, almost 67 percent said lack of staffing and/or resources was their biggest issues. Others cited patient boarding (65.4 percent) and long patient wait times (65.3 percent).

To find out more about the survey:
- read this Modern Healthcare article

Related Articles:
CDC backs emergency department overcrowding charges. Report
Hospitals develop strategies to cope with ED overloads. Editorial
Overcrowding worsens at nation's EDs. Report
Congress takes on ER overcrowding. Report
Less ambulance diversion means more profit. Report

Study: ED crowding affects care

Tue, 02 Oct 2007 06:59:54 -0400

A new study suggests that overcrowding has a direct impact on the care emergency departments provide, even if the ED hasn't exceeded its maximum capacity. Researchers behind the study argue that efforts to boost ED treatment quality should definitely include the impact of patient volume.

The study, which appears in the Annals of Emergency Medicine, looked at care provided to patients with community-acquired pneumonia in a university tertiary care hospital ED. Researchers looked at data on patients admitted and discharged between January 2004 and June 2005. It concluded that the likelihood of such patients getting antibiotics within 4 hours went down as the ED saw more patients. While 61 percent got antibiotics within four hours, many others didn't, and the impact of additional patients was felt even when the ED wasn't full.

To get more details from the study:
- read this article abstract

Related Articles:
CDC report backs emergency department overcrowding charges. Report
Hospitals develop strategies to cope with ED overloads. Editorial
Overcrowding worsens at nation's EDs. Report
Congress takes on ER overcrowding. Report
Less ambulance diversion means more profit. Report

Atlanta hospitals screen out non-emergent ED patients

Mon, 24 Sep 2007 06:59:54 -0400

The movement towards screening out non-critical emergency department visitors is continuing nationwide, with many hospitals opting to push such patients into primary care or charge them a fee to use the ED. In Atlanta, for example, such practices are growing more common in facilities across the metro.

For example, Atlanta's Piedmont Fayette Hospital recently launched a screening system to determine whether patients have an emergency condition as defined by EMTALA. If the patient doesn't, they'll have the choice of either seeing a primary care physician or paying $150 to stay. Other hospitals are placing a greater emphasis on providing primary care on-site, with some putting a primary care center next to the ED, according to the Georgia Hospital Association.

As with their brethren elsewhere in the country, by taking these steps, the hospitals hope to reduce ED overcrowding. The ultimate goal is to cut wait times to be seen in the ED, and in turn, to place in beds as needed.

To learn more about this approach:
- read this Atlanta Business Chronicle article

Related Articles:
ED overcrowding: FierceHealthcare readers weigh in on causes and solutions. Comments
Hospitals charge a fee for non-emergency ED visits. Report
Hospital ED routes patients to clinics. Article
Fast-tracking programs slash ED wait times. Article
CA insured patients overuse EDs. Article