Hospital-based emergency departments in the U.S. continue to be overwhelmed with more patients each year, while the number of facilities decreases. This trend places an immense burden on patients who rely on EDs and physicians who are responsible for treatment. A recent study showed that 18% of adults aged 18-64 visited the ED at least once in 2014 and 77% of the visits were for serious medical conditions. With the high demand for care, change is necessary to address the growing crisis in emergency medicine and ensure that more patients have access to rapid care.
ED issues: Demand, wait times
The supply (PDF) of EDs decreased by 11% from 1995 to 2010. However, ED visits have increased (PDF) at twice the U.S. population growth rate, to more than 130 million visits per year. As a result, overcrowding has become a central problem for the emergency healthcare system.
The American population is also living and needing care longer, which compounds the overcrowding. From 2006 to 2011, the average rate of ED visits by patients 45 years old and over increased by more than 4%. The demand for medical care among those 65 and older is high, especially with the increase in chronic disease associated with an aging population.
More patients mean longer wait times in the ED. Recent data published by ProPublica show the average wait time a patient spends before seeing a doctor can reach as high as 53 minutes depending on the state. In the District of Columbia, patients spend an average of 212 minutes before being sent home from the ED.
When EDs are clustered or mostly centrally located, as is the case in many places, access to care is limited for communities farther away. Patients must travel longer before being evaluated, diagnosed and treated, with potentially negative consequences depending on their condition.
All of these overwhelming issues in the ED have taken a toll on physicians. Emergency physicians have one of the highest burnout rates among medical professionals nationally. The average physician reports a 45% burnout rate, but emergency physicians had the highest at more than 60%.
Patient impacts
The delayed treatment that results from the issues that plague EDs can be detrimental, leading to adverse health outcomes. Patients at overcrowded EDs are 5% more likely to die compared to patients at less-crowded EDs. Overcrowding may also influence how medical decisions are made. In a study of all adult patients at an academic tertiary care center ED, the number of patients in the waiting room and physician patient load were associated with a greater likelihood that a patient was admitted. This shows that patient density in an ED may unintentionally affect medical decisions made by healthcare professionals. The emergency care community must look to new organizational structures that can help address and alleviate these problems.
One solution: Hospital-satellite EDs
Hospital-satellite emergency departments (HSEDs) provide a more distributed access model of emergency care that can be integrated into the healthcare system to relieve the strain on existing EDs and bring emergency care closer to patients.
HSEDs are structurally separate from a hospital, but offer patients emergency services that are equal to or surpass those at hospital-based facilities. The acuity levels for patients seen in HSEDs are similar to those seen at hospital-based EDs as well (broken bones, burns, chest pain, abdominal pain, pulmonary symptoms, head traumas and concussions). In short, when it comes to treatment, there is little to no difference between the two types, but HSEDs have the ability to provide more accessible and a greater value of care.
Having multiple HSEDs throughout local communities expands access to emergency medical care for more patients, including those who live far from a centralized hospital system. This type of medical delivery system is already implemented with decentralized imaging centers, laboratories and urgent care centers.
Next steps for emergency care
HSEDs can relieve the burdened emergency healthcare system. While it is prudent to be cautious of change that directly affects the health of a population, at one time even the concept of an ED was once new. EDs were first established as a room in the back of the hospital for those who did not have access to physicians.
Even 911 emergency medical services, which arose due to traffic accidents and trauma injuries, were not widely recognized until the 1970s and generated backlash to the idea of nonphysicians undertaking medical procedures on ambulances.
HSEDs can meet patient needs and have the potential to achieve better health outcomes in communities without compromising healthcare quality. For the emergency medical care system to work efficiently, HSEDs will work with established, leading healthcare systems to expand emergency care resources and promote collaboration and coordination of quality care.
Ricardo Martinez, M.D., chief medical officer of Adeptus Health, is a nationally recognized board-certified emergency physician and has practiced emergency medicine clinically for more than 30 years, and held senior roles in business, academia, and the federal government. He currently serves as faculty at Emory University School of Medicine and previously held roles at Stanford University School of Medicine and as executive director of the Medical Leadership Academy.