Overcrowded EDs seek to redirect patients

Faced with a growing physician shortage and overcrowding, many hospital emergency departments (EDs) must find ways to redirect patients, such as the elderly, to other settings that can provide more appropriate treatment, according to a blog post from the New York Times.

Experts project the number of people older than 65 who seek healthcare services will double over the next four decades--and may triple for those over the age of 85, according to the post. Due to factors like the physician shortage, many of these patients will seek care in the ED. "But given longstanding trends in American medicine, it's hard to imagine a healthcare setting more ill suited for the elderly than today's emergency rooms," writes Pauline W. Chen, M.D.

Effective emergency care, more often than not, is speedy emergency care, Chen writes, and survival rates for stroke, heart attack or trauma patients depend largely on how long it takes to triage, diagnose and treat them. And due to the problem of overcrowding, efficiency is more important than ever.

However, many elderly patients have multiple chronic diseases, take numerous medications and have difficulty answering questions, all of which makes it "nearly impossible to work quickly," she writes.

As a result, a group of emergency medicine and geriatric specialists suggest medical centers "geriatracize" their EDs to address the problem. For example, she writes, they recommend hospitals hire providers trained to care for older patients, install non-slip flooring, screen for cognitive impairments like dementia and train staff in care issues specific to elderly patients. Fifty geriatric EDs already exist in the U.S., with 150 in development, FierceHealthcare previously reported.

Meanwhile, two New York hospitals made recent changes to their ERs to shift patient mindsets so more people will use the ED specifically for life-threatening conditions instead of primary healthcare. SInce State University of New York (SUNY) Downstate Medical Center opened a pre-fab modular clinic directly outside its ED last May, administrators report a decline in emergency room visits, according to Brooklyn Bureau. Brookdale Hospital in East New York also opened an urgent care center across the street from its main facility in order to cut ED visits. 

"There needs to be a cultural change in the way people look at healthcare," a Brookdale administrator told Brooklyn Bureau. "When emergency rooms are used for primary healthcare, it puts a strain on the whole hospital's operations, because the hospital has to provide the same care for someone with a cold as someone with a gunshot wound." 

To learn more:
- read the New York Times blog post
- here's the Brooklyn Bureau article