Posted 8:12 pm Friday, January 11, 2008
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Emergency Room Crisis Degrades Quality Of Care
America's health-care system faces challenges in a number of areas, but perhaps the most critical conditions involve hospital emergency rooms.
There is such a great demand for service at these facilities, usually the waiting list is long and patients may have to wait for lengthy periods of time before getting a diagnosis or treatment.
Emergency medicine encompasses the care of patients with traumatic injuries or serious signs of symptoms of disease. These services are provided under the auspices of a hospital and are available to patients 24 hours a day, seven days a week.
Much of the emergency service overcrowding problem has been created in recent years by regulations that have resulted in a flood of patients with non-emergency type medical problems who often use these facilities for routine medical treatments.
Thus, a sizeable number of patients who visit the emergency department do not require the level of care an emergency room is designed to provide. In Maryland, for example, patients with non-urgent medical problems account for more than 40 percent of ER visits.
Increasing numbers of uninsured Americans and enrollees in public programs contribute heavily to overcrowding. Outdated federal and state policies are blamed.
Many emergency rooms already are operating at peak capacity on a day-to-day basis and that raises concerns that the emergency medical system is incapable of absorbing a massive surge in demand for emergency medical assistance in the event of a natural disaster or terrorist attack, said John S. O'Shea, M.D., a health-policy fellow at The Heritage Foundation.
Some recent trends are cited that highlight the challenge facing America's emergency care system: The system is stretched beyond capacity; in most states, the system could not absorb the surge in demand that would accompany a pandemic, natural disaster or terrorist attack; recent increases in demand are driven by patients seeking care for non-urgent problems; current conditions degrade the quality of patient care and contribute to the uncompensated care burdens on physicians.
Correcting federal and state laws and regulations would be a huge step in the right direction, and should rate emergency attention from legislators at both levels.
Policymakers also need to help hospital officials realign the economic incentives for emergency care, clarify the roles of hospitals and emergency departments and restore a federal approach to the provision of emergency care that clearly distinguishes between what is public responsibility and what is a private responsibility, and between the proper role of the federal government and what priorities should remain with the states.
O'Shea said the states should have the primary role in setting rules for first responders.
A priority for policymakers should be to move as many non-urgent patients as possible out of the emergency room to increase the capability to care for true emergency cases, he explained. Rapidly expanding private health insurance coverage is the key to accomplishing this.
In many respects, O'Shea added, delivery of emergency medicine should be viewed as a public safety function, particularly in the aftermath of a natural disaster or terrorist attack, and state officials should plan accordingly.
Also, emergency medical planning should be separated from laws governing hospital planning and construction and hospitals should be allowed to specialize in the conventional delivery of care.
Clearly defining federal and state responsibilities, streamlining financing and improving the capacity and efficiency of emergency services is essential. The Secretary of Health and Human Services should take the lead role in defining federal responsibilities and states should continue to exercise broad discretion over provision of emergency services.
Just throwing more taxpayer money at the American emergency room crisis would not be an effective remedy. Effective reform will require fundamentally rethinking the role of the emergency department and its relation to the acute care hospital.
This is a crisis that demands prompt attention. Failure to address the emergency medical care problem degrades the quality of care for everyone.
