U.S. emergency care "at breaking point"

[Guest]

Probe says U.S. emergency care in trouble

By LAURAN NEERGAARD, AP Medical Writer

1 hour, 17 minutes ago

Half a million times a year — about once every minute — an ambulance carrying a sick patient is turned away from a full emergency room and sent to another one farther away.

It's a sobering symptom of how the nation's emergency-care system is overcrowded and overwhelmed, "at its breaking point," concludes a major investigation by the influential Institute of Medicine.

That crisis comes from just day-to-day emergencies. Emergency rooms are far from ready to handle the mass casualties that a bird flu epidemic or terrorist strike would bring, the institute warned Wednesday in a three-volume report.

"If you can barely get through the night's 911 calls, how on earth can you handle a disaster?" asked report co-author Dr. Arthur Kellerman, Emory University's emergency medicine chief.

That ERs are overburdened isn't new. But the probe by the IOM, an independent scientific group that advises the government, provides an unprecedented look at the scope of the problems — and recommends urgent steps for health organizations and local and federal officials to start fixing it.

Topping that list is a call for coordinating care so that ambulances don't waste potentially lifesaving minutes wandering from hospital to hospital in search of an ER with room.

The idea is to set up regionalized systems that manage the flow much like airports direct flight traffic. That also should direct patients not just to the nearest ER but to the one best equipped to treat their particular condition — making sure stroke victims go to stroke centers, for example.

Other recommendations:

_Congress should establish a pool of $50 million to reimburse hospitals for the unpaid emergency care they provide to the poor and uninsured.

_Congress should ensure that more of the nation's disaster-preparedness funding goes to the hospitals and emergency workers who will provide that care. Typical government grants to hospitals for bioterrorism preparation are $5,000 to $10,000 — not enough to equip one critical-care room.

When it comes to getting ready for a bird flu outbreak, few hospitals even have the ventilation equipment needed to isolate patients. And emergency medical services received only 4 percent of the $3 billion distributed by the Department of Homeland Security in 2002 and 2003 for emergency preparedness.

_The board that accredits the nation's hospitals should establish strong guidelines to reduce crowding and ambulance diversion.

At the root of the problem: Demand for emergency care is surging, even as the capacity for hospitals, ambulance services and other emergency workers to provide it is dropping.

There were almost 114 million emergency room visits in 2003, up from 90 million a decade earlier. During the same time, the total number of U.S. hospitals decreased by 703, and the number of ERs by 425.

And the total number of hospital beds nationwide dropped by 198,000, as hospitals strive toward more outpatient care — which in turn leaves fewer beds for ER patients to move into when they're seriously ill.

Too often, busy ERs stabilize those patients and then have to leave them lying on gurneys in the hallway for 48 hours or more until a room becomes available and they can be admitted to the hospital.

That's not only a time of misery for the patient, but it means less timely care and potentially poorer care, without the specialized equipment and expertise available to inpatients, the report found.

Children have even scarcer help. They make up more than a quarter of all ER visits, yet one survey found only 6 percent of emergency departments had all the supplies needed, such as child-size equipment, to treat them.

Before getting to the hospital, the EMS system — emergency medical services that include ambulances and paramedics — is fragmented.

How well-trained and prompt local paramedics are varies greatly; there are no nationwide standards. Many ambulance services can't even effectively communicate with hospitals or other first responders because of antiquated equipment.

The American College of Emergency Physicians called the report groundbreaking but said Congress must heed recommendations to fund the necessary improvements.

[Guest paramedico987]

"Congress should establish a pool of $50 million to reimburse hospitals for the unpaid emergency care they provide to the poor and uninsured."

I disagree... It is not the government's responsibility to reemburse for profit companies (regardless of thier field) for losses. Our taxes are high enough already.

If the congress were to start, in effect, paying for the medical care of those who don't pay their bills then we simply are reenforcing the misguided belief held by many that medicine is a right. Nowhere in the constitution does it say anything about free healthcare.

I would much rather see a revision of COBRA to exclude people from the gross misuse of ED's across the country. It seems to me that an increased number of "urgent care clinics" would tremendously ease the burden on emergency rooms that occurs from patients who need simple suturing or "treatment" for cold symptoms.

-just my 2 cents

[WAS967 97]

I disagree... It is not the government's responsibility to reemburse for profit companies (regardless of thier field) for losses. Our taxes are high enough already.

It is when the government passes law requiring that every sick and injured person be treated regardless of thier inability to pay. Also remember, a lot of hospitals are not-for-profit.

If the congress were to start, in effect, paying for the medical care of those who don't pay their bills then we simply are reenforcing the misguided belief held by many that medicine is a right. Nowhere in the constitution does it say anything about free healthcare.

Maybe it should be. Look North to Canada. Every Canadian citizen has government sponsored healthcare. Medicines are cheap. People get the care they need.

I would much rather see a revision of COBRA to exclude people from the gross misuse of ED's across the country. It seems to me that an increased number of "urgent care clinics" would tremendously ease the burden on emergency rooms that occurs from patients who need simple suturing or "treatment" for cold symptoms.

Urgent Care Clinics are a nice thought but it bounces back to the real problem. Public Education. Healthcare as a whole needs to work on educating the general public to better understand what it is we do. If I were an uneducated consumer of healthcare, would I pick a "doc-in-a-box" or an ER when it came to seeking care. You bet I would probably turn to the ER.

Some of the blame lies in the MD/DO's hands. They need to tell people that you should see THEM not an ER for more things. PMDs should cosider being able to treat more stuff in thier office. Suturing - how many GPs can suture out of thier office. How many can take simple X-Rays? Etc Etc. Other problems lie in mistreatment or OVERtreatment of patients. Like giving antibiotics for crap they shouldn't be given for (flu being the BIG one).

There is no one cure for the healthcare crisis in America. But the government is there to lead - they should be paving the way to a fix. Maybe spending more money on healthcare and less on invading third world countires in the name of "anti-terrorism".

[ny10570 745]

The reason people choose ED's over office visits is very simple...money. There are many programs out there to help cover the cost of ED visits for those who can't afford to pay or are uninsured. Even for the insured, often times an ED vist is cheaper. With my curreny insurance, its a $25 co-pay for ED visits. Its $20 for a visit to my primary care physician and $10 for each referal visit. If I hurt my knee, I first have to go to my primary provider, then an orthopedist, then the radiologist, and if they feel like sticking it to me, they can charge me again to go back to the orthopedist. So I'm looking at spending between $30 and $50 along with the hastle of possibly traveling from facility to facility. The ED is cheaper and its all wyas one stop shopping.

[Guest]

The reason people choose ED's over office visits is very simple...money.  There are many programs out there to help cover the cost of ED visits for those who can't afford to pay or are uninsured.  Even for the insured, often times an ED vist is cheaper.  With my curreny insurance, its a $25 co-pay for ED visits.  Its $20 for a visit to my primary care physician and $10 for each referal visit.  If I hurt my knee, I first have to go to my primary provider, then an orthopedist, then the radiologist, and if they feel like sticking it to me, they can charge me again to go back to the orthopedist.  So I'm looking at spending between $30 and $50 along with the hastle of possibly traveling from facility to facility.  The ED is cheaper and its all wyas one stop shopping.

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Hi Guys

In the UK the GPs (family doc) have just been given new contracts, basically work 9-6, no weekends or on calls, BUT they have to opt in or out of a cooperative to provide emergency cover for their patients. Enter the new concept paramedic (emergency care practitioner) I'm one we have been operational for a year now we cann attend all category 999 calls treat & leave treat & refer or treat & admit, on an average day I attend 12 calls in 12 hours (so 1 /hour roughly) and of those 75% don't touch the ED.

I am allowed to prescribe antibiotics, oral analgesia, steroids, glue streistrip & suture wounds,admit to respite care, occasionally they go to the ED.

Since February our team & vehicle attended 1200 calls (7 staff working 24/7 1 truck) only 300 attended the ED.

Its free(ish) here paid for out of income tax national insurance. An attendence to the ED costs around £175.

It would appear that its not just a UK problem but a world wide problem

best regards

Jim