Emergency care system gets low grades
Overcrowding continues to plague emergency departments as the population ages and grows, and the number of emergency departments dwindles, says the ACEP "National Report Card on the State of Emergency Medicine," released in December 2008.
Boarding of patients in EDs is widespread and contributes heavily to overcrowding and ambulance diversions, the report noted. Combined with increasing numbers of specialists opting not to take emergency call, access to emergency care is nearly in crisis mode.
Several solutions come to mind. First, we need a primary care infrastructure so that patients do not go to the ED for primary care. The ED must handle patients better handled through primary care.
Second, we need more efficient hotel functions in hospitals.
Third, we could use "transition beds." A transition unit would take admitted patients waiting for a floor bed.
Fourth, we must develop a way to require specialists to provide ED coverage. Emergency physicians need reliable consultants. This will require tort reform and payment reform.
Unlike my recent press clippings, I empathize with the ED physicians. They often have to see unreasonable volume of patients. We (all other physicians) should not ignore the ED.
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3 Responses to The ER crisis
Govindan
January 21st, 2009 at 1:11 am
The ED crisis is tough not only on the ED Physician but also for the patients.
shadowfax
January 21st, 2009 at 1:56 am
First, we need a primary care infrastructure so that patients do not go to the ED for primary care. The ED must handle patients better handled through primary care.
Amen, brother. I will also predict that line will get you a link from Kevin MD tomorrow.
Cheers,
Sf
country solo doctor
January 21st, 2009 at 9:38 pm
My two local ED depts seem to have a surplus of medicaid patients. No copay is required for ED visits, but a $2 copay is required for office visits. The HMOs and PPOs are raising ED copayments to $100-$250 for 2009. Self paying patients routinely don’t want to pay $80 for an office visit and use the ER for free care. For insured patients, many of them can’t get in for weeks to see primary care doctors for simple sinus infections and UTIs. Part of the clogging is non urgent care being delivered for free and patients can be made to wait for hours but cannot be turned away for nonurgent conditions.