USA: Ailing ERs threaten patients and communities

[Guest guest]

Our view on medical treatment: Ailing ERs threaten patients, leave

communities vulnerable Fri May 30, 12:22 AM ET

On the night of her baby's seizure in February, Nannini

discovered a harsh reality of today's overtaxed medical system. The

ambulance crew that responded to her 911 call refused to take

23-month-old Bella to a nearby Washington, D.C., hospital where her

doctor was waiting. The emergency room was so crowded it was closed to

new patients. Despite Nannini's pleas, the ambulance was diverted to

suburban Virginia.

Bella got to a hospital in time. But Nannini, who has insurance but

goes to the ER often because of her child's seizures, was shocked that

emergency rooms could simply close.

They can, and they do. In fact, they have little choice. Once a rare

safety valve, " diversions " to other hospitals have become routine. And

they are just one symptom of an emergency system that is sick.

Rising health care costs have forced hundreds of hospitals out of

business, mostly in poorer areas, putting pressure on those that

remain. They, too, are racing to trim costs, and there's little

incentive to focus on ERs, which are not money-makers. So the sickest

patients are endangered, and communities are left unprepared for

disasters, whether a bus crash, a hurricane or a terror attack.

You don't need a medical degree to identify the symptoms: Waiting

rooms are often standing-room-only, corridors clogged with patients on

gurneys. Waiting times are longer, even for heart attack patients: One

in four waits nearly an hour to be seen by a doctor. ER patients so

sick they're already admitted to the hospital still could wait hours

parked in emergency room corridors for inpatient beds to open up. In a

survey last year by the American College of Emergency Physicians

(ACEP), 13% of ER doctors said they knew of a patient who died because

of that practice.

In a report last month, ACEP called on hospitals to make several

common-sense changes to fix the ER mess:

• Move admitted patients from the ER to other departments, even when

beds aren't available. That has been standard practice at Stony Brook

University Medical Center in New York since 2001 and it benefits

everyone, says Viccellio, director of the emergency department.

It takes the heat off the ER so doctors there can do their jobs, and

patients get the specialized care they need.

• Spread the scheduling of elective surgeries through the week,

instead of stacking most on Monday through Wednesday. That might annoy

surgeons, but it has opened more inpatient beds and alleviated

congestion at Boston Medical Center, home to one of the most crowded

ERs in the nation.

• Coordinate the discharge of hospital patients by noon, which helps

to open beds.

Too few hospitals have followed the leaders in making these changes.

It's easier to leave the burden in one spot, the ER, rather than

spread the pain around the hospital.

The American Hospital Association prefers to suggest that the crisis

is about the uninsured using ERs for primary care and that only

" fundamental reform " will help.

That aspect of the problem, while real, is overstated. According to

the National Center for Health Statistics, less than 14% of ER

patients come for non-urgent needs, while 70% require immediate or

semi-urgent care. (The other 16% were not tracked.) Yes, major health

care reform is needed, but the ER crisis is one hospitals could ease

themselves.

ERs have been at the breaking point for several years, an Institute of

Medicine study found in 2006. Bella Nannini, now 2 years old, and

millions of others are waiting for hospitals to do something about it.

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ilingersthreatenpatientsleavecommunitiesvulnerable