Alternatives For Overcrowding Emergency Departments

A huge effect of boarding patients/overcrowding emergency departments is ambulance diversion. It occurs when a hospital ED cannot accommodate any more emergency patients so

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on individuals who frequently utilize the emergency department (super-utilizers); and targeting the needs of individuals with behavioral health problems. (Mann, 2014, pp 2-4) Many resources and processes have been implemented in order to help decrease inappropriate emergency department visits. This paper is going to demonstrate some resources and processes that are in place to help individuals obtain health care at the appropriate health care setting.

EMTALA is the Emergency Medical Treatment and Labor Act that was developed in 1985 as part of the Title IX of the Consolidated Omnibus Budget Reconciliation Act that went into effect in the year 1986 (Sara Rosenbaum, 2012). EMTALA was developed after an article was published in 1986 that documented how Cook County Hospital in Chicago was receiving patients that were “dumped” there that were unemployed, minorities, and lacked health insurance (Singer, 2014). This problem also occurred in 1983 in Dallas where over 200 patients were transferred between hospitals that were not stable (Singer, 2014). EMTALA is under the direction of the Department of Health and Human Services and was developed to address the needs of Americans

Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

The Affordable Care Act was designed to provide coverage to many who have experienced healthcare disparity. However, providing coverage is only half of the equation, ensuring this population has somewhere to go to seek emergency and non-emergency care is the other component. Many medically underserved communities throughout California and the greater United States are experiencing the loss of small community acute care hospitals, which also provide Emergency Department (ED) access. Closures are occurring in rural, suburban, and urban environments whereby depriving residents of access and/or timely access to ED healthcare services. In their health

In the early 1980’s there was increased observation by emergency room physicians that patients were being transferred or dumped from private hospitals to public hospitals based on their inability to pay. Concern for the care of the patient was one of the mitigating factors for our nation’s development of Emergency medical treatment and labor act (EMTALA) . Enacted by Congress in 1986, EMTALA was government’s way of ensuring basic screening, stabilization and care for all patients. Non participation with EMTALA was not an option, since the law tied government payments to the institutions. Simply put, if you want Medicare/ Medicaid payments you will abide by this law. EMTALA would not have been needed since there were already safeguards for indigent patients, but they were not followed, rather seen as guidelines. With the backing of EMTALA, patients had better care assurances, and guarantee of non-dismissal. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care” It has been strongly inferred that based on the implementation of emtala, increased numbers of uninsured were using the emergency rooms as their primary source of care. The thought was those without insurance, did not seek preventative care through a primary care doctor,

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of a person’s ability to pay. The law's initial intent was to ensure patient access to emergency medical care and to prevent the practice of patient dumping, in which uninsured patients were transferred, solely for financial reasons, from private to public hospitals without consideration of their medical condition or stability for the transfer. EMTALA is considered one of the most comprehensive laws guaranteeing nondiscriminatory access to emergency medical care and to the health care system.

When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need

Because of the EMTALA, therefore, much more than emergency room care is provided regardless of ability to pay” (Menzel, 2011, p. 84).

Emergency room overcrowding is a major issue throughout not just the United States but in many countries. There have been many strategies on how to combat this issue as patient satisfaction is often being a major variable on hospitals being reimbursed, which interventions are most helpful? One intervention that is gaining more and more popularity is advertising wait times. Through a PICO search with key words of “ED triage” and “patient satisfaction” or “wait times” provided some great original research over the past five years that has been peer reviewed in the Journal of Canadian Association of Emergency Physicians. While multiple research papers came up, the methodology and potential of taking this particular study further was of great interest.

Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007.  JAMA 2010; 304: 664-670

Middletown Hospital is a 200-bed, not-for-profit-general hospital that has an emergency department with 20 emergency beds. The emergency department handles on an average 100 patients per day. The hospital’s CEO has authorized the Six Sigma Team (SST) to address complaints received from patients seeking treatment between 6:00 p.m. and 10:00 p.m. The complaints are centered on waiting times and poor service. During this time the data indicates that approximately 70% of the department’s admissions occur (University of Phoenix, 2009, Course Syllabus).

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).