Emergency Department Crowding Essay

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

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

The lack of health insurance reached began to become a serious issue in the mid-1990’s reaching a crisis level in the 2000’s. Individuals without insurance turned to emergency rooms across the country to obtain care routine care, turning emergency departments into primary care facilities. In many instances, people who presented at emergency rooms for treatment could not be turned away due to various health and safety regulations; therefore, patients were seen without the ability to pay often leaving the hospitals with millions of dollars in uncollectable debt, subsequently leading to the insolvency of hundreds of hospitals across the United States.

Approximately half of a million Americans are homeless, living in shelters or on the streets at any one time (Galea & Vlahov, 2002). The homeless population utilizes the emergency room to gain access to, primary care, nutritional, pharmaceutical and basic needs with non-medical issues is a contributing factor to emergency room overcrowding. The non-medical can primary care component needs to be moved out of the acute care setting of the emergency room but still readily accessible to the homeless clients.

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’.

One of the primary goals of the Affordable Care Act (ACA) was to provide affordable health care coverage and increase access to affordable health care to the community. Unfortunately, since the passage of the ACA, while there has been an increase in the number of people with health care coverage, those same people do not necessarily have access to affordable health care. Currently, the public views the Emergency Department (ED) as a safety net by the community it serves; as demonstrated by the increasing number of people who continue to seek treatment in the ED for non-urgent problems. Utilization of the ED for non-urgent care contributes to the rising costs of healthcare as treatment in this setting can be upwards of three times the cost

The overall results are presented as a qualitative analysis and it allowed the researchers the opportunity to produce new inputs.

Concern for the care of the patient was one of the mitigating factor 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 in government payments to the institutions. Simply put if you want Medicare/ Medicaid payments you will abide by this law. There shouldn’t have been need for emtala 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 not being dismissed. 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, as they did not have way to pay for services, but still received treatment through emergency rooms.

This chapter provides an overview that describes the basic types of hazards threatening the United States and provides definitions for some basic terms such as hazards, emergencies, and disasters. The chapter also provides a brief history of emergency management in the federal government and a general description of the current emergency management system—including the basic functions performed by local emergency managers. The chapter concludes with a discussion of the all-hazards approach and its implications for local emergency management.

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.

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).