The Problem Of Emergency Department Overcrowding

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

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’.

Although the Affordable Care Act (ACA) has increased the number of insured, the problem of access to primary care still remains an issue due to the large pool of individuals who are now receiving coverage. Nonetheless, even if the current health care reform debate increases insurance coverage, residents in areas with inadequate physician supply will still have greater difficulty receiving timely and appropriate clinical care (Walker et al. 2010). Over the last decade the healthcare system has continues with relatively the same level of access to care for most Americans, and although there is an upwards of 84% of Americans have some form of insurance, the rising cost of care, the large group of uninsured and underinsured, and the lack of focus on

The decline in hospital capacity was accompanied by a rise in staffing. Full-time equivalent personnel rose (Malagi & Kamath, 2016). Most of the additional personnel in hospitals are not focused on patient care but management or administration purposes. The American Hospital Association data shows that outpatient department visits have risen per 1,000 persons indicating that capacity for ambulatory services has risen overtime. Emergency departments have reduced with a larger percentage of closures being in rural areas. Compared to hospitals, physicians have continued to increase. Specialists have increased except for radiologists and general surgeons. There is, however, an uneven distribution of physicians between rural and urban areas. There is an estimated shortage of 3,000 physicians in nonmetropolitan areas. In addition to an increase in physicians, there are new forms of acute-care facilities. There are relatively new facilities that have been accredited. Ambulatory surgery centers have, for instance, risen (Best et al.,

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 uninsured face severe health care disparities based on several factors that impact their lives and the quality and availability of the health care they receive.

In the United States, the number of uninsured continue to increase everyday with no solution. "As of today the number of uninsured American remained at 10.9 % in the fourth quarter of 2016"(Holahan, 2017). In today economy where unemployment is at an all time high, millions of peoples are without insurance due to unemployment. There are also a lot of uninsured American that are employed, that can't afford insurance.

As enrollment increased emergency room over-utilization for non-emergent reasons decreased. The new Medicaid Managed Care population was being educated on the ‘Gate Keeper’ concept; the idea of having a primary care physician. A large primary care pediatric practice launched an Emergency Room diversion pilot program and conducted a study of Medicaid recipients, 18 years and younger . (2) 17,382 children were enrolled in an enhanced access group (intervention group) and 26,066 received services from other local primary care providers (control group).

Use of emergency room facilities is more costly than visits to doctor’s offices, so this model of care for the indigent contributes to the increasing cost of health care and insurance.

Not having health insurance or having inadequate health insurance is another obstacle in accessing health care. Health insurance is how people get into the health care system. With out health insurance many of the uninsured seek health services in emergency rooms. For patients with chronic diseases this is not an effective way to mange their disease. It is best managed with a primary care physician. After an emergency room visit uninsured patients are often burdened with large medical bills. In addition to financial considerations, the uninsured are most likely to have poor health status, be diagnosed later, less likely to receive medical care, and more likely to die prematurely (“Overview”, 2017). Individuals

So what happens when the uninsured need access to health care? Most rely heavily on the emergency room to provide them the care they need. According to a national ambulatory care survey “emergency room visits have increased by 20% since 1995” (Sultz, H., Young, K. 2009; 133(4). Health Care USA. Jones and Bartlett Publishers). The number of free care and self pay patients has also increased due to the economy and high unemployment rate. There are a number of patients that use the emergency room as a free clinic for minor illnesses or chronic problems that would be best suited to a regular doctor’s office. According to Health Care USA, 2009 edition, more and more people are “utilizing emergency rooms as a basis to obtain routine medical care

Due to the misdirected cost of care, access to healthcare has impacted through increased demands for medical services and the decrease in medical personnel to provide needed services. Comparatively, estimating by 2021 ten to twenty-one million new direct care workers will be needed in order to cover the projected health care demands (Herman & Rollins, 2003). Nevertheless, the juxtaposition of medical shortcomings and quality of care has also impacted. Henceforth, the current lack of medical personnel such as physicians, nurses, and advanced practitioners have impacted health care quality, causing the majority of Americans to receive health care services through hospital emergency departments and government- subsidized community health centers

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.

Auerbach, D. I., Chen, P. G., Friedberg, M. W., Reid, R., Lau, C., Buerhaus, P. I., et al. (2013). Nurse-Managed Health Centers and Patient-Centered Medical Homes Could Mitigate Expected Primary Care Physician Shortage. Health Affairs, 32(11), 1933-1941.