Part II: Too Crowded to Operate

 

            There’s nothing like adding more bodies in a room to making an already hectic environment nearly impossible to function in. Unfortunately, this is commonly the case in U.S. emergency departments; a study from the American Hospital Association found that 62% of hospitals feel they are at or over operating capacity.[1] The Emergency Medical Treatment and Active Labor Act prohibits U.S. EDs from turning anyone away, regardless of their ability to pay, so without proper resources and adequate staffing, triaging and treating can be extremely difficult.[2]

In this second article in our series on emergency department dilemmas, learn what your client is facing – whether they sought treatment in this chaotic setting or are working in it – and why.

 

What’s happening?

Along with a lack of available dedicated beds in each department, there is a growing population of individuals with behavior disorders and decreased availability of treatment options due to budget cuts in U.S. EDs.[3]  Besides patients seeking traditional emergency care are those who don’t have health insurance to cover any other type of medical visitation. Boarding times have skyrocketed in recent years; boarding quintupled between 2009 and 2012 in the Seattle area, with patients waiting an average of three days in a chaotic, ill-equipped environment with very little psychiatric care.[4] Elsewhere, patients may have to wait weeks before being officially assigned to a ward.[5]

 

Why is it happening?

Researchers from Harvard and MIT found that just 18 months after the Affordable Care Act went into effect, per-person emergency room visits among Medicaid patients increased by 40 percent.[6] Because previously uninsured individuals are now able to visit an emergency room without a co-pay, boarding numbers in EDs across America are on the rise, making it clear that insurance coverage is a problem that needed solving, but perhaps the bigger problem is the capacity, staffing, and resources of U.S. EDs.[7] As to problems still persisting from lack of insurance coverage, 75% of dental ER visits are by the uninsured or those with government insurance plans, since the Affordable Care Act does not cover dental services for adults, making for visits that cost three times more than a routine dental visit.[8]

 

What are some possible solutions?

While changing insurance coverage and building up larger emergency departments are long, difficult processes, there are other things that can be done to improve the situation short-term. Insurance companies and hospitals can provide education for the public emphasizing the use of urgent care centers for less serious or easily fixed health concerns. For example, Group Health Cooperative of Puget Sound reduced emergency room usage among their members by 27% over the past four years due to an educational social media campaign and such measures as requiring a $200 co-pay for an emergency room visit and just a $15 co-pay for an urgent care visit.[9] Hospitals can also work to funnel more funding into emergency department supplies, staff, and personnel training to ease the stress on everyone involved.

The final article in this series will focus on concerns that invoke the hatred of both patients and medical professionals alike: administrative issues.

 

[1]Pexton, Carolyn, “Issues and Solutions for Today’s Emergency Department,” iSixSigma, n.d. https://www.isixsigma.com/industries/healthcare/issues-and-solutions-todays-emergency-department/

[2] Warren, Bryan, “Managing Security for Emergecny Departments with High-Risk Patients,” Security Magazine, May 1, 2014, http://www.securitymagazine.com/articles/85454-managing-security-for-emergency-departments-with-high-risk-patients

[3] Ibid

[4] Ibid

[5] Ibid

[6] Emanuel, Ezekiel J., “How to Solve the E.R. Problem,” New York Times, May 6, 2015,  http://www.nytimes.com/2015/05/06/opinion/how-to-solve-the-er-problem.html?_r=0

[7] Ibid

[8] Ungar, Laura, “ER visits for dental problems on the rise,” USA Today, June 29, 2015,  http://www.usatoday.com/story/news/nation/2015/06/29/er-dental-visits/29492599/

[9] Emanuel, “How to Solve the E.R. Problem,”