Lots of medbloggers wrote about that ER wait time study, and everyone agrees that the basic problem is overcrowding. What I found interesting was the diversity of opinion as to what is causing the overcrowding:
Kevin believes the root problem is lack of PCP access:
Like most of today’s health care problems, a lack of primary care access is the root of long ER waits. With sufficient PCP access, the burden on the ER will be significantly lightened, leaving them to focus on true medical emergencies.
Nurse K thinks it is less about access than the wimp factor:
People with no access issues still come to the ER time and time again for routine problems. Many of these people, especially young ones, actually view any and all sensations of malaise to be “emergencies”.
Whitecoat blames “the system”:
There are many more people on Medicaid who are trying to do the right thing and who the “system” ignores. In fact the system makes it harder for these patients to find care.
ER Nursey blames bottlenecks caused by red tape and lawyers:
JCAHO and CMS are coming up with more idiotic and burdensome regulations requiring ER staff to spend more and more time on redundant paperwork. Litigation is making doctors gun-shy so they are ordering longer work-ups.
Cheerful says hospitals can’t afford to provide adequate capacity:
The only way to ensure that emergency care will improve in this country is to increase reimbursement to the point that hospitals can afford to expand their E.R. care.
Shadowfax thinks this is just another pre-quake tremor:
The nation’s ERs are in crisis — over-burdened, under-funded, beset by the collapse of primary care, and hamstrung by the scarcity of inpatient hospital beds. How much longer will it take before the policy-makers wake up and do something to avert the impending catastrophe?
Très intéressant, non ?
Comments 4
Ouais c’est interessant—
Je voulais dire que les personnes sans l’assurance maladie tranditionnel (alors, les personnes qui recoivent d’allocations) sont les mauviettes. La plupart des autres se rester chez eux.
Sorry, couldn’t resist.
En anglais:
I meant that people without traditional health insurance (people who receive welfare) are the wimps. Most of the others stay home.
Posted 18 Jan 2008 at 5:45 am ¶Interesting rundown, and I believe a number of good points are raised. Perhaps if EMTALA would allow, there could be a clinic portion of the ER, where they people can be brought in and assesed, maybe by NPs and sent to the right channel. If is is for non-emergency or primary care, give them the option of treatment at the clinic or a referral to a PCP. Is this something EMTALA would allow? Sorta like an advanced triage that can be bypassed by paramedics and EMTs.
Posted 18 Jan 2008 at 10:13 am ¶Many ERs already do this - they call it Fast Track or Clinic or something similar.
In my experience, these are just as crowded, and while the people triaged there are removed from the queue for more critical services, it is no less a drain on resources.
Posted 18 Jan 2008 at 12:23 pm ¶Thanks Rich, I figured I wasn’t the first to think of that. Then how about the next step, would it be possible that the triage clinic could weed out primary care patients to the ER period? Just say, “sorry, you’re in the wrong place?”
Posted 18 Jan 2008 at 2:20 pm ¶Trackbacks & Pingbacks 1
ER waits: The NY Times is half-right…
Their interpretation of the recent ER wait study:…
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