Minor Complaints Don't Cause ED Over-Crowding
Research shows the real gridlock in emergency department crowding is a "throughput" problem, caused by the lack of inpatient bed capacity in hospitals, not by too many nonurgent patients
Published Apr 3, 2006
Washington, DC - A recent report promotes the use of urgent care centers as a solution to emergency department overcrowding, although the gridlock in emergency departments is related to the lack of inpatient bed capacity, not patients with nonurgent medical conditions, according to the American College of Emergency Physicians (ACEP). .
Urgent care centers that pull paying patients out of the ED are not a solution for ED over-crowding and offer the unintended consequence of draining resources from real improvement efforts.
-- Publisher comment
"Urgent care centers may appear to be a reasonable safety valve for overcrowded emergency departments, and educating people about when to seek emergency care is beneficial to the public, but offering the wrong solutions to overcrowding might actually threaten patient safety," said Dr. Rick Blum, president of ACEP. "Hospitals across the country have serious shortages of resources, physicians and nurses that have led to an increasing number of holes that are jeopardizing the nation's emergency medical system. Solving these problems is critical for responding effectively to the day-to-day emergencies and to disasters and acts of terrorism.."
Dr. Blum said only 13 percent of emergency visits are classified as nonurgent, according to the latest statistics from the Centers for Disease Control and Prevention. The report released by the National Association of Community Health Centers uses an older statistic of one-third.
Research shows the real gridlock in emergency department crowding is a "throughput" problem, caused by the lack of inpatient bed capacity in hospitals, not by too many nonurgent patients. The General Accountability Office (GAO 03-460) reported in 2003 that "boarding" of critically ill patients causes overcrowding, tying up staff and resources, making them unable to treat any more patients from the waiting room or from an ambulance.
"Urgent care centers are linking themselves with the overcrowding issue," said Dr. Blum. "However, the link is not really appropriate, especially when they don't have a federal mandate, like emergency departments, to treat patients, regardless of their ability to pay."
A large number of patients in a waiting room is a symptom of a deeper problem in the emergency department itself. Patients with nonurgent medical conditions can usually be treated quickly and released. Emergency departments use a triage process to sort patients, which means the most critically ill patients are cared for first. Even if some patients in a waiting room went to urgent care centers instead, the patients who remained would still wait until critically ill patients were cared for.
Dr. Blum said the nation's emergency physicians are asking the public to visit www.acep.org and send a message to Congress in support of bipartisan legislation introduced by Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX). The Access to Emergency Medical Services Act (H.R. 3875) would help reduce dangerous trends that are limiting the public's ability to receive high-quality, lifesaving medical care by:
- Addressing the growing lack of resources by recognizing emergency medicine as an essential community service that must be funded.
- Addressing the growing physician shortages by extending limited liability protection to physicians who care for patients in emergency departments.
- Providing financial incentives to hospitals to end the practice of "boarding" patients in the emergency department.