How Overcrowding In Emergency Rooms Has Impacted Patient Care

Have emergency rooms become the safety net of our healthcare system? We’ll speak with a doctor who says emergency care has turned into ‘everything care.’

Guests

Dr. Amy Ho, an emergency physician in Dallas-Fort Worth, Texas. (@amyfaithho)

John Diedrich, investigative reporter for the Milwaukee Journal Sentinel. (@john_diedrich)

Dr. Kathy Kozak, internal medicine doctor at Straub Clinic and Hospital and host of “The Body Show” on Hawaii Public Radio. (@wearehpr)

From The Reading List

Milwaukee Journal Sentinel: “She collapsed next to the best stroke center. Her ambulance was turned away. It was policy. She died.” — “As she got ready to work the breakfast shift at the Medical College of Wisconsin cafeteria, Tiffany Tate didn’t feel well.

“Tate, 37, was a fixture on the cafeteria’s ‘hot line,’ where she worked behind a steaming grill. She knew the names of many workers and their kids, always sharing smiles and small talk.

“With a teenager and 8-month-old at home, recent months had been an exhausting blitz for Tate. That morning, she told some of the other kitchen workers she had a headache and felt weak. She figured it was due to a new medication for her back pain.”

Honolulu Civil Beat: “State Aims To Reduce Unnecessary ER Visits By Empowering Paramedics” — “Minor wounds, rashes, gout pain — these are some of the many medical conditions that should be taken seriously, but they may not merit a 911 call or a trip to the emergency room.

“Hawaii health officials are considering how to reduce unnecessary ER visits through a community paramedicine program. The revised emergency transport system that could begin next year would allow medical professionals to transfer patients to predesignated destinations, such as urgent care clinics, or even provide complete treatment at the scene.

“’Can paramedics go treat people in the field, in the community setting under a physician’s direction, and offer a treatment when they don’t need to go anywhere?’ asked James Ireland, a nephrologist and the former director of the Honolulu Emergency Services Department. ‘Can they do some simple wound cleaning and start the patient on some antibiotics under the guidance of a physician? I think that’s where the huge cost savings can be.’

“When Gov. David Ige signed Act 140 into law June 25, it marked the latest development in an effort to make Hawaii’s emergency response system run more smoothly. Starting as early as next year, the law will allow paramedics or other medical professionals to treat some patients at the scene of an emergency — or nonemergency — and navigate them to appropriate care at other clinical sites.”

Milwaukee Journal Sentinel: “A Milwaukee woman who sat in the ER with chest pain for hours left because of the wait time — and died soon after” — “Tashonna Ward, a 25-year-old day care teacher from Milwaukee, died Jan. 2 while trying to find a doctor to help her.

“Ward’s family is seeking answers from Froedtert Hospital, where she spent more than two hours in the emergency department before she left to find quicker care and, later, collapsed. She had reported chest pain and tightness of breath.

“The Milwaukee County Medical Examiner’s Office has not determined the cause of death. Its report doesn’t say whether Ward was admitted or seen by a doctor at Froedtert before she left.

“Ward’s family says she was kept in the waiting room and was not under any monitoring when she decided to leave.

“A spokesperson for Froedtert Hospital provided a statement: ‘The family is in our thoughts and has our deepest sympathy. We cannot comment further at this time.’ Officials did not answer questions from the Milwaukee Journal Sentinel about the death or general emergency department procedures.

“Ward’s family members said they are scheduled to meet with representatives from the hospital next week.

“‘How can you triage someone with shortness of breath and chest pain, and stick them in the lobby?’ said Ward’s cousin, Andrea Ward. “Froedtert needs to change their policy.'”

The New York Times: “A Doctor’s Diary: The Overnight Shift in the E.R.” — “My choices as a doctor in the emergency room are up or out. Up, for the very sick. I stabilize things that are broken, infected or infarcted, until those patients can be whisked upstairs for their definitive surgeries or stents in the hospital. Out, for everyone else. I stitch up the simple cuts, reassure those with benign viruses, prescribe Tylenol and send home.

“Up or out is what the E.R. was designed for. Up or out is what it’s good at. Emergency rooms are meant to have open capacity in case of a major emergency, be it a train crash, a natural disaster or a school shooting, and we are constantly clearing any beds we can in pursuit of this goal.

“The problem is, traffic through the emergency room has been growing at twice the rate projected by United States population growth and has been for almost 20 straight years, despite the passage of the Affordable Care Act, and through both economic booms and recessions. Americans visit the E.R. more than 140 million times a year — 43 visits for every 100 Americans — which is more than they visit every other type of doctor’s office in the hospital combined.

“The demand is such that new E.R.s are already too small by the time they are built. Emergency rooms respond like overbooked restaurants during a chaotic dinner rush, with doctors pressed to turn stretchers the way waiters hurriedly turn tables. The frantic pace leaves little time for deliberating over the diagnosis or for counseling patients. Up, out.”

Houston Chronicle: “Study: Avoidable ER visits costing U.S. health care system $32 billion per year” — “Going to the emergency room for medical care that could — or should — be handled elsewhere is costing the U.S. health care system an extra $32 billion a year, a study by the nation’s largest insurer shows.

“In fact, as many as two-thirds of the nation’s 27 million annual emergency room visits are avoidable, the research by UnitedHealth Group, parent company of insurer UnitedHealthcare, showed. The data come from an analysis of 2018 claims from employer-sponsored health plans.

“At the heart of the findings, released this week, are staggering price differences.

“For instance, a trip to the emergency room is on average 12 times higher than being treated at a physician’s office for common ailments. That translates to $2,032 on average for an emergency room visit compared to $167 in a doctor’s office.

“That same trip also is 10 times higher than a visit to urgent care, which on average costs $193. This can be a crucial difference in Texas, where patients continue to be confused between urgent care clinics and the state’s hundreds of free-standing emergency rooms, health analysts say.”

This article was originally published on WBUR.org. [Copyright 2020 NPR]