ER Overcrowding Caused in Part by Surgeons’ Scheduling Autonomy
Emergency room overcrowding is partially caused by surgeons' "traditional freedom" to set their own operating schedules without taking hospital capacity into consideration, according to new findings, the Boston Globe reports. Researchers at Boston University studied 12 hospitals and found emergency rooms "jam up" because a lack of hospital beds keeps patients from leaving the emergency room. This situation varies on a day-to-day basis based on the number of patients admitted to the hospital. The study concluded the "swings" in the number of patients is caused not by variations in the number of emergency patients, but rather by "unevenly scheduled" elective surgeries. To improve the situation and reduce the amount of time hospitals divert ambulance traffic, the researchers suggest that hospitals take more control over scheduling to help surgeons coordinate operations, the Globe reports.
The recommendations "raise difficult questions" because "honoring doctors' authority and autonomy is a longstanding tradition," the Globe reports. Because physicians must accommodate office hours, teaching and other responsibilities, altering doctors' schedules must be done carefully. Some hospitals have already adopted tactics recommended by the researchers. For example, the Lahey Clinic is requiring cosmetic surgeons to schedule surgeries weeks in advance. Massachusetts General Hospital is monitoring the time it takes surgeons to complete procedures and is asking them to schedule accordingly. In Eau Claire, Wis., Luther Hospital is limiting overcrowding by giving nurses the authority to close the intensive care unit when it is over capacity. Although surgeons were angry at first, the new policy reduced ambulance diversions and cut losses incurred by doctors because they could not admit patients due to overcrowding. Also, the policy helped the hospital decrease its nursing vacancy rate from 10% to 2%. "The next step is to see how effective it is, how disruptive it is and how much of the problem still has to be solved by adding more beds," Alan Woodward, director of Emerson Hospital's emergency department, said (Barnard, Boston Globe, 9/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.