Overcrowding in EDs Raises Readiness Concerns
Between 40% and 50% of U.S. emergency departments in 2003 and 2004 experienced overcrowding, raising concern that in the event of a disaster, they will be unable to handle large surges of patients, according to a CDC report released Wednesday, the Washington Post reports (Lee, Washington Post, 9/28).
For the report, CDC's National Center for Health Statistics examined data from a 2003-2004 National Hospital Ambulatory Medical Care Survey that included responses of 467 24-hour EDs (Sedlar, CQ HealthBeat, 9/27). The report deemed an ED to be crowded based on whether ambulances had to be redirected to other facilities because of a lack of available rooms; if wait times averaged more than one hour for patients in need of immediate care; and if at least 3% of patients left without receiving care (Washington Post, 9/28).
Between 2003 and 2004, one out of 10 EDs had an annual visit volume of more than 50,000 patients, with those in metropolitan areas experiencing wait times two to three times longer than those in nonmetropolitan areas, the report finds (CQ HealthBeat, 9/27). In addition, about half of EDs in metropolitan areas had more than 5% their nursing staff positions vacant.
The Senate Subcommittee on Bioterrorism and Public Health Preparedness on Wednesday convened a panel of experts to discuss the findings. Panelists recommended the development of a network of regional, integrated emergency care systems; more nursing education programs; and financial incentives for primary care physicians to treat patients after hours.
Subcommittee Chair Richard Burr (R-N.C.) in a statement said, "If our emergency rooms are stretched thin now, how will they provide medical care in the event of a disaster?" He added, "Our emergency care safety net is at risk. We must identify ways to reduce overcrowding and improve coordination."
Panelist Frederick Blum, president of the American College of Emergency Physicians, said, "We currently have no surge capacity to deal with the next big thing that comes along, be it a terrorist attack or a natural disaster" (Washington Post, 9/28).
The CDC report is available online. Note: You will need Adobe Acrobat Reader to view the report.
"America's emergency and trauma care system has deteriorated to an alarming degree," in the past 10 years, Arthur Kellermann, professor and chair of the Department of Emergency Medicine at Emory University School of Medicine, writes in an opinion piece in Thursday's New England Journal of Medicine.
"The effects of emergency department crowding are exacerbated by a nationwide shortage of nurses" and physicians, Kellermann writes, adding, "Economic forces underlie these trends." According to Kellermann, the 1986 Emergency Medical Treatment Act, which affords all individuals the right to emergency care regardless of their ability to pay, "created a perverse incentive for hospitals to tolerate emergency department crowding," which "diminished" access to care.
"Instead of taking decisive action to address these concerns, the federal government has largely ignored them," he adds. Kellermann notes that the Institutes of Medicine "envisions a coordinated, regionalized and accountable emergency care system that is capable of delivering lifesaving treatment to all in need," concluding, "It is up to Congress, the federal government and all of us to make this vision a reality" (Kellermann, New England Journal of Medicine, 9/28). The opinion piece is available .