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Patience Lost in Overcrowded ERs

By Candace Hoffman
WebMD Health News

Feb. 25, 2000 (Lake Worth, Fla.) -- Crisis is brewing in the nation's emergency rooms, an article in the January issue of the Annals of Emergency Medicine reports. Patients may not always be able to rely on their emergency department (ED) for quality care and timely treatment, say researchers from the University of California, Davis, who conducted the study.

While this news may spur some people to stay home and hope their chest pain will go away on its own, John R. Richards, MD, one of the study's authors, tells WebMD this is the last thing he would want patients to do.

"But at the same time, [patients should] realize that the problems are getting worse and if there is a long wait and people seem to be rushing around and seem impersonal, [don't] be critical, because we try our best." Sickest patients are always seen first, he explains, "but too many sick patients bring things to a standstill."

Richards, who is assistant professor of emergency medicine at UC-Davis, and his colleague Robert W. Derlet, MD, conducted a survey among many of the nation's EDs.

They found a laundry list of causes for the overcrowding, such as more chronic illnesses; a shortage of nursing and administrative staff; managed care patients being forced to use the ED because their specified primary care physician or clinic is too busy; more patients being treated in the ED instead of being admitted to the hospital; and delays caused by other departments, such as laboratory and radiology.

They also found that ED overcrowding is not confined to urban hospitals -- rural hospitals' EDs are packed as well.

The overcrowding has resulted, among other things, in poor patient care, decreased staff productivity, ambulances being diverted to other hospitals, and violence, Richards' article notes.

Adding to these problems, Michael T. Rapp, MD, president of the American College of Emergency Physicians (ACEP), tells WebMD that during the last few years many hospitals have closed their doors. "Yet the demand hasn't gone down," he says, explaining that emergency rooms handle about 100 million visits every year. And only a few patients were admitted to the hospital through the ED 20 years ago, Rapp says. Now nearly 50% of them are.

There are always seasonal factors, such as flu, adding to the bustle. This year, the problem was worse than usual, Rapp says. "It seems like we've pretty much wrung the excess capacity out of our health care system. What we have is kind of the straw breaking the camel's back," he says.

The other problem, Richards says, is that if a hospital is full, patients have to wait in the ED until they can be admitted to the hospital. "We end up being a de facto intensive care unit with people who are getting very comprehensive care," he says. This adds to waiting times for less seriously ill patients. "If you have a broken ankle, you're going to wait awhile," he says.

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