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National Perspectives on Emergency Department Crowding

National Perspectives on Emergency Department Crowding. Arthur L Kellermann, MD, MPH Paul O’Neill Professor in Policy Analysis. Disclaimer:. These views do not necessarily represent those of the RAND Corp. or my previous employer, Emory University. IOM Reports: The Future of Emergency Care.

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National Perspectives on Emergency Department Crowding

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  1. National Perspectives on Emergency Department Crowding Arthur L Kellermann, MD, MPH Paul O’Neill Professor in Policy Analysis

  2. Disclaimer: These views do not necessarily represent those of the RAND Corp. or my previous employer, Emory University

  3. IOM Reports: The Future of Emergency Care

  4. An Essential Community Service • ERs are the “front lines” of our health care system • Key components • EMS • Trauma Centers • Poison control • Disaster response • Public health

  5. A Key Access Point to Care ERs handle: 10% of all outpatient encounters 38% of all acute-care visits Nearly all after-hours and weekend visits Entry point for half of all hospital admissions Use growing at twice population growth

  6. Emergency Care System • Hospital-based Care: • General • Pediatric • Trauma • ER Care: • Triage • Stabilization • Disposition • EMS Care: • Initial stabilization • Transport

  7. “Access Block” • On-call crisis • ICUs at capacity • ↓ Nurses • ED boarding • ED crowding • EMS diverts • ED parking • Rolling blackouts • No unit available X X

  8. Hospital Challenges • 1/2 of U.S. hospitals are severely crowded; 2/3rds in urban areas • Growing # of specialists unwilling to take ER call • Many ER admits face long waits for a bed • Hospitals annually divert ½ million ambulances

  9. Demand vs. Supply:1993 - 2003 Population ↑12% Admissions ↑13% ED visits ↑26% Hospitals ↓703 EDs ↓425 Inpt Beds ↓198,000

  10. Form Follows Finance Elective admits get priority, because they pay higher margins and keeps referring MDs happy OR “Block time” keeps surgeons happy “Boarding admissions keeps ward nurses happy “2 admissions for the price of one” keeps administrators happy

  11. September 10, 2001

  12. Nine Years Later…

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