Thesis on "Over Crowding in Emergency Departments"

Thesis 5 pages (1758 words) Sources: 6

[EXCERPT] . . . .

Crowding in Emergency Departments

Over the years, healthcare setting especially hospitals are witnessing a phenomenal surge in patient admissions in their emergency departments -- EDs, aggravating the issue of 'overcrowding'. The 'Centre for Disease Control and Prevention -- CDC' recorded 108 million emergency departments -- 'ED visits' during 2000 registering a fourteen percentage rise from the 95 million 'emergency department -- ED visits' during the year 1997 according to latest figures that are available. As the amount of hospitals rendering 'emergency level care' went down 'to 3934 from 4005' within the years of '1997 & 2000', 'emergency department's visits' with regard to each hospital registered an increase of sixteen percentage rising to '27,000 visits from about 24,000 visits' annually. The rise in 'emergency departments visits' can be attributed to increase in populace, especially among the elderly. ("Emergency department overcrowding challenges hospitals -- Update-Brief Article," 2002)

US citizens aged 75 years and above were the most likely candidates to visit EDs. Statistical figures put per 100 persons of about 65 visits annually as against the national annual 'average visits' of about 39 for every 100 individuals. Further overall spurt in ED -- emergency department visits is compounding the already overcrowding situation at its bursting point. The 'American Hospital Association -- AHA' observed that with regard to several hospitals, inclusive of seventy-five percentage of hospitals in urban areas, and ninety percentage of the hospitals having facilities of 300 beds and upwards, it is a general practice in case of an 'emergency department' to run at or more than the limit. Overcrowding has rendered thirty-three percentages 'of hospitals' to divert their 'emergency department' patients to other hospitals, a phenomenon seen in urban areas. ("Emergency department overcrowding challenges hospitals -- Update-Brief Article," 2002)

1. Analysis of the Problem:

The problem of overcrowding in EDs leading to a constantly rising demand of EDs has been mainly due to the following:

(i) Slack care management of 'Health Maintenance Organizations -- HMOs': With the rise in the HMO enrollment during the middle part of 1990s, as well as methods attaining higher benefit with regard to the usage trends, availing ED services witnessed a sharp drop. Of late, there has been a huge spurt in the ED service usage by the HMOs. In major part this growth has been attributed to lower restrictive management a practice which is a reaction "to the consumer backlash against managed care" as well as liberal "interpretations of what constitutes a medical emergency" particularly with regard to the practical law for the common man operation in over forty 'states' of America. (Brewster; Rudell; Lesser, 2001)

Besides, it seems that 'Health Maintenance Organizations' subscribers are more and more visiting EDs for less acute medical problem since they are not able to receive access to general practitioners. In fact general practitioners paid by 'capitation fee' has minimum motivation 'to see patients' requiring critical 'care' when compared to referring them to the EDs. Apart from that modifications in the HMO structure to attend the demand of consumers for less preventive health insurance products have been playing a part in the rising demand for emergency services. (Brewster; Rudell; Lesser, 2001)

(ii) Stringent 'EMTALA -- Federal Emergency Medical Treatment and Labor Act Enforcement': In the aftermath of the 'new funding' mandated with regard to 'Health Insurance Portability and Accountability Act -- HIPPA' of the year '1996', the 'Office of the Inspector General -- OIG' at 'U.S. Deptt of Health and Human Services' made strict 'enforcement of' the 'Federal Emergency Medical Treatment and Labor Act Enforcement -- EMTALA'. Under the 'federal law' of the year '1986' it is a necessity that 'all of the hospitals' which attain 'reimbursement of Medicare', the huge bulk 'of the hospitals in the nation' to make provision for 'screening for an emergency' situation, required calming therapy and suitable transfer of patients, irrespective of their affordability. During the year '1998', the 'Office of the Inspector General -- OIG' released a 'special advisory bulletin' expounding the insinuations 'of the law' as well as boosted the 'enforcement'. Further this initiative placed the focus, rendering stabilizing treatment and if needed admitting. (Brewster; Rudell; Lesser, 2001)

(iii) Rising uninsured patients looking for care in ED: Increased no. Of individuals having lack of 'health insurance' has augmented the 'pressure' on EDs. In spite a narrow reduction in insurance in the year 1999, the amount of individuals not subscribing to any form of insurance went up by nearly 10 million during 1990s, thus raising the pressure for treatment in EDs that 'commonly' activity "as the uninsured's total source of care." (Brewster; Rudell; Lesser, 2001)

2. Proposed Plan for Addressing this Problem:

A proposed plan which addresses the problem as a two pronged strategy which entails (i) reducing the 'hospital demand' as well as (ii) optimizing the 'bed capacity of the hospital'. Under reduction of 'hospital demand' primary attention of the problem is (a) diversion or substitution. The primary attention of the strategy is diverting 'patients towards community services' as well as extends added services within 'the community' which conventionally happen 'in hospitals' for instance in "hospital in the home, hospital outreach programs and enhanced general practice services" during the 'after-hours'. (b) Lowering 'expectation' levels: Lowering "community expectations of what a public hospital system is able to provide is a sensitive strategy" judged from the political angle which has not been handled in an organized manner. Blocking access is not able to "be regulated without certain restrictions being accorded in the provision of services. Understandably, demand for healthcare is elastic as well as potentially restricted, particularly in a rather free healthcare system." (c) Prevention: There is prospect for lowering demand through techniques relating to 'disease prevention' as well as enhanced 'patient's management' having long-term sickness. (Cameron, 2006)

Under optimizing hospital bed capacity, the following plans are proposed for addressing the problem (i) Improved processes: A lot of endeavor by healthcare workers for capacity enhancement through enhanced efficacy of 'delivery of health care'. A lot of 'initiatives' bringing about immediate 'returns have' since being 'implemented'. Besides, major 'improvements' would require substantial 'investments' as regards 'infrastructure', particularly in Information Technology. Reforms in workforce are needed to raise the 'workforce flexibility' as also the capability with regard to healthcare system. Currently the healthcare system has been suffering from a virtual shortage of every category of skilled worker. (ii) Balancing non-compulsory as also 'emergency workload': Opposite of the 'popular' notions, 'the workload' handled by the emergency department is extremely predictable across the metropolitan regions. Non-compulsory 'treatment' needs to be customized to fulfill the level permitted by 'emergency work' which is 'predicted'. (iii) Improved 'discharge': Shifting 'patients' rapidly 'from acute hospitals to' hospitals having greater 'facilities' raises availability 'of hospital' beds. Accessibility pertaining "to rehabilitation, residential aged care as also community outreach programs is" regarded as an indispensable constituent of a well-organized as well as properly "managed health system." (Cameron, 2006) Tackling the 'social', 'physical' as well as 'psychological' matters via "coordination of care in the emergency department" as well as following 'discharge' could also assist in reducing the length of stay in the hospital as also readmission. (Cameron, 2006) (iv) More bed times: A pertinent fact "to note is that access block does not augur well with the absolute number of hospital beds." Making more "hospital beds lessens access block; but is not" a generic answer to the problem as the beds are filled up with recurrence of the problem. (Cameron, 2006)

3. Possible barriers to implementing your plan:

(i) Among the main barriers that patients more and more look forward to care at the ED is that they face difficulties in locating or scheduling a timely appointment with that of Primary Care Physicians -- PCPs. This is especially the fact in case of areas that are not served properly and where lesser PCPs are pertinent to be located and in which they might not accept uninsured or publicly insured patients. (Shactman; Altman, 2002)

(ii) Use of ED for non-urgent condition also constitute a major barrier because of the net effect of slack managed care, large scale patient protection regulation and lower accessibility to PCPs give inducement for patients to use the ED for non-urgent conditions as well. A considerable number of ED patients could be consulted and treated in primary care environments which could help in alleviating overcrowding of EDs. Indeed, some patients who are insured are able to avoid co-pay completely by visiting the ED in place of a PCP. Some of the hospitals and health plans have designed charges and co-pays for ED use. (Shactman; Altman, 2002)

(iii) Rising complexities in diagnostic technology also constitute a barrier with the increase in medicines, more complex and more costly diagnostic instruments assume necessity in the part of a patient's life. Some of these methods cannot be completed in a PCP's office just because of the equipment needed, or the time needed for the elaborate tests and procedures. There are some patients who need a broad spectrum of tests, all of which are capable… READ MORE

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