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ED Woes Bad Today, Worse Tomorrow

Joe Cantlupe, for HealthLeaders Media, July 12, 2012

One of the great things about an eight-year study of emergency departments published last month in the Annals of Emergency Medicine is that it challenges some preconceived notions about the problems in EDs these days.

The National Trends in Emergency Department Occupancy report covers from 2001 to 2008, and yes, we know how some of the story goes, with the power of hindsight over the past four years. During those study years, patient visits increased 60% faster than population growth, according to the report.

Ouch. Major overcrowding. Aggravating throughput issues.

Those problems are expected to intensify since the U.S. Supreme Court has upheld the healthcare reform law, guaranteeing that more uninsured will be brought into the system, as far as emergency physicians see it.

And while the court has left it up to the states whether to expand Medicaid coverage, any increase in "the number of patients on Medicaid without an equivalent increase in the number of physicians willing to take that insurance will surely increase the flood of patients into our nation's ERs," David Seaberg, MD, CPE, FACEP, president of the American College of Emergency Physicians, said in a statement this week.

"While there are provisions in the law to benefit emergency patients, it is clear that emergency visits will increase as we have already seen nationwide,"Seaberg added.

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2 comments on "ED Woes Bad Today, Worse Tomorrow"


chris thomson (7/13/2012 at 8:33 AM)
The volume of testing is also directly related to the 'new' role of emergency departments in this era of more comprehensive care in the ED. Many patients treated frugally for their acute care needs in the traditional realm of emergency medicine simply return for follow up since they lack primary care. The role of the emergency department has extended far beyond emergencies. The options are to ignore this need or move to accommodate this need, and accommodating this need for care has driven increased care intensity. The pressures in the emergency department must be evaluated in the context of the healthcare system and its inadequacies.

Gus Geraci, MD (7/12/2012 at 3:36 PM)
You end with, "How can we get doctors to order fewer tests?" That's similar to asking, "How can we get pilots to crash fewer planes?" The reasons for test ordering go way beyond the desire of the physician, and to decrease the burden of time testing takes requires a thorough analysis of why tests get ordered, many of which you listed. How about phrasing the question, "How can we decrease the number of unnecessary tests ordered?" Thus not blacing blame on physicians, but including all the reasons unnecessary tests are ordered.