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ED Woes Bad Today, Worse Tomorrow

Joe Cantlupe, for HealthLeaders Media, July 12, 2012

Meantime, the crowding continues. Citing a General Accountability Office report, ACEP has stated that emergency patients who need care within one to 14 minutes are not always seen that quickly. For some it takes as long as 37 minutes.

As physicians and healthcare leaders evaluate ED improvements, the trends study is instructive because it delves into the weeds of the past to identify the causes of some of today's overcrowding.

Too many clinical tests and boarding, a pair of issues that often swirl around ED overutilization debates, were among the topics targeted in the report by Stephen Pitts, MD, MPH of the Department of Emergency Medicine at Emory University in Atlanta, GA, and Jesse M. Pines, MD, MBA, of the center for health care quality at the George Washington University Medical Center in Washington D.C.

Researchers found surprises in their evaluation of the data.

While imaging increased tremendously from 2001 through 2008, by 140%, routine tests had more of an overall impact on crowding in the ED, the physicians said in the report. Those tests included giving of intravenous fluids, blood tests, or other routine procedures.

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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.