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ACEP Chief Rails Against ED Diversions, Scheduling

Cheryl Clark, for HealthLeaders Media, June 16, 2011

Yet it happens all the time in U.S. hospitals where "ambulances are lined up waiting in a queue, waiting to get someone checked into that ED, sometimes as long as two or three hours, and that's because there's a hospital patient in that ED bed."

Schneider lashes out against the U.S. healthcare system that she says allows this to go on, and even make the problem worse. For starters, she says, nursing homes often don't accept patients from hospitals on the weekend.

Also, many hospitals could organize elective surgeries more efficiently, on a seven day-a-week schedule rather than a five-day one, to avoid backing up EDs in the early week peak and provoking many ambulance diversions.

"For many, many reasons, elective surgery patients are often brought into the hospital on Sunday, Monday, and Tuesday and undergo operations on Monday, Tuesday and Wednesday. One reason is because the services they need, such as occupational, physical, respiratory therapy – all that stuff they need to recover from their surgeries – operate only five days a week," Schneider said.

It's those elective cases, she says, that take up hospital beds, leading to:

  • ED flow impediments
  • ED patient boarding during peak times
  • Patients becoming exasperated and stressed
  • More avoidable deaths

"Very few services these days are just open Monday through Friday. I can go to the bank, the dry cleaners, and the post office on Saturday. But hospitals aren't fully open on Saturdays," she explained. "This flow through the hospital is really essential to keep the emergency department open, so patients don't die, and in this particular case, don't die from heart attacks."


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Her late aunt's situation illustrates the problem.

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1 comments on "ACEP Chief Rails Against ED Diversions, Scheduling"


Sam Breneiser (6/16/2011 at 7:55 PM)
Thank you for the very good article on E D crowding and issues. Since the newsletter indicates you are in California, I am curious of you mentioned our legislated staffing ratios to Dr Schneider? Here in California hospitals are barred from the choice of flexibility the two of you advocate in the article. To that extent I think you missed an opportunity to point out that excessive health care regulation is also not the solution – it is not the "health care system" of the U.S. that [INVALID]d those regulations, it was very well meaning but deeply misguided legislators – the legal and political system - that imposed those rules here in California. I think your point was that in order to improve health care outcomes we all need to pull our heads out of our respective standard operating procedure boxes and engage in creative thinking to respond appropriately. I just don't agree that its solely the health care system causing the problem, nonetheless it is ours to clean up.