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ED Woes Bad Today, Worse Tomorrow

Joe Cantlupe, for HealthLeaders Media, July 12, 2012

The problem wasn't the time it took to perform the clinical tests and interventions, but the frequency of the tests and treatments, researchers found. While CT scans, MRIs or ultrasonography increased significantly, so did the volume of procedures, such as performing three or more diagnostic tests on single patient and issuing two or more medications.

The frequency and wait times for those patients in the ED increased from 26% to 76%, and the combination of all of the "routine" testing exceeded the crowding and delays wrought by imaging work, they said.

"These are things we do on an everyday basis," Pine told HealthLeaders Media, referring to the routine tests.  The impact on ED crowding and waiting "was a surprise," he added.

Ironically, it is possible that innovations intended to speed ED throughput—such as authorizing the early ordering of blood testing, intravenous lines and radiographic testing at triage—may also be slowing down ED operations, Pines says.

All those clinical tests, which the report described as "greater treatment intensity," may reflect several factors, including the practice styles of physicians geared to order more testing, according to Pines.  That could be pinned on a variety of issues that could range from docs seeking higher quality care, but also those practicing defensive medicine, or pursuing financial incentives.

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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.