In every minute of every day, on average, an ambulance carrying a patient is turned away from a hospital because its emergency
room is too full to take more patients.
That was one of the findings of a report released in June by the Institute of Medicine (IOM), warning that the U.S. lifesaving
system is failing to handle daily emergencies and could also break down in the event of a natural disaster, disease outbreak
or terrorist attack.
The IOM's "Future of Emergency Care" report was prepared by a 40-member board after a two-year investigation. It is the most
comprehensive national review of emergency procedures in 40 years, according to IOM, reporting on three areas: hospital emergency
rooms, pediatric emergency care and prehospital care given by ambulance services.
Many emergency rooms barely can handle their daily patient loads, children don't always get good care and the quality of rescue
services is erratic, the report says. Long waits for treatment are widespread, with ambulances sometimes waiting for hours
to unload patients. Once in the emergency room, patients sometimes wait for up to two days before being admitted to a hospital
bed. "We are not prepared," says Brent Eastman, MD, chief medical officer for Scripps Health in San Diego and a member of the IOM
board. "We struggle to survive day-to-day."
The study cited three contributing problems to the rise in emergency room visits: the aging of the baby boomers, the growing
number of uninsured and underinsured patients, and the lack of access to primary care physicians.
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The report found that 114 million people, including 30 million children, visited emergency rooms in 2003, compared with 90
million visits a decade ago.
In that same period, the number of U.S. hospitals decreased by 703, the number of emergency rooms decreased by 425, and the
total number of hospital beds dropped by 198,000, mainly because of the trend toward cheaper outpatient care, according to
the report.
Brian F. Keaton, MD, who will take over as president of the American College of Emergency Physicians in October, says the
rise in emergency room visits is part of a much larger issue facing hospitals.
In the early 1990s, there were 30 million people on Medicare and 1 million staffed hospital beds, Dr. Keaton says.
Today, there are 45 million people on Medicare and 850,000 staffed hospital beds. And the projection is for 78 million people
to be on Medicare in 2020.
"We have absolutely saturated capacity and every bed in the hospital is filled with an admitted patient," says Dr. Keaton,
who is also director of Emergency Medical Informatics in the Department of Emergency Medicine at Summa Health System in Akron,
Ohio. "Some patients that I've examined in the ER, and who need to be upstairs, are boarded as admitted patients in my department—sometimes
for days. They are taking up my beds, hallways and nursing staff. I get to the point where I can't take the next patient."
WHAT HEALTH PLANS ARE SEEING
Two health plans contacted say their data shows different results on emergency room use than the IOM study.
A spokesman for Highmark Blue Cross Blue Shield of Pittsburgh says the health plan saw a 5% increase in emergency room utilization
from its members in 2005 compared with a year earlier.
Paula Sauer, vice president of care management for Medical Mutual of Ohio, says emergency room utilization among its members
has gone up and down every other year since 2001.
"I'm not seeing a consistent upward trend," she says.
While Sauer says there is an abuse of the emergency room that "is beyond comprehension," other factors are contributing to
the increased utilization, including the growing tendency toward consumerism in healthcare.
