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ER Crowding a Significant Problem, But Experts Divided on Solution

By Reed Cooley, CQ staff

May 7, 2008 -- Experts agree that overcrowded emergency rooms are part of a mounting health care crisis in the United States, yet differ in their beliefs of what is causing the crisis and how to solve it.

A report, released Wednesday by the Center for Studying Health System Change (HSC), advocated the expansion of non-emergency health care providers, including community health centers and clinics, to deal with the problem.

According to the study, many low-income patients seek emergency room care for non-emergencies when faced with the prospect of months-long waits at more appropriate venues or the physicians' refusal to provide care to patients with inadequate insurance coverage.

"The growing reluctance of physicians and dentists to serve Medicaid and uninsured patients, along with shortages of primary care physicians and certain specialists . . . in some communities make obtaining clinic or physician appointments increasingly difficult," said an HSC press release.

The release said that turning to emergency rooms for non-urgent health issues is an inefficient use of the health care system.

"Emergency departments are very expensive settings and are not designed to treat ongoing, chronic needs," said Paul B. Ginsburg, president of HSC.

Sandra Schneider, secretary and treasurer of American College of Emergency Physicians (ACEP), agrees that extended emergency room stays should not be allotted to longer-term patients like those with pneumonia, but disagrees with HSC's position on non-urgent patients as a whole, many of whom she thinks can be treated quickly and efficiently in the emergency room.

"We are in a crisis situation in these emergency departments . . . However, the answer is not to take out the people we can turn around quickly; the answer is to take out the people who are waiting for an inpatient bed," she said.

Many patients seeking non-urgent care, for a sprained ankle for example, are referred to the emergency room by a primary care physician, and are in and out of the hospital in a matter of hours, according to Schneider.

"What's causing crowding . . . are inpatients being housed in emergency departments for days," she said.

She noted the downsizing of inpatient capacity in hospitals, due to nursing shortages and other issues, as a reason inpatients are waiting long hours or days in the emergency room before getting assigned to a bed, and advocated the re-expansion of this capacity as the only way to cut down on emergency room crowds.

Schneider cited a 2001 ACEP study that surveyed hospitals on a random night, and found that 22 percent of patients across the country had spent over two hours in the emergency department before being moved.

These are the patients that need to be redirected if emergency room crowding is to be stopped, she said.

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