Imagine getting into a car accident and getting seriously injured. Imagine being raced to the hospital in an ambulance. Imagine rushing through the emergency room doors on a stretcher to receive desperately needed care. And then imagine waiting. Waiting for hours while crippled by pain and fear as the emergency room, the place you expect to be ready for you at any time, is too crowded to provide help.
Sadly, not only is a situation like this not impossible, it’s not even rare anymore. As visits to emergency departments increase nationwide, it is becoming increasingly common for treatment to be delayed due to long wait times or ambulance redirection. Though this lack of care in emergency rooms is a part of the broader deficit of available medical care throughout the United States, the structural faults in the ER go deeper. The emergency room’s position as the nation’s healthcare safety net makes it more vulnerable to mistakes, and the high-stakes, high-speed nature of the care it provides makes these mistakes more dangerous to patients.
People looking to the Affordable Care Act as the solution to this problem will be rudely disabused of the notion. A study that took place in Oregon showed that, at least in the short term, expansion of coverage has resulted in a dramatic increase in emergency room visits for the newly insured. This unexpected result stems from a deficit in available primary care physicians, a situation that leaves even patients who are insured with an emergency room visit as their only viable healthcare option.
At the same time as ER visits have been increasing at a rate faster than the rate of growth of the general population, with an estimated 131 million visits in 2011 alone, the United States has experienced a concurrent decline in the number of ER facilities. Fifty percent of emergency rooms operate at or above capacity, a figure made even more shocking when one realizes an emergency department only considers itself “full” when all rooms, stretchers and chairs are occupied by people needing care. This means when an emergency room is full, it physically cannot accommodate any more patients.
The Centers for Disease Control and Prevention reports the average emergency department wait time is 30 minutes while treatment time is 90 minutes — numbers that can vary wildly by hospital and by time of day. Longer ER waits are not only inefficient, but they can turn dangerous. A report from the Annals of Emergency Medicine warned that crowded ERs are associated with 5 percent greater risk of patient death. Beyond the immediate increase in death rates, long emergency room waiting periods have insidious effects that aren’t immediately noticeable. These can be anything from a longer hospital stay to an increase in medical errors from overworked hospital staff.
All of these problems are serious, but most can at least be mitigated in the short term with the implementation of new hospital practices. Emergency Departments across the country have responded with ingenuity to the incredible pressure they are facing, creating new practices and techniques to maximize the efficiency of their departments. Some of these new tactics include computerizing physician-ordering systems to minimize testing waiting time and the formation of fast-track subdivisions in the ER that allow patients with minor ailments to be treated quickly and discharged. While this creativity provides hope for the future, these reforms have not been widely implemented.
However, reforms focused exclusively on change within the ER will fall short because many of the problems we are facing are symptomatic of events in other parts of the medical community. Complications that originate in separate medical fields are ultimately entangled in the ER due to its position as the system’s safety net. This has been most noticeable in primary care, an area where the United States will be facing a shortage of around 45,000 primary care physicians by 2020, a deficit that will continue to push more patients into already strained emergency rooms.
To address the issue at its source, legislative action is urgently needed. An amendment to the Affordable Care Act might seem a logical choice for healthcare reform, but the political polarization surrounding the act would poison the atmosphere around what has thankfully been a bipartisan issue. Instead, Congress should act on a bipartisan bill already on the floor that seeks to increase the number of federally funded residencies. More immediately applicable solutions include a greater emphasis on team-based care and a larger role for nurses in primary care.
Whatever actions we choose to take, we must take them soon, or we may find that our safety net can no longer support us.
Alex Mink is an Opinion columnist for The Cavalier Daily. He can be reached at a.mink@cavalierdaily.com.
Read More
SULLIVAN: Ramp up physical accessibility on Grounds
By Scarlett Sullivan | YesterdayThe University must take responsibility for the inaccessibility of Grounds and work to promote accessibility for all students despite misguided laws.
EDITORIAL: Scapegoating students will not stop hazing
By Editorial Board | 3 days agoInstead of retroactively responding to extreme hazing allegations, we, and especially the University, must begin asking more probing questions about the role of fraternal organizations on Grounds.
EDITORIAL: Celebrating and reflecting on The Cavalier Daily’s independence
By Editorial Board | April 18, 2024Our independence grants us the ability to ask the hard questions and to say what University representatives cannot.
