Hospital emergency rooms see patient population explosion

A CNN NewsStand Report: Quality care threatened in busy ERs

July 14, 2000
Web posted at: 1:58 p.m. EDT (1758 GMT)

From CNN NewsStand Correspondent Perri Peltz and Producer Kara Thomas, with staff reports

(CNN) -- Emergency department overcrowding can be bad for your health. It's no good for the hospital, either.

We're generally full all the time," said Dr. Sam Stratton, a veteran of the late shift at Harper UCLA Medical Center in Torrance, California. "There are 35 beds in this emergency department and it's almost constantly filled."

ERs around the country are experiencing a surge in patients, many of whom use the department for primary health care. Experts cite a variety of other reasons as well, including an aging population, patients waiting longer to seek treatment so they are sicker when they arrive and shrinking hospital revenues.

According to the American Hospital Association, more than 1,000 ERs closed in the United States between 1988 and 1998. Those that remain are finding that budget cuts have left them caring for more patients with fewer resources in staff and equipment. Each year, the nation's 4,500 emergency departments are bombarded by nearly 100 million patient visits, statistics show.

"We see just over 50,000 patients a year," said Dr. Tom Scaletta, emergency department chairman at West Suburban Hospital. "We're actually the most busy community hospital in the Chicago area right now."

Unless the problem of overcrowding is solved soon, emergency physicians warn, the general public may not be able to rely on ERs for timely or quality care.

"We're starting to get to the point where we're underproviding," said Scaletta. "We're not putting the right number of individuals in place. We're not building emergency departments as big as they ought to be and ... hospitals reach capacity and have to turn away ambulances."

The poor and uninsured have long used ERs like a private physician's office. By law, hospitals must treat all who come to the emergency department. And even in today's booming economy, some 43 million Americans have no health insurance.

"The profile of an uninsured patient is that of somebody who is working, sometimes two jobs -- usually they're low-wage jobs, however -- in a situation where the employer may offer the option for the employee to purchase insurance and they simply can't afford it," explained Scaletta.

"It's often very difficult to come up with the upfront fee to go to a doctor's office," agreed Dr. Toni Mitchell, a Virginia-based doctor who is on the board of the American College of Emergency Physicians. "They call and (someone tells them) 'It's $65 just to walk through the door' and they say 'I can't do that.'"

Increasingly, many point to managed care as a reason for the ER patient boom.

"The access to plans, restriction to certain hospitals, all of those taken together add layer after layer after layer so that coming to the emergency department ultimately becomes the easiest choice," added Mitchell.

Scaletta said he talks daily to people who are fed up with the long waits to schedule an appointment with physicians in their managed care network. And while an industry spokeswoman agreed there are some problems, she said that managed care can't be wholly to blame.

"It's been a little too easy to attribute it to managed care," said Karen Ignagni, president and CEO of the American Association of Health Plans, a trade group representing more than 1,000 health maintenance organizations and other network-based plans. "There are a number of factors here that could explain overcrowding and increases in the numbers of people in certain periods going to the emergency room."

Weekends, when many physician offices are closed, for instance, are often busy for hospital emergency departments. The likelihood of significant trauma also tends to increase on weekends and holidays, when more people are usually out and behavior can get reckless.

"We accept the fact that there may be stretchers in the hallway all the time," said Mitchell. "In the past, that would have been unacceptable, but in order to provide the care that patients need and patients expect, we've learned to accept what in the past might have been considered unacceptable."

Hospitals face their own challenges. Declining insurance reimbursements often cover only a fraction of health care costs -- and that's when the patient is insured. Many who use emergency rooms are not.

What Mitchell and Scaletta find completely unacceptable is the notion that the situation seems likely to continue -- or perhaps get worse.

"On average, every patient who walks into the emergency department may be a (financial) loss for the hospital," said Scaletta. "I think the public needs to think about that, to make phone calls to their legislators and to their local hospital CEOs to let them know that they want the emergency department to be there for them. At this point, I wouldn't bet my life on it for the future."

For many of the nation's hospitals, 85 percent of which are community-based nonprofit institutions, finances have become a delicate balancing act, said hospital association spokesman Rick Wade.

"In some parts of the country, recruiting ER physicians has become a problem," Wade said, adding that the resulting "lack of coverage" also can negatively impact a department's effectiveness.

Smaller, rural and less financially healthy institutions have simply had to close, taking their emergency departments with them, he said.

Survey: Americans underuse 911 services in response to heart attack symptoms
July 12, 2000
4,000 workers walk out of San Francisco area hospitals
July 6, 2000
Study: Observing in ER can help family members
April 17, 2000
Emergency response to trauma makes life or death difference
July 30, 1999
The HMO debate: Who decides emergency care?
July 14, 1999
New technology closes gap between accident victims and ER
April 7, 1999

American College of Emergency Physicians
American Academy of Emergency Medicine
American Association of Health Plans

Note: Pages will open in a new browser window

External sites are not endorsed by CNN Interactive.