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EMERGENCY!!! in the Emergency Department. Ashley Killinder, PA-S University of Kentucky, 2008. Objectives…. History of Emergency Department (ED) Reasons for Overcrowding in the ED Solutions to the Problem Questions and Answers. History….

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emergency in the emergency department

EMERGENCY!!!in the Emergency Department

Ashley Killinder, PA-S

University of Kentucky, 2008

objectives
Objectives…
  • History of Emergency Department (ED)
  • Reasons for Overcrowding in the ED
  • Solutions to the Problem
  • Questions and Answers
history
History…
  • The first American hospital was established in 1752.
    • Patient Care = Free!
  • For-profit hospitals in 1900’s
    • Patient Care = Expensive!
history1
History…
  • The introductions of Medicare, Medicaid, HMOs, and DRGs in 1970s-80s.
    • Patient Care = Free for some, expensive for others.
  • National Hospitals 2007
    • Administration Corruption
    • Abuse of the System
    • Collapse of Infrastructure
shocking statistics
Shocking Statistics…
  • 90% of Nation’s large hospitals operate Above Capacity
  • In the past 10 years, the number of patients seen in the ED has risen 26%, while population has grown only 11%.
  • In the past 5 years, the number of Medicaid patients seen in ED risen 23%.
how is the ed compensating
How is the ED compensating?
  • They are not!
  • In the past decade, 500 EDs have been closed, 1/3 of those in rural populations.
  • There is currently a 114,000 bed shortage in hospitals nationwide.
  • The US is currently in a state of Nursing Shortage as large numbers are leaving the medical field.
why should we care
Why should we care?
  • The Emergency Department is the sole Safety Net healthcare provider in the US.
  • Since 1986, Federal Law requires the ED to treat all patients, regardless of the ability to pay.
  • Collapse in the ED  Collapse of US healthcare system
    •  Saturation of patient care outside the hospital.
the bottom line
The Bottom Line
  • The Emergency Department is in a state of Emergency!!!
  • Caused by:
    • Decreased Bed Availability
    • Increased Numbers on Medicaid
    • Outflux of Hospital Staff
methods
Methods
  • The information presented today is based on data collected via PubMed.
  • The data is construed from 17 core articles, the majority of which were conducted research studies within the past five years.
define overcrowding
Define Overcrowding…
  • How crowded is too crowded?
    • National ED Overcrowding Study (NEDOCS)
    • Trzeciak and Rivers
  • Quantitative rather than Subjective
    • Putting patient numbers makes more of a statement than personal judgment of overcrowding in the ED
increased numbers
Increased Numbers
  • Which population contributes the most to the overcrowding problem in the ED?
    • Uninsured patients ?
    • Medicaid patients ?
    • BOTH ?!
increased numbers ethnic low income uninsured populations
Increased Numbers: Ethnic, low-income, uninsured populations
  • Communities with higher levels of…
    • Low-income
    • Racial/ethnic minorities
    • Immigrant residents
    • Uninsured population
  • …were NOT the communities with the highest numbers of ED visits.
increased numbers influx of medicaid schip
Increased Numbers: Influx of Medicaid/SCHIP
  • Populations with highest numbers of ED visits = highest number of Medicaid enrollees.
  • The average Medicaid patient has 16 more ED visits than the average uninsured patient.
who is at fault
Who is at Fault?
  • Are Medicaid patients the “Bad Guy”?
  • Look out for large cuts in Medicaid/ SCHIP funding
outflux of staff
Outflux of Staff
  • Increased patient numbers = increased responsibility
  • 2004 NEDOCS questionnaire:
    • 1. Qualify the degree of overcrowding
    • 2. If the staff felt rushed
    • 3. Quantify the degree of overcrowding
  • Patient : Staff ratio
    • Overcrowding = Unsafe!!!
solutions
Solutions
  • Donated Care Program
    • Local physicians provide pro bono work
    • Hospitals contribute $20,000/year toward free community healthcare.
  • Employeeing Mid-Level Providers
    • Physicians Assistants are cost effective, skilled, and on the rise in the ED.
    • 47% of EDs use PAs in the ED
conclusion
Conclusion
  • The ED is in trouble, reflecting a problem on the entire healthcare system.
  • Solutions to the problem must be initiated at every level of care.
  • Local communities provide hope for restoration.
  • Utilization of PAs eases burdens in ED.
  • Action must start NOW!
references
References
  • Barlett DL, Steel JB. Critical condition: how healthcare in America became big business and bad medicine. New York (NY): Doubleday; 2004.
  • Brewer C, Kovner CT. Is there another nursing shortage? What the date tells us. Nursing Outlook. 2001 Jan; 49(1):20-26.
  • Brewster LR, Felland LE. Emergency department diversions: hospital and community strategies alleviate the crisis. Issue Brief Cent Stud Health Syst Change. 2004 Mar;(78):1-4.
  • Congress of the United States. Diagnosis related groups (DRGs) and the medicare program: implications for medical technology – a technical memorandum. Office of Technological Assessment. 1983 Jul: 23-25.
  • Cowan RM, Trzeciak S. Clinical review: emergency department overcrowding and the potential impact on the critically ill. Crit Care. 2005 Jun;9(3):291-5.
  • Cunningham PJ. Medicaid/SCHIP cuts and hospital emergency department use.Health Aff (Millwood). 2006 Jan-Feb;25(1):237-47.
  • Cunningham PJ. What accounts for differences in the use of hospital emergency departments across U.S. communities? Health Aff (Millwood). 2006 Sep-Oct;25(5):324-36.
  • Dorsey JL. The health maintenance organization act of 1973 and prepaid group practice plans. Med Care. 1975 Jan;13(1):1-9.
references1
References
  • Eastaugh SR. Overcrowding and fiscal pressures in emergency medicine. Hosp Top. 2002 Winter;80(1):7-11.
  • Ganapathy S, Zwemer F. Coping with a crowded ED: An expanded unique role for midlevel providers. Am J Emerg Med. 2003 Mar;21(2):125-128.
  • O’Malley AS, Gerland AM, Pham HH, Berenson RA. Rising pressure: hospital emergency departments as barometers of the health care system. Issue Brief Cent Stud Health Syst Change. 2005 Nov;(101):1-4.
  • Oswanski MF, Sharma OP, Raj SS. Comparative review of use of physician assistant in a level I trauma center. Am Surg. 2004 Mar;70(3):272-9.
  • Taylor EF, Cunningham P, McKenzie K. Community approaches to providing care for the uninsured. Health Aff (Millwood). 2006 May-Jun;25(3):173-82.
  • Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003 Sep;20(5):402-5.
  • U.S. Department of Health and Human Services. EMTALA: emergency medical treatment and labor act. Center for Medicare and Medicaid Services. 2006 Oct, Available on: http://www.cms.hhs.gov/FACA/07_emtalatag.asp.
  • Weiss SJ, Derlet R, Arndahl J, Ernst AA, et al.Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004 Jan;11(1):38-50.
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