As a volunteer in the Emergency Department of my local hospital, I walk along the hallways, keeping an eye on the patients lined up against the walls and sequestered in the various rooms within the ED. Near the entrance, a woman squirms and babbles as a nurse asks her a series of basic questions. When asked her name, she gives six different spellings of it. The nurse later explains to me, “She came in yesterday too, just pretending to have pain so she could get food, but she won’t admit it. She won’t even give us her real name—or at least the name she gave yesterday—so we cannot look up her records.” For every patient who comes into the ER with an emergency, many more come with non-emergent—and sometimes wholly feigned—issues that take advantage of the ER’s accessibility under the Emergency Medical Treatment and Active Labor Act (EMTALA). Such patients, who often do require medical attention but go to the ER only because they have no other way to obtain healthcare, contribute to many ERs’ shortages of staff and supplies, long patient wait times, and compromised quality of care in the Emergency Department.
Image Source: Chris Ryan
As a result, emergency centers have been forced to spread their resources painfully thin, with ER visits increasing 40% with increased coverage under Medicaid. The issue affects the quality and efficiency of patient care as well. As of 2010, 500,000 incoming ambulances are turned away from the nearest hospital each year because there is no space to accommodate the patients. With the number of ER visits increasing approximately 20% each year and the capacity of ERs actually decreasing in turn, the care of individual patients and their access to efficient, affordable medical treatment becomes increasingly compromised.
There have been several attempts to correct the problem, including increasing the capacity of emergency departments by hiring more staff and allocating more resources to the ED, as well as to other departments of the hospital to minimize “boarded patients” and thus facilitating the flow of patients within the ED. Other solutions have involved increasing communication both within the hospital and to the public, such as through hotlines or online wait clocks that show non-emergent patients the approximate wait time at the ER.
An additional approach to alleviating the situation has come from public health and the expansion of primary care. While overcrowding is a burden to ED staff, the influx of non-emergent patients has allowed for the development of a prominent public health facet as EDs treat patients who lack health care and whose repeated visits to the ER often correlate with underlying chronic health conditions such as hypertension, mental disorders, and substance abuse. As Dr. Gail D’Onofrio of the Yale Haven Hospital notes, “the emergency department is really a reflection of the community.” As such, primary healthcare holds potential as a preventative solution to chronic health problems that culminate in ER visits and overcrowdedness in hospital emergency departments.
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