If you鈥檝e ever been to the emergency room, chances are it was overcrowded and you had to wait a while.
But that long wait isn鈥檛 necessarily due to patients coming to the ER for non-critical medical care, according to a new report from a committee of doctors convened by 海角换妻 lawmakers.
Rather, emergency room 鈥渂oarding鈥� is to blame.
鈥淏oarding鈥� is when patients are made to stay in the ER, often on a bed in a hallway, as they await transfer to another part of the hospital.
These delays can last hours, days, weeks, or longer, according to the .
鈥淧eople often think [ERs are crowded] because people are over utilizing the ED,鈥� said Dr. Chris Moore, an ER physician at Yale New Haven Hospital, and committee member who helped author the report.
鈥淏ut one of the major issues is that hospital patients who are admitted remain in the emergency department,鈥� he said. 鈥淭hat constricts the space to take care of and evaluate incoming patients, and those are what's called boarded patients.鈥�
Moore and the committee of doctors outlined the state鈥檚 boarding crisis in handed over to lawmakers in advance of the legislative session that began on Jan. 8.
Across 海角换妻, ERs provide care to more than , regardless of their ability to pay. In addition to life-saving treatment for heart attack, stroke or trauma, ERs are the last safety net for many working poor, along with people in crisis from mental health or substance use disorders.
overcrowding in the ER is a public health crisis that can result in delays in care, missed diagnosis, harm to patients and even death.
Non-critical patients presenting at the ER not the issue, report says
The group advised lawmakers that ER crowding is not the result of ER overutilization, even when patients presented at 海角换妻 ERs for non-emergency symptoms. The top 10 reasons people go to ERs statewide for non-threatening conditions according to state data are:
- Urinary tract infection
- Other chest pain
- Low back pain
- Dizziness and giddiness
- Acute upper respiratory infection
- Unspecified fever
- Nausea with vomiting
- Suspected exposure to unspecified communicable disease
- Unspecified abdominal pain
- Acute pharyngitis (sore throat)
The working committee wrote that while it supported the use of urgent care centers and primary physician practices as a means to reduce ER crowding, 鈥渋t is essential that patients are not prevented from seeking care in the ED when they believe they need it.鈥�
According to the , a federal law that provides patient protection, anyone can receive emergency care regardless of insurance status or ability to pay.
The 海角换妻 group of doctors wrote that patients are not expected to know if their symptom is serious, and non life-threatening conditions are the easiest to deal with in the ER.
鈥淯ncomplicated upper respiratory infections (URIs), sprained ankles, and sore throats may be able to be cared for elsewhere, but they are not what is causing ED crowding as they can be quickly discharged,鈥� the report stated.
Moore acknowledged that many patients in hospitals in 海角换妻 do not require hospital-level care, but are unable to be placed 鈥渇or various social issues, or there's just not space for them, whether they're elderly or have mental health or substance abuse issues.鈥�
Proposed solutions
The committee is mandated to advise legislators and the commissioner of the Department of Public Health about ways to alleviate ER crowding and the lack of available ER beds in the state.
Proposed solutions outlined to lawmakers include:
- Establishing a quality measure on hospital boarding in every ER statewide. This database would be implemented by the Office of Health Strategy and data would be publically available.
- Increasing Medicaid reimbursements, which would allow hospitals to potentially fund solutions to reduce ER wait times.
- Establish and fund a 海角换妻 鈥淓R ombudsman鈥� to monitor the flow of patients through hospital ERs.
- Implement a statewide information system for ER capacity, hospital capacity, and transfers.
鈥淚t is very important for the legislature to address the Medicaid rates here in 海角换妻,鈥� Dr. Gregory Shangold, committee member and ER physician at Northeast Emergency Medicine Specialists.
鈥淭hey have been flat for 17 years,鈥� he said. 鈥淎dditionally, the impediment of prior authorization severely hampers the flow of patients through the hospital and contributes greatly to the boarding situation.鈥�
Prior authorization , and leave patients lingering as doctors and insurers hash out what鈥檚 medically necessary and who will pay for the care.
The 海角换妻 Hospital Association [CHA] says it is also in favor of increasing Medicaid reimbursements and addressing insurance prior authorization delays, two solutions it believes would more quickly alleviate the ER boarding crisis.
鈥淲e should dedicate limited resources to solutions that address the known issues that influence wait time, [rather] than more and more data collection,鈥� CHA said.
Hospitals in 海角换妻 are required to analyze the percentage of patients who are admitted to the hospital after presenting at the ER, but were transferred to an available bed outside the ER more than four hours after an admitting order. Starting this year, the data must be submitted annually by hospitals by March 1.
