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ER Overcrowding Solutions

ER Overcrowding Solutions

ER Overcrowding Solutions Continue to Fall Short

Overcrowding continues to plague emergency departments around the country, and some hospitals are trying new strategies to cope with the overload. The problem, according to experts, is that the expansion of coverage under the Affordable Care Act is driving more patients to the ER than before. But hospitals seem to have done little to fix the problem, and overcrowding in many cases is not seen as a priority.

Innovative Solutions in Massachusetts General Hospital:

At Massachusetts General Hospital, eight of 10 ER patients need to wait for care because of poor bed management. While that remains an issue, a new program in Syracuse could help break up the crowds. The Upstate at Home program uses house calls to treat patients whose conditions require treatment but not emergency transport and care. This program shows promise, although it is in its infancy and has limited reach.

Exploring Community Paramedicine:

Some areas are trying out community paramedicine or mobile integrated healthcare-community paramedicine, where paramedics respond to provide preventive and interventional care for people not sick enough for emergency treatment. But until busy hospitals adopt common-sense measures, such as bedside registration that can reduce overcrowding, the troubles will continue for ERs around the country.

Challenges with Bed Management:

It's not that all of the beds are always full, according to the Globe. The problem is that 30 to 45 beds in shared rooms go unused because staff can't match patient gender or don't want to put someone in a room with disruptive patients. "One of the clear lessons learned is the value of single rooms," Sally Mason Boemer, senior vice president of finance, told the newspaper. "There were more demands than we anticipated."

The Situation in San Diego:

In San Diego, officials said emergency room visits swelled by 40 percent between 2004 and 2014, with more than half of ED visits in that time for non-emergencies. Too few people understand when to use emergency services, and many don't have primary care doctors they can visit, Wilma Wooten, M.D., county public health officer, told The San Diego Union-Tribune. She also noted the county's population of older patients with chronic conditions has grown, putting more strain on the ED.

Barriers to Primary Care Access:

Another problem, according to the local hospital association: Too few primary care doctors accept Medi-Cal, the state's Medicaid program, because reimbursements rank 49th in the nation. More than 40 percent of patients surveyed by the hospital association didn't have a primary care doctor, and 56 percent didn't know when to use an ED versus urgent care or a clinic, according to the article.


Dr. Kris Dinucci

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