Monday, November 06, 2006

ER system reform needed

The Associated Press brought up the case of the woman who died in the ER waiting room that was ruled “homicide” by our Coroner’s Inquest jury again yesterday. It was in an article about long wait times in ERs and doctor’s offices.

It also “came up” at a recent meeting of the local regional healthcare council, being fostered by the Metropolitan Chicago Healthcare Council, (alright, I brought it up as an example of a system problem that should be looked at for “remedy”).

At that meeting we briefly discussed how many problems are contributing to this “system problem”, some of those things are also touched on in the article I referenced above. ERs are overcrowded. There has been a 26% growth in the number of patients seen in the ER between 1993 and 2003, while the number of ERs in this country have dropped by 12%. This growth/contraction combination took place without much modification in the system (the way that ER care is delivered) designed to keep up with the changes and load engendered or designed to improve efficiencies in providing ER care.

This is compounded by a variety of other confounders. There are “health literacy” problems. Many people don’t always know what is appropriate for an ER visit or because of that “illiteracy” don’t know what to do short of going to the ER for various medical problems. That “illiteracy” may also impair their ability to follow medical instructions for care and to keep them out of the ER. There are access issues for both acute and chronic health problems, denying people other options for care. There are “down-stream” problems, e.g. lack of hospital nursing staff and/or beds impairing the ability to get patients out of the ER and freeing up space for the next patient. There are many facets and/or contributing problems.

Some places are making changes to address some of the contributors. ERs are adding staff to handle cases that present. Some hospitals are using physicians for triage at busy times so that necessary testing can be begun more quickly. Groups are looking at “best practices” and exporting them to other ERs. Groups are developing alternatives for expanding healthcare access.

As I said before it is a system problem and requires system intervention to prevent any more individuals from dying in the waiting room.

No comments: