Emergency rooms are essential to the fabric of society, though often ridiculed for their protracted wait times and quality of care. However, most ER professionals, from administrators to physicians, work tirelessly to treat and support patients, oftentimes in high-stress, and life-threatening scenarios.
Unfortunately, most patients and communities are unaware of the strains and dilemmas that emergency rooms face today. Dr. Eike Blohm, an emergency medicine physician, is privy to the behind-the-scenes workings of an ER in the United States. In this article, he reviews several principal factors that threaten the financial security and future of many ER institutions.
Emergency Treatment and Labor Act
In 1986, the American Congress passed the Emergency Treatment and Labor Act, in an effort to curb “patient dumping.” Under EMTALA, patients have the right to emergency care from hospitals that accept Medicare despite their inability to pay. For context, most hospitals participate in Medicare.
Furthermore, EMTALA guarantees patients three things: emergency screening, emergency care, and medical transfers (if necessary). In an emergency, a hospital must screen for an emergency, stabilize the condition, and provide care even if you’re uninsured or lack monetary funds.
Naturally, the majority of medical professionals within an ER prioritize the care of an individual, but the financials paint a far bleaker picture. Critics of EMTALA consider it a significant contributor to hospital overcrowding and rising costs. According to the National Center for Health Statistics, emergency departments in the US receive approximately 139 million visits annually, whereas only 40 million of those visits are injury-related, 14.5 million results in hospital admission, and 2 million results in critical care. Thus, implying that the majority of ER visits each year are the result of patients who do not require immediate attention, yet pose an administrative strain on the system.
Capacity
On average, patients who visit the ER without a life-threatening pretext can expect to wait four to five hours before being admitted to a bed, though in reality, it could take substantially longer. If it’s determined that a patient requires care in an adjacent care facility within the greater chasm of the hospital, the ER may board patients for several hours, even days, until an inpatient bed becomes available. This practice is known as “boarding” within the medical community. As reported by the Centers for Disease Control and Prevention, it’s common for American hospitals to board patients in the ER for more than two hours. A study conducted in 2003, “Emergency department crowding: A point in time,” noted that as many as one in five ER patients are boarded. Consequently, among other contributing factors and studies, the American College of Emergency Physicians officially associated boarding with overcrowding, which negatively affects admission rates, care (including administering medicine), as well as quality control.
Staffing
Thankfully, emergency medicine specialists are increasing year over year in the United States, whereas there is a substantial shortage of physicians in primary care. Nevertheless, emergency physicians oversee 25% of all acute care encounters, even though they account for less than 5% of all doctors. With an increase in ER visits, ER doctors must do more with less, but it’s not always enough. Between 1994 and 2014, the American Hospital Association found that 12.5% of all emergency departments and hospitals closed their doors. Over the same time, ER visits increased by a whopping 51.2%. As such, without reform across the board, including federal regulations, the safety nets that provide such an essential service to us all may belt under the weight of the ongoing predicaments.
About Dr. Eike Blohm: Dr. Eike Blohm is a highly motivated emergency medicine physician and medical toxicologist. He is a problem solver with a proven track record of growing UVMMC’s Emergency Medicine Research Associate Program to three times its size and increased the research output by 40% within a year.
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