We’ve all heard stories about the long wait times in our emergency rooms (ERs). In some cases this has translated into bad outcomes, as demonstrated by the case of Esmin Green, the 49-year-old woman who collapsed and died on the floor of a waiting room at a Brooklyn psychiatric hospital.
A recent survey of ER physicians in 65 emergency departments assessed their perceptions about their working environment and their capacity to handle patients. The results show physicians lack the resources to adequately care for ER patients:
- About 40% of physicians reported that there was insufficient space for the delivery of care at least some of the time
- 50% said that the number of patients sometimes exceeded ER capacity to provide safe care
This validates previous concerns about ER overcrowding, which is making emergency care not only expensive but dangerous. So why are our ERs so crowded? Some say that the main problem is the uninsured who use ERs for their routine primary care needs or wait until they’re so sick that they have to be rushed to the ER. Although this makes sense, there is strong evidence suggesting that “the rise in ER visits cannot be primarily attributed to the uninsured.” It appears that “uninsured individuals account for only about 16% of ER visits.” Most people who go to the ER are in fact insured but they lack access to convenient care. They go to the ER because it’s a one-stop shop and, despite the long wait times, they can be seen by a physician and get their blood work and X-rays done all in one place.
Among people going to the ER are those who truly need emergency care and if neglected can end up like Esmin Green. In the real world, it’s sometimes very hard to separate such people from those who are not truly emergency patients. I think the best way to fix the problem is to focus not on providing universal coverage but universal access to care by working towards developing a more efficient and intelligent healthcare delivery enterprise.
