Institute of Medicine Worried about State of ER
The Institute of Medicine (IOM) of the National Academies issued yesterday three alarmed reports about the state of Emergency Medical Services (EMS) in the US: Emergency Medical Services: At the Crossroads, Hospital-Based Emergency Care: At the Breaking Point, and Emergency Care for Children: Growing Pains. These reports depict a system under crisis because of increasing strains. In 2003, almost 114 million ER visits were made, up 26 percent from 90 million in 1993. But during the same timeframe 425 EDs closed alongside about 700 hospitals and 198,000 beds.
The nature of demand also evolved, with older and sicker patients requiring more complex treatment. Since the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, hospitals have had to provide access to all patients including uninsured ones. Medicaid beneficiaries also often turn to EDs as a substitute for primary care.
The IOM’s committee is finding there is a lack of funding from the federal government and is asking for extra resources from Congress. It notes that the proportion of funds allocated by the Department of Homeland Security for emergency medical services was just 4 percent of the $3.38 billion it spent on emergency preparedness in 2002/2003. The IOM is also calling for a reward program to steer hospitals into handling their patient flow more efficiently, rather than “boarding” patients in halls and waiting rooms. It is advocating regionalization to reduce the number of ambulance diversions that tend to cascade as patient overflow goes from hospital to hospital. (See for instance our previous coverage of how the San Diego County is considering handling its heart attack victims.)
June 15, 2006 Related topics: Emergency