Maryland Looks at ER Crowding
The Maryland Health Care Commission (MHCC) published yesterday a report titled Use of Maryland Hospital Emergency Departments: An Update and Recommended Strategies to Address Crowding (pdf). It states that In fiscal year 2006, there were about 2.3 million visits to Maryland hospital emergency departments or about 398 visits per 1,000 persons. About 18 percent of these visits resulted in an admission to the hospital. Visits to Maryland emergency departments increased by 18 percent during the 1990’s and another 23 percent between 2000 and 2006. The number of hours on ambulance diversion has ramped up along. 18.1 percent of visits to MD ER departments were classified as non-emergent while another 17.3 percent were emergent but treatable by primary care, which totals to more than a third of ER visits not being actual emergencies (see this PDF for charts and data tables). Patients end up in the ER because they don’t have access to a doctor over the weekend or at night for instance.
The report issues a number of recommendations to ameliorate crowding, including:
- “Strategies should be developed and implemented to encourage the use of primary care and urgent care services in the community rather than emergency departments. Effective strategies will combine efforts to improve the availability and convenience of services, to develop innovative service delivery models, and to provide incentives to both patient and provider.
- The MHCC and Health Services Cost Review Commission should study the access, quality of care, and reimbursement issues associated with hospital and non-hospital based urgent care center models, including the pilot free-standing medical facility at the Germantown Emergency Center.
- The Maryland Hospital and EMS Emergency Department Overload Mitigation Plan, developed by the Maryland Institute for Emergency Medical Services Systems (MIEMSS) with the assistance of the Yellow Alert Task Force, should be used to manage resources during periods of regional overload when ambulance diversion significantly reduces emergency department availability.
- The Maryland Hospital Association should collect information on innovative approaches developed by Maryland hospitals and hospitals in other states for designing emergency departments, improving patient flow to enhance emergency department throughput, assessing the effectiveness of those approaches, and disseminating best practice models. Each Maryland hospital CEO should establish a hospital-wide multidisciplinary process to identify key factors that contribute to emergency department crowding and strategies to address crowding. There should be a hospital-wide plan with defined responsibilities and specific actions that implement and track appropriate measures of efficiency.
- The MHCC and Health Services Cost Review Commission, with consultation from Maryland hospitals and other interested organizations, should evaluate their existing data sets to determine if additional reporting would be necessary to assist in addressing emergency department utilization issues.
- In consultation with the academic and research communities, the Maryland Patient Safety Center, the Maryland Chapter of the American College of Emergency Physicians, and hospitals, the Maryland Health Care Commission should develop standardized measures of emergency department utilization and patient flow that recognize differences in patient acuity and can be used to support performance evaluation and quality improvement.”
See also coverage in the Baltimore Sun.
December 21, 2006 Related topics: Trends