The Future Of Emergency Care In The United States Health System
Key Findings
The Institute of Medicine (IOM) report concludes "a national crisis in emergency care has been brewing, and is now beginning to come into full view." Contributing to the problems facing the emergency health care system are issues of overcrowding in hospital emergency departments, fragmentation among the different agencies in the emergency health field, a shortage of on-call specialists, and an overall lack of emergency preparedness. Funding is a major focus of the IOM report, which the report's authors conclude is a key reason for the lack of emergency preparedness. In short, very little of the money spent on emergency preparedness since 9/11 has gone to emergency medicine. The report recommends a significant increase in federal resources and attention be directed towards the many problems facing emergency medicine.
The IOM report is divided into three distinct reports that examine the troubled state of emergency medicine in the United States:
Hospital-Based Emergency Care: At the Breaking Point
Visits to emergency departments have been increasing dramatically in recent years. In 2003, there were nearly 114 million visits to the emergency room in the United States - more than 300,000 visits every single day. Ambulances are now routinely "diverted" in many communities, as hospitals are forced to turn away patients when a facility's ability to care for even one more patient is jeopardized. For patients inside overcrowded emergency departments, long waits are common. Emergency departments are forced to practice "boarding," where hallways are lined with patients on gurneys while they receive care and wait for an in-patient bed to become available.
The IOM report calls on hospitals to end the practice of "boarding" altogether, except "in the most extreme circumstances, such as a community mass-casualty event." It also calls on hospitals to improve efficiency and patient flow using research being applied in various industries, including banking and the airlines. Information technology could be more fully developed in the EMS system, according to the report, including dashboard systems in ambulances that better coordinate patient flow and communications systems that enable emergency physicians to access patient records.
Emergency Medical Services: At the Crossroads
Fragmentation and an overall lack of coordination among hospital emergency departments and the many emergency medical services systems is a focus of the IOM report. The report notes the lack of a single federal agency or department in charge of overseeing the enormously complex network of emergency responders serving the public. The fragmented nature of emergency medical services should instead be a seamless integration of hospitals, 9-1-1 and dispatch, and EMS workers where communication is key and patients are treated in the most efficient way possible.
The IOM report concludes that the current fragmented system should instead be "seamless" from a patients' point of view, with all professionals in the emergency care arena communicating continuously and working together. A regionalized system of coordinated EMS activity is suggested in the IOM report, with a call for 10 demonstration sites throughout the country to test new ideas and create adaptive strategies in improved patient care. The shortage of on-call specialists is addressed, with a call for Congress to "mitigate the effect of medical malpractice suits on service provided to patients in the ED." In addition, a lead federal agency should be designated, according to the report, in order to consolidate the various government programs that currently have jurisdiction over emergency care.
Emergency Care for Children: Growing Pains
The IOM report notes that while children make up more than one-fourth of all emergency room visits, many hospitals lack the supplies necessary to treat the full range of pediatric emergencies: "Only six percent of U.S. emergency departments have all the supplies necessary for handling pediatric emergencies, and only about half of the departments had even 85 percent of the essential supplies." In addition, the report cites a general lack of preparedness to deal with the special needs of children and their families in times of national emergency.
The IOM report stresses the need to keep children in mind throughout their experience in the emergency health care system, and calls for the development of improved standards and protocols to ensure quality care for pediatric patients. In addition, the IOM report encourages research in the field of pediatric emergency care to "determine which treatments and strategies are most effective with children in various emergency situations."
