Emergency departments at most hospitals in Massachusetts, and across the nation, are stretched to the breaking point, raising concerns that they would not be able to handle the surge of patients due to a terrorist attack or natural disaster.
Even under routine conditions, emergency physicians face almost insurmountable obstacles to the delivery of timely patient care. Many Emergency Departments have patients waiting for hours to be admitted to inpatient hospital beds. Frequently, this causes ambulances to be diverted to hospitals farther away, wasting precious minutes for critically ill patients and causing problems with the local availability of those ambulances.
If inpatient hospital beds are not available, emergency patients can't be transferred into them, leaving these patients to "board" in emergency departments where they are typically lined up in hallways, with little or no privacy, until beds are free. Those waiting for less emergent, but no less serious care, end up waiting even longer.
This bill seeks to reduce hospital emergency department crowding by requiring the Department of Public Health (DPH) to establish guidelines for the prompt admission of patients presenting in the ED who are determined to require inpatient care. The bill specifies that the guidelines include the development of a "reasonable median time" within which an admitted patient should be moved out of the ED to an appropriate inpatient destination; protocols to track and identify length of stay patterns; and DPH data collection and monitoring programs to ensure compliance.
The bill also directs DPH to establish a financial incentive program to reward hospitals that comply with established guidelines to reduce crowding in emergency departments. The Department is charged with reporting back to the legislature with recommendations/legislation by December, 2008.
The bill further requires the establishment of an Advisory Council on Hospital Crowding and Emergency Department Boarding within DPH. The Advisory Council would assist in the development of data collection and analysis initiatives, in the development of boarding standards, and in the financial incentive program. The Advisory Council would be broad based, including legislators, state agencies, physicians, nurses, hospital administrators, insurers, EMS personnel, and consumer advocates.
This bill is based on the assumption that crowding is not an emergency department problem; rather it is a healthcare system wide problem that is best addressed by the cooperative efforts of the state legislature, hospitals, providers, insurers and consumers. Only in this way, can our hospital emergency departments ensure full access and the delivery of quality care on a timely basis.