Wednesday, February 2, 2011

Emergency Emergency


This afternoon, I went on a hard-hat tour of a satellite emergency facility, expected to open next month as part of my local community hospital's health care system. Besides state-of-the art equipment, the building will house twenty primary care physicians, specialty care, a test lab, and a diagnostic imaging lab. Patients will sit in comfort in chairs that will unfold into examining beds, blood tests will occur on site with results returned as close to instantaneously as possible, and Electronic Medical Records will be instantly synced with the main hospital IT system.

The facility will include a conference room for group consultations -- for example, a dozen diabetics might meet with their doctor and a nurse for instruction in lifestyle changes. Should I have the misfortune to need the emergency room, the expected wait time is 15-17 minutes. This will be at least the fourth such facility in my suburban area to go with three hospitals, each of which has its own Emergency Department.

Obviously, this will be one of the better areas in the country to need emergency care.

Which at first blush makes stories like this all the more perplexing:
A 10-year old boy in Arizona had a severe asthma attack and couldn’t breathe. An ambulance was called, but all the hospitals near his home were full and on diversion, including two children's hospitals. The closest open hospital did not admit children, but opened to take him, even though it was also overwhelmed. While waiting for a treatment room to open up, the child waited in the hallway on the ambulance gurney for several minutes. He died in the hallway, before he could be seen by even a nurse, because all the staff were overwhelmed caring for other critically ill patients...
A patient was boarding in my emergency department, waiting for an inpatient bed to open in the hospital.  His family gathered around him and was forced to make end-of-life decisions with him while he lay dying on a gurney in a hallway...
An elderly man came to the hospital with weakness, pneumonia and new onset of renal failure with very high potassium levels. He arrived at 10 pm and we were unable to move him to an ICU bed until 4 pm the following afternoon. 
All over the country, Emergency Rooms face increasing pressure, although the reasons for this are more complex than one might think. Certainly uninsured people use the ER, but most patients have Medicare or Medicaid. Reimbursements have become so low that many physicians refuse to see Medicaid patients, and so they resort to the ER. The shortage of primary care physicians contributes as well.

Still, at a time when emergency departments are closing and urban wait times increase, it's not an accident that the facility I visited is located in a hospital district with a per capita income of over $100,000 or that there are nearly as many emergency facilities the greater suburban area as in the more populous urban core. At the end of the day, emergency care is rationed, too: The uninsured and underinsured who resort to urban emergency departments because they have no other choice have access of a sort, but it's hardly equal access.