22 November 2016

Getting Creative with Emergency Room Care Starts with the Human Element

There is a new authority ruling emergency rooms across San Diego County, created to combat the influx of patients overwhelming the health care system in recent years. Known as “bed czars” and “zoomer nurses,” as featured in the San Diego Union-Tribune, medical personnel at Sharp Grossmont Hospital and Tri-City Medical Center monitor the ED and help make decisions to “fast track” patient care. They determine the patients with minor medical problems and allow them to remain for treatment and discharge, while patients with more severe conditions requiring at minimum an overnight stay are quickly transferred to the appropriate department.

The creation of these new positions highlights a heightening dilemma in ED overcrowding. Over the past 20 years, annual ED visits have increased by 40 percent, from 97 million in 1995 to 136.3 million in 2012. After two decades of steadily rising visits, hospitals have seen a rapid spike in ED use over the last several years due to increased health care coverage and several public health concerns, including:

  • Nearly half of ED physicians (.pdf) believe that the severity of illness or injury among patients has increased since 2014, which necessitates spending more time determining whether their illness or injury can be addressed in the ED.
  • Physicians also note a rise in behavioral health-related visits, spurred by a nationwide shortage of funding for psychiatric inpatient services, which account for 12.5 percent of all ED patient visits.
  • Further, the ED has become the first stop in hospital readmittance for patients with chronic health care issues, which include not only mental illness but also diabetes, hypertension and congestive heart failure. About one in five hospitalized patients visited an ED within 30 days of their discharge, and 55 percent of these patients were readmitted to an inpatient department after being examined. 

With these multifaceted concerns straining ED staffing, time and resources, it is no wonder that hospitals are getting creative in their efforts to manage and eventually eradicate overcrowding. To deal with specific causes of readmittance, particularly mental health concerns, hospitals such as Sinai Health System in Chicago and the SSM Health St. Mary’s Hospital in Madison, Wis. are greatly expanding community access to mental health care through new psychiatric services and facilities. The Nassau University Medical Center in Long Island is addressing staffing and space concerns by building a new primary care unit to relieve the patient burden in the ED.

Meanwhile, several upstate New York hospitals have joined the Community Partners of WNY, a performing provider system which provides follow-up calls to ED “super-utilizers” to coordinate patient care and redirect patients to relevant hospital services based on ailment severity. The Charleston Area Medical Center has also employed technological solutions through the use of TeleHealth Services, an interactive patient education platform that has helped reduce readmission rates by 30 percent.

While these solutions address long-term issues in the health care industry, most programs designed to solve ED overcrowding rely on access to funding and administrative support. Many hospitals across the country do not have these resources readily available, thus in the struggle to deal with overwhelming patient needs EDs are increasingly ill equipped to adhere to practices that ensure efficiency and patient safety.

However, EDs can make many immediate and low-cost improvements to begin to address overcrowding, as examined in Sheridan Healthcare’s white paper "The Evolving Emergency Department."  Training ED teams in crew resource management (CRM) proactively increases collaboration and improves team communication, as individuals are encouraged to monitor, identify and communicate information such as potential patient harm. Improving triage processes by having medical personnel treat patients as soon as they are available, rather than based on a traditional waitlist, reduces patient wait times while allowing the ED team to quickly determine the severity of the emergency and required departmental treatments for the ailment. Finally, medical personnel can be empowered to continuously contribute to the improvement of ED efficiency through the Kaizen principle of management.