Is Emergency Care an Emergency? Maybe Not

Bad planning on your part does not constitute an emergency on my part

proverb

When I first started practice, my radiology group also covered a much smaller local hospital. That hospital had a small Emergency room that could kindly be described as “second tier”. The department was staffed by general practitioners, with no specific training, and sometimes only one or two nurses. In reality, it was just a doctors office that happened to be near a hospital. Nevertheless, it was quite adequate for the routine colds, backaches, and expired prescriptions that make up the bulk of Emergency room visits in America. Fortunately, the county had a method for sending ambulances with real emergencies to the better equipped hospitals. However, sometimes patients would come through the door with heart attacks, stokes, and other severe problems that needed specialty care. I remember on several occasions watching the covering doctor desperately trying to find a cardiologist or surgeon, or more frequently, sending the patient to another hospital. Such delays can result in poor outcomes or death. I was quite relieved a few years later when we dropped the contract to that hospital.

A first rate emergency room is a very different place. Modern Emergency rooms are not only staffed with board certified emergency doctors, additionally trauma surgeons, neurologists, cardiologists, radiologists and intensive care doctors are in-house or quickly available. Furthermore, advanced imaging, such as CT, MRI and ultrasound can be performed immediately. Staffed Cardiac labs and operating rooms need to be kept open. In my hospital a patient coming in with a bleeding aortic aneurysm, could be stabilized, CT scanned and in the operating room in 45 minutes. Maintaining this level of care is expensive, requires dedicated hospital resources, and is simply beyond the reach of smaller hospitals. The study referenced today bemoans the loss of Emergency rooms, and the headlines suggests this represents the further deterioration of medical care in America. What the authors do not mention is that if you do go to an Emergency room today, you are far more likely to get optimal care than you were 20 years ago. The hospitals that have kept their services open are the ones willing to make the commitment to the level of care that is now required.

I think much of the problem goes to the perception of the American public about what emergency care is. Although I liked the TV show ER, the series and its clones gave a very distorted view of what actually happens in most emergency settings. In reality, most things in an Emergency room are not very exciting. The vast majority of visits are for minor problems that have more to do with patients being unable or unwilling to wait for an appointment to see their regular doctor. These patients can be treated appropriately by walk-in centers far more cheaply and efficiently than Emergency rooms. The best solution is to have a walk-in center affiliated with the Emergency room to siphon off these minor problems before they burden the high level centers. Fewer facilities, treating real emergencies, and allowing the other patients to be treated by after hour “doc in a box” facilities may be a better answer to our healthcare needs than having more ersatz “Emergency Rooms”, which are really no more than glorified doctor’s offices. I recommend you spend some time evaluating the Emergency rooms near you. Make sure it has the facilities you might need if you or your family truly needs one, it could save your life.

http://www.nytimes.com/2011/05/18/health/18hospital.html?partner=rss&emc=rss

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