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    Saturday, August 26, 2006

    GOMER Study: GOMER- n. An unwanted emergency room patient. Origin: Engl. Get Out of My Emergency Room.

    Overcrowded emergency rooms are often blamed on people who use them for routine care, but at least one study suggests that's not the case:

    Redirecting emergency room patients who don't have urgent symptoms, the new policy at Harris County's public hospitals, does little to improve the efficiency or timeliness of care given to more acutely ill ER patients, according to a new study.

    The study of more than 4 million patient visits at emergency rooms in Canada found the policy's impact is negligible — for each non-emergency patient who arrives, the remaining emergency room patients experience an increased length of stay of just 32 seconds.

    ....Schull said previous research has shown that it is sicker patients, particularly those requiring hospital admission, that lead to crowded ERs. The research links the problem to a coinciding reduction in hospital beds in the U.S. in the past 15 years.

    Someone in the article is quoted as saying the results are counter-intuitive, but they aren't, really. Easy cases are just that - easy. They can be a welcome mental break in the middle of a busy day of complicated cases. It doesn't take a lot of thought or time to take care of a runny nose or a simple sprain. But it does take a lot of time and mental effort to care for an exacerbation of a complex chronic illness or a life threatening emergency. Like any difficult mental task, one can only do that sort of work for a limited time before becoming mentally fatigued. Unfortunately, with the aging of the population, things are bound to get worse - for all of us. A larger elderly population means more very sick patients who really need to be in the emergency room. Yet, for some people, the whole problem remains "the sick system":

    "Dr. Schull's study shows, yet again, that patients using the emergency department — even those with relatively minor illnesses or injuries — are not to blame for emergency department overcrowding," said Dr. Frederick Blum, president of the American College of Emergency Physicians. "Our broken health care system is."

    What broken feature of our healthcare system is responsible for the surge in the chronically and complexly ill population? The failure to recognize that the use of antibiotics and immunizations against infectious diseases would mean more people living longer with chronic, complex illnesses? You can legislate healthcare until the cows come home, but it won't change the demographics for the 20-30 years to come.

    posted by Sydney on 8/26/2006 04:17:00 PM 2 comments


    The thing I see in my ED that would help is more access to the patient's PCP.

    Many of the patients I see have PCP's, tried to get in to see them, and were told there wasn't any room in the schedule (many patients tell me for weeks into the future) and had no choice to come to the ED.

    By Blogger Allen, at 8:05 PM  

    I think that's true. A lot of doctors don't keep enough open appointments on the books for acute visits and are reluctant to double book. I think that's changing with the growing trend toward "open access," though.

    And by the way, I see something similar in my office when patients try to see the surgeon who did their surgery for a red, angry incision or the cardiologist who is managing their coronary artery disease for their angina. They're often told to call their PCP because the specialist is too busy.

    By Blogger sydney, at 8:59 PM  

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