On a recent Saturday morning, I drove a good friend from her health club to an emergency room at a nearby hospital.
Her symptoms — not remembering what she had just done and repeating herself — spoke of a potentially serious condition. The emergency medical technicians who were called to the club said we had to have my friend’s condition checked right away.
But “right away” turned out to be several hours later. The emergency room was jammed.
The triage nurse at the front desk sorted us out according to urgency of case. My friend fell somewhere in the middle.
Why was the ER jammed on a sunny weekend morning? For starters, they are open when most doctors’ offices are not and they take all comers. But they are also an exceedingly expensive place to deliver health care.
The health care reforms were to tie the previously uninsured with doctors. That way, they would not go to ERs with minor ailments.
But many emergency departments (hospitals prefer the word “department” to “room”) are busy as ever. Something must be done about that.
Let’s first dispel one myth. Most who go to the ER do require prompt medical attention. The Centers for Disease Control and Prevention say that over half need to be seen within an hour.
But do they need a fully staffed hospital emergency department? A man who passes out may just require a safe place to sober up. Others clearly belong in a mental health facility. (One woman in our waiting room was hollering about discomforts large and small.)
And numerous ailments or injuries could be treated at a walk-in clinic or by a nurse in a drugstore health center.
Many people go to the ER because it’s open after hours. Example: the working mother whose child has a bad sore throat.
Here are a couple of solutions, successfully tried in various communities:
» Reno, Nevada, is using specially trained paramedics to assess the patients who call 911. In some cases, they treat them on the spot. If the patients need the ER, they take them there. Or they may determine that an urgent care center or mental health clinic could provide care.
They also do follow-ups to keep an eye on certain patients, especially repeat 911 dialers. For instance, a man with heart disease kept calling because he never knew whether a flutter feeling was serious or not.
» Washington state is trying to discourage frequent visitors to the emergency room by enrolling them in primary care services. It’s even scheduling appointments for them and making sure the patients show up.
» A number of states have tried more punitive approaches, such as charging copays to Medicaid patients who use the ER for non-emergencies. This doesn’t seem to have helped, because low- or no-income patients tend not to pay. Collecting from them costs more money than the copays generate.
And what about my friend? It seems she had experienced something called transient global amnesia, a temporary and not worrisome condition known to affect strenuous exercisers. To rule out something more serious, the ER checked her blood pressure, pulse, heart rhythm and blood sugar. This could have been done in any number of non-hospital settings.
Had we gone to an alternative, she probably would have received prompter attention and would have been told — as the ER doctor advised — to call her doctor on Monday. The cost of this treatment would have been a fraction of what it was.
Health reforms aside, unnecessary use of emergency departments continues to waste medical resources. Some communities are grappling with the problem. Successes deserve to be copied.
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