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Unpleasant Diversions

A new study reveals that nine of 10 larger hospitals operate either at or over maximum ED capacity.

By Elizabeth Thompson Beckley
Modern Physician Magazine, May 1, 2002

More than 60% of emergency rooms in the U.S. are filled to capacity and have difficulty accepting additional patients. The situation is especially acute for hospitals with more than 300 beds, according to a survey by the Lewin Group of Falls Church, Va., a research and consulting division of pharmaceutical data marketer Quintiles Transnational.

Released in April at the annual meeting of the American Hospital Association in Washington, D.C., the survey of 1,501 hospitals, representing 36% of facilities with EDs, found nine of 10 larger hospitals operating either at or over maximum ED capacity. Additionally, more than half of urban hospitals and one in eight teaching hospitals sometimes must divert ambulances to other facilities.

``There are more seriously ill and injured patients than we have hospital beds to care for them,'' says Brent Asplin, M.D., a member of a task force on overcrowding empaneled by the American College of Emergency Physicians. Staffing those beds is part of the dilemma, says Asplin, emergency medicine research director at Regions Hospital in St. Paul, Minn. Nurse vacancy rates as high as 16% exacerbate diversion for more than 20% of hospitals surveyed. Additionally, some 40 million uninsured patients continue to use the emergency room for primary care.

Difficulty in maintaining adequate physician coverage for EDs also plays a role. Surveyed hospitals report that neurosurgery, neurology and cardio-thoracic surgery are the hardest slots to fill, but Asplin points out that specialist needs vary among hospitals. Low reimbursement, lifestyle concerns and increasing malpractice insurance premiums are the main contributing factors to poor specialty coverage, Asplin says.

Overcrowding results in longer waits for treatment by physicians, longer ED stays and increased time for admittance to a general acute or critical care bed. ``The ED is the flood door, not the back door, of the hospital, and it is wide open,'' says Wesley Curry, M.D., president of the California Emergency Physician Medical Group, a network of 800 providers, 47 EDs and 20 ambulatory care practices.