Our Ailing Emergency Rooms

The emergency room provides a crucial vessel for our community, a place where, at some unexpected moment, each of us might need to pour all of our hopes. Perhaps that is why the video of the unattended waiting room death of Esmin Green, an appalling, preventable tragedy, inspires such anguish and outrage.

As the New York Times reported:

“I can’t explain what happened there,” Mayor Michael R. Bloomberg said.

Someone may need to clue Mr. Bloomberg in. This death appears to be a result of systemic failure in two areas in which the mayor is credited with great expertise: public health and public management.

ER delays have become routine in America, even as they prove deadly. We remember Edith Rodriguez, Christopher Jones, Beatrice Vance and and recognize that many unknown others have died waiting for emergency care.

Hospital ERs, by law, must welcome all patients who present for treatment. Hence last year’s Presidential quip, “I mean, people have access to health care in America. After all, you just go to an emergency room.” Yet over recent years we have seen our ERs progressively overwhelmed.

The Institute of Medicine reported in 2006 that ER visits climbed more than 25 percent over ten years while the number of hospital emergency departments declined by about 10 percent. No wonder we have overcrowded ERs and longer wait times.

For several years the fact that emergency room delays can mean life or death has made its way into the mainstream discussion.

This year, a benchmark study, by Dr. Andrew Wilper and other Harvard researchers, published in Health Affairs, found that heart attack patients admitted to the ER in 1997 typically waited 8 minutes for treatment, but in 2004 waited 20 minutes, a 150 percent increase.

http://www.pnhp.org/blog/2008/07/21/our-ailing-emergency-rooms/

is in the ER unless of course you are a trauma patient at a Level 1 Trauma Center.
Unfortunately, the ER has the fewest gatekeepers for medical access and sometimes the worst diagnosticians staffing them and the uninsured have no other access to treatment options.
I always am amazed when I work the ER to find that patients actually come to the ER for gynecological issues that could be addressed easily (and much better) in a clinical setting but they refuse to used Planned Parenthood services because they think PP is only about abortions.