Hospital-Based Emergency Care At the Breaking Point (2007) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 17-36
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It is operating well oer capacity, with more than 0 patients actiely undergoing care, 0 of whom lie on wheeled stretchers in hallways. Of these 0 patients, are waiting to be admitted to inpatient beds; hae been waiting –0 hours, for 0 hours, and for oer hours.
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Hospital-based emergency and trauma care is critically important to the health and well-being of Americans. In 2003, nearly 114 million visits were made to hospital EDs, more than one for every three people in the United States.
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While the demands on emergency and trauma care have grown dramatically, however, the capacity of the system has not kept pace. Balancing these roles in the face of increasing patient volume and limited resources has become increasingly challenging.
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In a nationwide survey of nearly 90 EDs across the country, conducted on a typical Monday evening, 73 percent of hospitals reported boarding two or more admitted patients. Boarding not only is frustrating and at times hazardous for the patient, but also adds to an already stressful work environment for physicians and nurses and enhances the potential for errors, delays in treatment, and diminished quality of care.
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No federal funding is allocated to offset the costs of this care. Uncompensated emergency and trauma care services can impose an extreme
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Emergency medical services (EMS) agencies, hospitals, trauma centers, public safety services (e.g., police and fire)
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Despite the importance of emergency and trauma care, research funding in the field lags well behind that in other fields. IMPACT ON QUALITY AND PATIENT SAFETY Quality and safety have been driving concerns of emergency care leaders for decades, and notable achievements in quality have been made.
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In major tertiary hospitals, emergency and trauma care brings together the best of American medicine -- highly trained, interdisciplinary teams of dedicated special
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They have little or no opportunity for follow-up contact with patients, chronic care management, assurance of patient adherence to treatment, and coordination of care across providers and patient care settings. Patient-Centered EDs are designed to maximize visibility rather than to preserve patient privacy.
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For example, the increasing amount of primary care delivered in EDs has important cost and quality implications, and may detract from the ED's primary mission of providing emergency and lifesaving care. Further, the high degree of liability exposure in emergency and trauma care can lead to defensive medicine -- the use of diagnostic tests and treatment measures primarily for the purpose of averting malpractice lawsuits (Lawthers et al., 1992; Berenson et al., 2003; Katz et al., 2005; Studdert et al., 2005)
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, Emergency Medical Services for Children (EMS-C) program; the National Highway Traffic Safety Administration; the Agency for Healthcare Research and Quality; the Centers for Disease Control and Prevention, Center for Injury Prevention and Control; and the Josiah Macy, Jr.
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Foundation, 1995) examined the young specialty of emergency medicine and explored a vision for the future development of emergency medical practice, research, and care delivery.
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rendered by bystanders; 9-1-1 and dispatch; emergency medical response and treatment at the scene; transport of patients via ambulance or air medical service; emergency assessment and treatment at the hospital ED or trauma center; critical care services in the operating room, the intensive care unit, or other inpatient departments; interfacility transport of patients; treatment in specialized facilities such as burn, stroke, and cardiac centers, as well as children's hospitals; and access to follow-up in community-based referral sites, such as primary care practices, skilled nursing facilities, psychiatric hospitals, and substance abuse clinics. Emergency care is unique in the health field because it operates at the intersection of medical care, public health, and public safety.
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Hospital-Based Prehospital Pediatric Emergency Care Emergency Care Emergency Medical Services Subcommittee Subcommittee (13 members) Subcommittee (11 members)
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It is important to note that the committee's definitions of emergency care and emergency care system may be narrower than other definitions, such as those used by the federal Emergency Medical Services for Children program, which also encompass injury prevention and rehabilitation services. Trauma care is the care received by a victim of trauma in any setting, while a trauma center is a hospital specifically designated to provide trauma care.
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To avoid confusion, the terms emergency medical serices for children and EMS-C denote the HRSA program itself. ORGANIZATION OF THE REPORT This report -- one of a series of three -- summarizes the committee's findings and recommendations regarding hospital-based emergency care: • Chapter 2 describes the evolution of emergency and trauma care and the multiple roles currently served by the emergency care system -- from care for those in urgent need to primary care for the uninsured, public health surveillance, and preparation for disasters.
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2004. Emergency Department, Trauma Unit Closures Increasing Patient Wait Times in Los Angeles County.
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emergency departments. Academic Emergency Medicine 8(2)
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2003. Hospital emergency departments: Where the doctor is always "in." Medical Care 41(2)
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2004. Estimating the degree of emergency department overcrowding in academic medical centers: Results of the national ED overcrowding study (NEDOCs)
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