U.S. emergency care in critical condition

WASHINGTON – Emergency medical care in the United States is on the verge of collapse, with the nation’s declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.

That’s the grim conclusion of three reports released by the Institute of Medicine Wednesday, the product of a massive, two-year look at emergency care.

Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients, and patients, once in the ER, waiting up to two days to be admitted to a hospital bed.

As a system, American emergency care lacks internal stability and has no capacity to respond to disasters or epidemics, according to the 25 experts who conducted the study. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money.

Fixing the problems is likely to cost billions of dollars and will require the leadership of a new federal agency, which Congress should create in the next two years, they wrote.

“This is a crisis that could jeopardize everyone in this room, and all their loved ones,” A. Brent Eastman, a surgeon and chief medical officer of ScrippsHealth hospitals in San Diego, said at a daylong conference on the reports, which were prepared by the National Academy of Science’s Institute of Medicine.

“There is just such a gap between what the public knows, or thinks it knows, and the reality. And it is getting worse,” said Robert Giffin, the Institute of Medicine staffer who headed the study.

The reports – on hospital ERs, on pediatric emergency care, and on pre-hospital care given by ambulance services – were embraced by the 24,000-member American College of Emergency Physicians, and its president admitted that that fact, itself, was telling.

“What other industry says, ‘Hey, look at us, our whole system is broken’?” said Frederick Blum, a physician in Morgantown, W. Va.

Two key steps for improving emergency care are regional planning and creating a standard way to measure outcomes, so that low-quality ERs and ambulance services can be identified and fixed, the committee wrote.

Other recommendations:

“Congress should establish a pool of $50 million to reimburse hospitals for unpaid emergency care provided to the poor and uninsured.

“Congress should ensure that more of the nation’s disaster-preparedness funding goes to the hospitals and emergency workers who will provide that care.

“Hospitals should stop diverting ambulances and boarding patients in the hallways.

The American College of Emergency Physicians called the report groundbreaking but said Congress must heed recommendations to fund the necessary improvements.

Between 1993 and 2003, the U.S. population grew by 12 percent but emergency room visits grew by 26 percent – more than twice as much – from 90 million to 114 million. During that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds.

In the hospitals that have them, ERs are notorious money losers.

About 14 percent of ER patients are uninsured. About 16 percent are covered by Medicaid, the federal-state insurance program for the poor, and 21 percent by Medicare, the program for the elderly. More than half of hospitals report losing money on emergency care of both groups of government-insured patients.

All of this has led to extreme bottlenecks in ERs, manifested by delays in every step of treatment, according to the reports.