Overcrowded ER Points to Larger Problems

San Francisco Chronicle, By Victoria Colliver –

August 7, 2012: California hospitals in areas with large minority populations are disproportionately affected by emergency room overcrowding, making them more likely to ease the congestion by diverting ambulances to other hospitals, according to a UCSF-led study.

The study, which looked at 2007 data from 202 hospitals around the state, found hospitals that served the greatest percentage of minority patients turned away ambulances because of overcrowding as much as four times as often as those that served the smallest number of minorities.

Health experts say ambulance diversion, the practice of turning ambulances away temporarily when a hospital’s emergency department becomes overcrowded, can lead to delayed care and poorer health outcomes.

What this study points to is that overcrowding is a symptom of larger problems within the health care system, the study’s author said. These include patients who lack primary-care services that could keep them out of the hospital, and hospitals that are overwhelmed by poorer patients or could use better emergency management. These issues can be particularly acute in areas with higher minority populations.

“Diversion originally was created for patient safety; it was created as a safety valve,” said Dr. Renee Hsia, lead author of the study and assistant professor of emergency medicine at UCSF.

“What diversion shows is that the system is not prepared to provide the care it was designed to provide,” said Hsia, who is also an attending physician in San Francisco General Hospital’s emergency department. She said the study is the first to use hospital-level data to show how diversion affects minorities.

Emergency departments become overcrowded for several reasons. Patients – often those who are uninsured or lack adequate access to primary-care services – end up there for nonurgent care or for serious conditions that could have been treated earlier or even prevented.

Sometimes the emergency department becomes overcrowded because hospitals lack the proper staffing to admit patients into the hospital so they get stuck waiting in a room or on a gurney in the emergency department for hours. Other times the hospital may lack the equipment or services it needs to treat a specific medical problem.

Overcrowding, whatever the cause, can lead to ambulance diversions and impact the quality of care. In a separate study, which was published last year in the Journal of the American Medical Association, Hsia found that patients seeking care for heart attacks at busy hospitals undergoing ambulance diversion had a significantly higher chance of dying within 30 days.

Hospital officials weren’t surprised by the results of the new study, which were published online Monday in the journal Health Affairs.

Jan Emerson-Shea, spokeswoman for the California Hospital Association, said communities with high numbers of minorities tend to have more people who are uninsured, are on Medi-Cal or otherwise lack access to care.

“If they had access to primary-care services either through a clinic or an urgent-care center to treat that earache … it would help mitigate the ER overcrowding issue,” she said.

Hsia said a number of issues must be addressed to fix the problem, including better management of hospital flow as well as possible statewide policies to regulate diversion.

Overcrowding can affect all patients, even those who live in areas that are not diverting ambulances. “If another hospital is crowded,” she said, “they may be going to go to your ER.”

Source: John & Rusty Report via Word & Brown