We have read, over the past several years, stories of overburdened emergency departments, overworked hospital staff, and profit driven emergency care. When the bottom line is the driving force behind healthcare and medical care policy decisions, sick patients and their families are frequently the losers. Patients are finding themselves waiting in the emergency room – or the waiting room – for hours or even days before admission because it is more profitable to hospitals. When hospitals prioritize revenues over sick patients, vulnerable patients and their families lose.
Typically, a patient will present to the Emergency Department for some acute issue. The patient will be triaged and their condition will be evaluated. If the patient needs to be admitted, they will be moved to the part of the hospital that can provide them the care they need. “Boarding” is the term used for patients that are kept in the emergency department for lack of space and staffing in the hospital. These circumstances are often designed as such by hospital administrators. It is more profitable to keep hospital floors near capacity with minimal staff than to build in space to allow for surges in-patient admissions.
These “misaligned healthcare economics” are causing poor outcomes for patients. There are reports of patients having significant treatments such as brain bleeds, hip fractures, or necrotizing conditions treated in the waiting room, or other patients even dying before admission. We saw in Kitsap County earlier this year an emergency department seek help from firefighter EMTs to help manage their overburdened ED. Additionally, as many as 10% of patients are leaving hospitals without receiving care.
Improvement will require significant overhaul of the way hospitals manage patient flow, how CMS compensates hospitals for patients, and perhaps even real time patient wait times available to the public and aid cars. This situations has been years in the making, but there are ways forward to reemphasize patient outcomes while making room for hospital systems to maintain revenue streams.
