EditorialA room with a view: On-call specialist panels and other health policy challenges in the emergency department☆
Section snippets
A visit to the emergency department
Paramedics respond to a 911 call for a patient with a head injury. They initiate appropriate treatment and begin transport; however, they soon learn that the destination hospital’s ED is “on divert,” forcing them to transport the patient to the city’s only remaining open ED. This requires an additional 15-minute transport, and the ambulance is out of its service area for an extra 45 minutes.
In the ED, paramedics note the long row of gurneys in the hallway, signaling that this ED may soon need
Converging health policy challenges
This case vignette is no longer shocking for most emergency physicians. After all, there was no dramatic adverse patient outcome, and problems with ED overcrowding have become so familiar that the struggle to find inpatient beds is part of our daily routine. Waiting hours or even days in the ED for an inpatient bed, however, is still shocking to our patients. In some EDs, a 7-hour stay in the department awaiting ICU admission would be cause for celebration. In others, it would be a disaster.
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Cited by (28)
Medicaid Expansion's Impact on Emergency Department Use by State and Payer
2022, Value in HealthCitation Excerpt :Studies also show that Medicaid beneficiaries are affected by more barriers to timely primary care, for example, physicians’ unwillingness due to low reimbursement rate.40 EDs are required to provide care to any patients requesting treatment and are indicators of healthcare system performance.41,42 When primary care providers are in short supply, sick people are forced to seek medical care in EDs.
Waiting room medicine: Has it really come to this?
2010, Annals of Emergency MedicineThe worsening of ED on-call coverage in California: 6-year trend
2009, American Journal of Emergency MedicineCitation Excerpt :These data do not suggest that individual practitioners or specialists are at fault. Market forces dictate specialist behavior [15]. The major changes over time between the 2000 survey [8] and the current one are the following:
The Safety of Emergency Care Systems: Results of a Survey of Clinicians in 65 US Emergency Departments
2009, Annals of Emergency MedicineCitation Excerpt :This supply-demand mismatch is further exacerbated by a lack of timely access to inpatient beds, which leads to the “boarding” of admitted patients in the ED.24,33-35 Our findings are also consistent with previous reports of a shortage of specialists available to provide emergency care.23,38-44 In general, the frequency with which ED clinicians reported problems with systems that facilitate safe care was greater than the frequency with which these problems are reported by general hospital staff.45
The On-Call Crisis: A Statewide Assessment of the Costs of Providing On-Call Specialist Coverage
2007, Annals of Emergency MedicineCitation Excerpt :Hospitals across the nation have complained of increasing challenges in maintaining specialist on-call coverage for their emergency departments (EDs).1-8
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