How to reduce the burden of high ER admission rates
Emergency room (ER) crowding is a worldwide phenomenon. However, while there are many reports describing the negative outcomes of overloaded ERs, fewer are available that discuss solutions.
The need to address ER crowding has resulted in process monitoring to identify bottlenecks, as well as the introduction of national policies to regulate waiting times.
In Australia, guidelines state that patients should spend no longer than four hours in the ER. Figures from the Australian Institute for Health and Welfare over 2012 to 2013 indicate that over 6.7 million people were seen in public emergency departments, and 67 per cent had a wait of less than four hours.
Medical care systems and resources
Although reducing patient input may be an attractive proposal for policy makers, it has been suggested that the majority of ER admissions are legitimate, and targeting so-called 'inappropriate attenders' would have a minimal impact. In addition, the time and effort involved in diverting patients from the ER once they have arrived is not worthwhile.
The example of Sweden demonstrates that changes in health care systems can reduce ER crowding. Sweden does not have significant issues with ER crowding, and approximately 80 per cent of patients are discharged within four hours.
This result has been achieved, in part, by the use of an extensive general practitioner network that enables 'same-day' and 'after-hours' visits. Patients are also encouraged to contact a medical professional before ER admission, allowing streamlining of cases to the most appropriate location.
Supporting patients who require greater attention
Patients who tend to require the greatest care in the ER are the elderly, and those with mental illnesses or critical conditions. Evidence suggests that efficient treatment of individuals who need a low level of care reduces the ER backlog, making staff available to those with more challenging needs.
Alternatives to ambulance diversion
The prevalence and persistence of ER crowding suggests that ambulance diversion is not an adequate 'plan B', and the volume of cases must be directly targeted.
Given the continuing rise in the number of elderly and/or diabetic patients in the population, a forward-thinking idea may be to set up satellite centres dedicated to these groups. This strategy would not only lower ER admissions, but may also enable better care because physicians in these clinics would be seeing patients with similar needs.
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