Newsweek last week examined how "no single, sweeping solution exists" to address the "dismal picture of overburdened, understaffed and underfunded" U.S. emergency departments. According to three Institute of Medicine reports released last June, EDs face a shortage of on-call specialists such as neurosurgeons; inadequate coordination between EDs, hospitals and ambulance teams; and a lack of preparedness for large disasters. In addition, the reports found increased use of "boarding," in which hospitals admit ED patients when no rooms are available and leave them in hallways for extended periods of time, and "diversion," in which hospitals reroute ambulances because their EDs have reached capacity.
The reports recommended increased Medicare and Medicaid reimbursements to hospitals that provide a large amount of uncompensated care to uninsured patients. In addition, the reports recommended that Congress establish an agency for emergency care within HHS. "Currently, that responsibility is spread over numerous agencies," which "hampers decision-making and limits accountability," Newsweek reports. The reports also recommended increased coordination among EDs, hospitals and ambulance teams to help increase efficiency and improve patient care.
Reform Efforts
Kevin Yeskey, director of the Office of Preparedness and Emergency Operations at HHS, said that the office has established a working group of representatives from all of the department's divisions to study the IOM reports. The working group has focused on three recommendations: the establishment of an agency for emergency care, the establishment of regional trauma care systems and additional funds for research on emergency care. HHS also has sought to improve preparedness for large disasters in EDs.
In addition, several congressional committees plan to examine problems with emergency care. House Oversight and Government Reform Committee Chair Henry Waxman (D-Calif.) said that the committee in mid-June plans to hold a hearing on "the federal government's failure to address the crisis in emergency care." Both the House Homeland Security Committee and House Ways and Means Committee also plan to hold hearings on the issue. However, in "the absence of grand solutions from government, hospitals will have to focus on internal steps" to improve emergency care, according to Newsweek (Campo-Flores, Newsweek, 5/11).
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