Ronda Kotelchuck

How to Get Emergency Rooms Off of Life Support

A recent, alarming study conducted by The New York Post on Emergency Room overcrowding in New York City offers even more evidence that the path to true healthcare reform in our city and state hinges largely on our ability to bolster our primary care infrastructure.

“69 percent [of 425 NYC ER doctors polled] said they had personally experienced patient suffering or harm because there was no hospital beds available and the patient was held in the ER. Another 28 percent said a patient died as a result,” The Post revealed.

The Post further discovered that “City ERs were on diversion a total of 5,600 hours - a 77 percent increase over the same period last year.”

A huge factor explaining the jamming of Emergency rooms and the frequent re-routing of patients is that more than 80 percent of ER visits are for non-emergency conditions, according to the most recent data. Those patients with non-emergency illnesses are going to the ER because they cannot get access to needed care elsewhere.

And this overcrowding will likely only get worse. Following a period of stagnant population growth, a million additional people will flood New York City in the next two decades, according to Mayor Bloomberg’s PlaNYC.

Add the challenge that many hospitals are closing or consolidating due to the recommendations of the Berger Commission, and you’re left with even more people squeezing into even less space than cited in The Post.

The solution?

Multiple studies show that ER overcrowding would not only ease, but that the city and state would save hundreds of millions of dollars if patients suffering from non-emergency conditions went to primary care physicians instead.

To be clear, emergency rooms are an invaluable part of our healthcare infrastructure and the very definition of a lifeline to patients who are indeed in crisis.

But I am speaking specifically of those 4 in 5 New Yorkers who are using ERs for non-emergencies and who receive a far greater continuity and quality of care in a primary care setting with their everyday doctor than they do in an emergency room with a doctor the patient has never met before.

In order to give patients the primary care options, however, we must support the community health centers, private practitioners and hospital outpatient departments that deliver the best in primary care. And that starts with the city and state committing themselves to a full healthcare system, rather than solely a disease-treatment system.

The state took an unprecedented first step this year when it allocated an additional $240 million to bolster primary care and committed itself to reforming the woefully inadequate system of primary care payment . The city is taking measures to expand primary-care capacity and improve its quality.

To make ER overcrowding a thing of the past, these steps must represent a first foray toward reform rather than a one-time commitment. Both the city and state must build on these reforms so that patients look first to their family doctor instead of their local emergency room.

If not, lines at the emergency will get longer. Patients will continue wait until ordinary conditions becomes crises, requiring needless use of ER and inpatient resources. They will continue lack the continuity and care management possible only in a primary care setting. And the State and City will continue to incur ever-spiraling costs with very little outcome to show as a result. There is a better way.

Ronda Kotelchuck: Author Bio | Other Posts
Posted at 9:31 AM, Jun 02, 2008 in Health Care
Permalink | Email to Friend