ER Overload

Basically, there's not enough money for beds? 
Right. So, let's say your grandmother breaks her hip and comes in and has surgery. There are fewer beds upstairs on the inpatient units, as well as fewer in the ER. So if Grandma can't go home after her surgery, there are fewer places we can put her. Now we're looking for a bed upstairs for a week or two weeks, which means the next grandmother with a broken hip waits and waits behind her in the emergency department, because I can't get someone upstairs to a bed that doesn't exist.

This has to be affecting patient care. 
Absolutely. We are fantastic at treating emergencies, but we do not run an intensive-care unit as well as the intensivists can. And we know that increasing the wait time to see a doctor in the emergency department can lead to worse patient outcomes.

So now that we know what the problem is, how the heck do we fix it?
There are no easy solutions. The ER can work on through-put issues—do we need to hire more nurses? Do we need to streamline our system? But that's a tiny fraction of the problem. We cannot control how many people show up at our door. We cannot control how soon someone can get a bed. One of the keys is that you can't blame any one part of the system. You can't say this is the ER's fault, or the inpatient services', or primary care's. If we keep pointing fingers and blaming people, we're not going to change anything. This is a system wide problem. All parts of the system need to sit down and discuss it as a whole.

There's no specific reform you can think of that would make a difference?
We could change the way primary care doctors are reimbursed and make it more affordable for them to see lower-income patients, or more attractive for them to have longer hours. That would probably be where I'd start.

Is there anything in either of the presidential candidates' platforms that would help? Their proposals seem mostly focused on getting more people insured.
Providing insurance to more people will help with overall health. It may help the currently uninsured find a primary care provider. But it is not going to help with ER overcrowding, because the primary care doctors are still going to be overbooked.

If anything, it might encourage the newly insured to come to the ER more than they do now. 
Right. It's not a panacea. It's a great thing to do, but it's not going to solve this problem. 

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