State Issues
Working to Solve ED Overcrowding
Since last summer, PaACEP has been participating in a work group put together by the Governor’s Office of Health Care Reform (OHCR). Its charge is to develop workable solutions to ED crowding and related problems. PaACEP President Ron Strony, MD, FACEP, Chapter Secretary Dan Wehner, MD, FACEP, and David Blunk, PaACEP’s executive director, represent the Chapter on the work group.
Recently, PaACEP News asked Dr. Wehner to give members an update on the group’s activities thus far.
PaACEP News: Who is represented on this work group convened by OHCR and what is the group trying to accomplish?
Dr. Wehner: The group is comprised of representatives of OHCR, PaACEP, HAP, the Pennsylvania Department of Public Welfare, the Pennsylvania Academy of Family Physicians, and the Pennsylvania Medical Society. The Pennsylvania Department of Health has also been invited to participate.
Our goal is to find ways to deal with every day crowding in emergency departments. We are working on a mechanism to decompress the ED, such as putting patients in non-traditional areas and developing a process to track information.
PaACEP News: Has the group made any headway towards reaching its goals? What has the work group done thus far?
Dr. Wehner: We have caught the attention of the Governor and the OHCR. I believe they now realize that hospital overcrowding is what normally causes ED crowding, and that ED crowding is a huge issue, causing a significant negative impact with respect to quality and timeliness of care, patient satisfaction, hospital morbidity/mortality, length of stay, and health care costs.
As a result of our meetings, I think OHCR now understand that it's not patients with minor problems using EDs "inappropriately" that is causing the crisis, but instead the inability to promptly move ED patients to the inpatient setting, when hospitals are at or near their staffed capacity. We believe the OHCR has abandoned its original plan to alleviate ED crowding by encouraging patients to use nurse practitioners in retail clinics.
OHCR now also understands that issues such as inability to discharge patients promptly to extended care facilities, inadequate psychiatric resources, and the lack of true 24/7 functioning of many hospital departments and services compound the problem. And, we believe OHCR now understands that most hospitals are ill-prepared to handle our "usual" surges of patients on Mondays and Tuesdays, when our hospitals are at, near, or over capacity, let alone being prepared to deal with a true catastrophe, pandemic illness, or other reasons for increased volumes of significantly ill or injured patients.
PaACEP News: Representing PaACEP, what do you hope to accomplish that will benefit the Chapter and its members?
Dr. Wehner: This spring, we expect to advance legislation, regulation or policy that would require all hospitals to have a surge capacity plan, which can be activated when the ED is overwhelmed. The plan will allow for expedient transfer of significant numbers of admitted patients from the ED to non-traditional areas in the inpatient setting, such as foyers, atria, hallways, PACU, or normally unoccupied floors.
To accomplish this, the Pennsylvania Department of Health (DOH) must relax its guidelines and facilitate hospitals in their efforts to find suitable areas to help decompress the ED. Hospitals should not have to report to the DOH every time this surge capacity plan is activated, as altering DOH guidelines often invites inspection. Otherwise, fear of inspection may limit a hospital’s use of its surge capacity plan.
A similar plan has been in effect in New York State for several years, thanks to Peter Viccellio, MD, FACEP, and the New York DOH. At a recent teleconference, Dr. Viccellio, his colleagues, and collaborators shared their wisdom, experiences, and ideas with our work group. They were quite helpful and persuasive.
PaACEP News: In your opinion, what is the most important thing emergency physicians in Pennsylvania need to know about this work group and its initiatives?
Dr. Wehner: We have had input from dozens of knowledgeable, concerned, and dedicated emergency physicians from across Pennsylvania, and some significant help from New York as well. Without everyone's help, we couldn't have come this far. We are working very hard on the behalf of all ED physicians, nurses, ancillary personnel and our patients to mitigate the effects of hospital overcrowding upon EDs throughout the Commonwealth. As of now, it does appear as though we are making significant progress, but it's far from completed.