Emergency Department Misuse: Ethical Solutions

            The emergency department (ED) of a hospital can be important in determining whether a person suffering a life threatening illness lives or dies. The clinical staff and physicians stand in wait of whatever comes through the emergency room doors, whether by walk-in or by ambulance. However, challenges arise when nursing staff and physicians attempt to balance an overloaded ED with incoming traumas. Patients with minor injuries and illness flood the ED, at all hours of the night, looking for treatment, comfort, medication or maybe just a meal and a roof over their head.

            Minor injuries and illness are some of the most common representations in the emergency department. Such injuries could be treated by a primary care physician or an urgent care clinic, but patients continue to use the emergency room despite significantly longer wait times and a much higher cost of care. Why? Some individuals say that they use the emergency room because it is convenient and others say that it offers them a better level of care, but what about the individuals with life threatening emergencies who show up unannounced?

            Many patients, after being admitted to a room in the ED, will be confined to that room for several hours, or even days, waiting on a hospital bed. This ties up valuable resources leaving a sick patient to sleep and lie for hours on an uncomfortable stretcher with an exhausted nursing staff.  What if there are no rooms left? In these situations, hospitals will have to divert patients to other hospitals which means that sick patients may have to travel hours farther before they can receive medical treatment.  

            What about individuals who show up to the emergency room on a weekly basis? Frustration with what are often referred to as “frequent flyers” can often lead to a poor level of care. Often times, the frequent flyers are described as the “difficult patient” who is physically or verbally abusive to the hospital staff. This abusive behavior leads to further frustration and even less attention paid to the patient who may have a new, emergent condition that needs to be treated.

            Individuals with chronic illnesses and substance abuse issues can also be classified as frequent flyers. What can we do to manage the constant use of the ED resources by individuals who do not follow the guidelines to manage chronic conditions such as diabetes, COPD or congestive heart failure? What about recurrent drug users who have been resuscitated multiple times due to overdose? How can the ED create change in that particular community.

            Staff turnover has led to many shortages, and an influx of non-emergent issues can tie up important hospital resources. Physicians and clinical staff are forced to work long hours and take a patient load that would be considered dangerous under normal conditions. These conditions then create more turnover leading to an ED with lesser experienced nurses and physicians, often fresh out of school and unexposed.

What then is the solution to the problem? How do we lessen the number of individuals who use the ED for non-emergent issues? Can we simply send them away and say their need isn’t great enough or they have messed up too many times? What if a non-presenting condition is missed because we are making mere judgments based on their physical or outward appearance. How can we create positive change and an efficient emergency room.

https://www.houstonchronicle.com/business/columnists/tomlinson/article/Patients-who-misuse-the-emergency-room-and-run-up-13138582.php

http://www.georgiahealthnews.com/2013/03/misuse-emergency-rooms-costly-avoidable-error/

https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf

https://www.nehi.net/writable/publication_files/file/nehi_ed_overuse_issue_brief_032610finaledits.pdf

Quiz Questions (Prezi):

1.     An emergency room is a hospital room or area staffed and equipped for the reception and treatment of person’s requiring __________ care.

2.     What is the Emergency Medical Treatment and Labor Act of 1986?

3.     What percentage of individuals visited the emergency department in 2015?

4.     How many of those individuals were admitted to the hospital?

5.     Name one reason why people choose to go to the emergency room over other places.

6.     In any capacity, describe a “frequent flyer”.

7.     How many times did “Patient G” visit the hospital in three years?

8.     Name a consequence of hospital misuse.

9.     Name an alternative to using the emergency room.

10.  T/F. Most emergency room users are uninsured.