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Published: July, 2006; Vol 3, Num 2
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Emergency Room Care: Slow, Questionable and Costly

If you need more motivation to avoid unnecessary trips to the emergency room, three reports released June 14 by the National Academy of Sciences’ Institute of Medicine may help.

“The ER is the last place a member should go for non-emergency care,” says LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “The cost is high and, often, overcrowding causes service to be slow and quality of care to drop.”

The LHSFNA and LIUNA health and welfare funds have for years discouraged unnecessary emergency room visits, mainly because the high cost in these settings drives up expenses for the funds. These unnecessary expenses contribute to the high cost of health care, curtailing potential wage increases for Laborers and crimping signatory employers’ bottom lines.

The new studies, however, add further dimensions to the emergency room problem. One is slow service. A 2004 study found that university-based hospital ERs were crowded 35 percent of the time. What did crowded mean? It meant all emergency beds were occupied, some patients were on beds in hallways, the waiting room was full and it took more than an hour to receive treatment. Another report, from 2003, noted that more than a half-million ambulances were diverted from their normal ER destination to a secondary one because the first was full. In 2004, most city hospitals (70 percent) reported that diversions were necessary at least once during the year.

Though more study is necessary to determine the number of deaths caused by these kinds of delays, it is likely to be significant. Slower treatment can also contribute to worsened conditions and slower or more difficult recoveries. Many studies show generally that high-stress, chaotic situations facilitate mistakes, and one study showed that 70 percent of adverse outcomes caused by negligence in hospital treatment occur in ERs.

“Given the slow service and questionable care of emergency rooms,” says Sabitoni, “it makes good sense to avoid them. Far too many of us rush to the ER with a non-emergency health concern, when we could just as easily call our doctor and schedule an office visit within a day or two or get advice on what to do over the phone. Another option is urgent care facilities, if they are available. The emergency room is for emergencies only. If you don’t have a real emergency, we urge you to save yourself and your health and welfare fund the trouble and the expense.”

Problems in emergency room care have been developing over the last couple decades, according to the Institute of Medicine and the American College of Emergency Physicians. They stressed that the entire system of emergency medical care in the United States is in danger of collapse.

From 1993 to 2003, the U.S. population grew by 12 percent, but emergency room visits leaped 27 percent. Meanwhile, due to increasing profit-orientation in the hospital industry and the resulting consolidation of health facilities, the industry lost 425 emergency departments, 700 hospitals and almost 200,000 beds. Rising demand and falling supply sharply increased prices.

Yet, most hospitals insist that they lose money in their ERs. This is because they are forced to provide care even if they will not be fully compensated. Under a 1986 federal law, emergency rooms must evaluate and stabilize anyone who requests help. However, 14 percent of ER patients are uninsured, 16 percent are covered by government insurance for the poor and 21 percent are covered by government insurance for the elderly. With prices rising so much, few of these patients and their insurance providers pay the full cost of care. Hospitals attempt to recoup these loses by increasing rates for ER patients who can pay and by charging higher rates in other departments. In both cases, LIUNA health and welfare funds end up subsidizing the cost of some of the care provided others at below-market rates.

The reports urged more regional planning with regard to emergency room services and more standardized ways to measure emergency room outcomes.

One notion of improved planning would establish a centralized city, regional or statewide trauma center that would monitor where emergency services are open so that ambulances could be directed to hospitals immediately ready to accept patients. This improves allocation of need within the supply of emergency beds, but does nothing to address the shrinking and inadequate supply of beds, in general. Similarly, better outcome measurements might help identify low-quality emergency services, but that alone may not lead to improvements.

Through its study of a number of health care cost containment initiatives, the LHSFNA has increasingly recognized that the profit motives of hospitals – and the increasing predominance of profit-oriented hospitals in the health care services industry – is a great impediment to improved care and lower costs. LIUNA funds have been encouraged to join health care coalitions, share data, press for increased hospital transparency and accountability, identify bad apple providers and, generally, hold the industry accountable for quality and cost of service.

“Until a national solution to the health care problem is created,” says Sabitoni, “we have a battle to contain costs on our hands. Every member can help by using the hospital emergency room only in emergencies.”