Crowded ERs Raise Concerns On Readiness

By Christopher Lee
Washington Post Staff Writer
Thursday, September 28, 2006

Emergency rooms at many hospitals are routinely stretched to the breaking point, raising concerns that they would not be able to handle victims during a terrorist attack or natural disaster, according to congressional testimony yesterday and a new federal study.

Between 40 percent and 50 percent of emergency departments experienced crowding during 2003 and 2004, the study by the Centers for Disease Control and Prevention found. It deemed an emergency room to be crowded if so many patients flooded in that ambulances had to be diverted to other hospitals; if people in urgent need of care had to wait an average of more than an hour; or if at least 3 percent of patients simply gave up and left before being seen.

The problem is more dramatic in metropolitan areas, where almost two-thirds of emergency departments experienced crowding conditions, the study found.

The crunch springs from a problem of supply and demand. The annual number of visits to emergency departments rose 18 percent, to 110 million, from 1994 to 2004. At the same time, the number of hospitals operating 24-hour emergency departments declined by 12 percent.

The problem is exacerbated by a shortage of nurses. More than 5 percent of nursing staff positions were vacant at half of all emergency departments in metropolitan areas, the CDC reported.

The findings echo three reports published in June by the Institute of Medicine, a branch of the National Academies, which concluded that the nation's emergency medical system is "overburdened, underfunded, and highly fragmented," and is not equipped to cope with disasters such as hurricanes, disease outbreaks and terrorist strikes.

The findings are stirring interest in Congress, and the Senate Health subcommittee on bioterrorism and public health preparedness convened a panel of experts yesterday to discuss the problems.

"If our emergency rooms are stretched thin now, how will they provide medical care in the event of a disaster?" Sen. Richard Burr (R-N.C.), the subcommittee chairman, said in a statement. "Our emergency care safety net is at risk. We must identify ways to reduce overcrowding and improve coordination."

Panelist Frederick C. Blum, president of the American College of Emergency Physicians, said policymakers and emergency departments must find ways to reduce "boarding." That is the practice in which emergency patients who are admitted to a hospital are left in the emergency department because no regular beds are available, reducing the hospital's ability to handle new emergency patients. Blum said reductions in reimbursement from Medicare and Medicaid in recent years are part of the reason some hospitals have reduced the number of inpatient beds.

"We currently have no surge capacity to deal with the next big thing that comes along, be it a terrorist attack or a natural disaster," Blum said.

Leon L. Haley Jr., chief of emergency medicine for Grady Health System in Atlanta, suggested providing financial incentives for primary care physicians to see patients after hours so that fewer people with non-emergency conditions seek treatment at hospitals.

Nancy M. Bonalumi, president of the Emergency Nurses Association, said the federal government should invest more in nursing education programs. About 147,000 qualified applicants to nursing programs were turned away in 2004 because of faculty shortages, Bonalumi said.

Robert R. Bass, executive director of the Maryland Institute of EMS Systems, said experts believe that the federal government should help fund the development of a network of regional, coordinated emergency care systems. The government also should designate a lead federal agency for emergency care and should better integrate the resources of the Department of Veterans Affairs into civilian disaster planning, he said.

"Strong measures must be taken . . . to achieve the level of response that Americans expect and deserve," Bass said.

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