Newspapers Examine Trends In Emergency Care

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 17 Sep 2008 - 10:00 PDT

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Summaries of two articles examining trends in emergency care appear below.

• Free-standing emergency departments: The Washington Post on Tuesday examined how free-standing EDs that have no inpatient beds are able to offer "streamlined" full-service emergency care. The Post reports that health care experts and physician groups "agree that [hospital] emergency rooms are caring for more patients who tend to be sicker than their counterparts were a decade ago," and "[i]ncreasingly ERs are jammed with patients lining the hallways on gurneys." Caroline Steinberg, vice president of trends analysis at the American Hospital Association, said that crowded EDs are "definitely a symptom of deeper problems in health care," and that while the problem of ED overcrowding needs to be addressed through multiple approaches, freestanding EDs "are a very effective strategy." The Post profiled Inova HealthPlex in Springfield, Va., a free-standing ED that is designed to divert patients away from EDs at local hospitals to alleviate overcrowding. According to the Post, the ranks of such EDs "have increased dramatically." Patients at HealthPlex face shorter wait times and those who require hospitalization are transferred via ambulance to nearby hospitals. HealthPlex also has onsite laboratory and radiology departments operating around the clock; both places tend to be major bottlenecks in hospitals, according to HealthPlex Director Rachel Mooney (Boodman, Washington Post, 9/16).
  
  
• Patient understanding: The New York Times on Tuesday examined how a "vast majority" of ED patients "are discharged without understanding the treatment they received or how to care for themselves once they get home." According to a study published in the July issue of the Annals of Internal Medicine, 78% of English-speaking patients at two Michigan hospitals did not understand at least one of four areas related to their care: diagnosis, treatment, instructions for at-home care and warning signs for when to return to the ED. Misunderstandings can "lead to medication errors and serious complications that can send [patients] right back to the hospital," the Times reports. The problems with communication can arise because "[e]verything is exaggerated in the emergency department. Doctors are harried, they have little time to go over complicated information and they do not know the patients," the Times reports. In addition, most patients are "anxious, upset and not likely to be thinking clearly," according to the Times. Experts in doctor-patient communication say a "teach back" approach is the best for physicians to use, in which the patient, preferably along with a caregiver, repeats the instructions to the physician (Tarkan, New York Times, 9/16).

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