A new study last week snapped a detailed picture of hospital emergency rooms bursting at the seams, with incoming patients tucked into conference rooms, storerooms and shower stalls while other admitted patients take up precious space in treatment areas waiting for hours for an inpatient bed to open up.
Meanwhile, another study of emergency-room costs and revenue suggested that it's in the best interest of hospitals to expand capacity to meet the demand, concluding that patients admitted from the ER account for 20% of a hospital's overall bottom line.
The second report, a survey of 245 nontrauma emergency rooms in California, challenges "this undercurrent of conventional wisdom that (ERs) are a public service, don't fit with a managed-care climate and aren't profitable," said Glenn Melnick, lead author and a healthcare finance professor at the University of Southern California.
The report, commissioned by the California HealthCare Foundation, used an accounting model that tracks ancillary revenue and expenses incurred by emergency patients outside of the ER as well as the financial impact of the one in seven emergency patients admitted to the hospital.
The average ER loss per patient was $84, but the average profit on the patients who needed to be admitted was $1,220-more than covering losses on patients not admitted. More than one-third of all inpatients came through the ER, underscoring the importance of making sure prospective patients are not diverted to other hospitals because of full capacity or discouraged from using a hospital's ER because of poor service, Melnick said.
But according to a study in the August issue of Annals of Emergency Medicine, hospitals are hemmed in by a lack of treatment space and further constrained by long delays in admitting emergency patients. On a typical Monday evening in March 2001, 100% of the treatment spaces in 89 surveyed emergency rooms were occupied, and 59% of the ERs reported routine use of hallways for treatment. Other nonclinical areas were pressed into service by 47% of surveyed departments.
The number of overcrowded ERs would decrease by 30% if admitted patients were not taking up needed space because of poor coordination with inpatient operations or full occupancy on nursing floors and critical-care units, the study said. Nearly three-fourths of the surveyed facilities reported "boarding" at least two patients ready to be admitted but with no place to go.
"Boarding causes crowding because these patients, who are often critically ill and waiting for a bed in the intensive-care unit of the hospital, require emergency medical equipment and staff time, which further shrinks emergency department capacity to treat more severely injured and sick patients," said Sandra Schneider, the study's lead author and chair of emergency medicine at University of Rochester (N.Y.) Medical Center.