Evidence is lacking to support common assumptions about the reasons for emergency department crowding in hospitals, according to a new study in the Journal of the American Medical Association. The purpose of the study was to compare common, unsupported statements about uninsured patients presenting to the ED with the best available evidence on the topic.
Led by Manya Newton, a clinical instructor in emergency medicine and internal medicine at the University of Michigan, researchers found that in 127 identified articles, 53 had at least one assumption about uninsured ED patients, with a mean of three assumptions per article. One assumption was uninsured patients use the ED for nonurgent/nonemergent primary care, which was not clearly supported by current data. However, the assumption that uninsured patients use the emergency department because they lack access to primary care does have evidence to support it.
ED overcrowding is extremely multifactorial, said Newton, who is also a Robert Wood Johnson Foundation clinical scholar. We cant blame it on the uninsured. Its a systemwide problem, she said, adding that countries that have universal healthcare coverage also struggle with crowded emergency departments.
According to Newton, factors that contribute to emergency department crowding include an aging population with chronic illness, closures of emergency departments, fewer staffed inpatient beds for patients, and difficulty in seeing a primary-care physician. For that last factor, Newton suggests changes to the reimbursement system so that physicians have more incentive to practice primary-care medicine. As the nation prepares for a new presidential administration, Newton suggests a collaborative approach to solving this problem.
Providing everyone with insurance would be a wonderful thing, but it will not solve ED crowding, Newton said. There arent going to be any quick fixes. People from all parts of the systeminpatient, outpatient, primary care, specialistshave to sit down together and look at the problem. -- by Jessica Zigmond