Nation's strained emergency care getting worse, ER docs warn

The emergency-care environment in the U.S. is worsening because of increased demand and shrinking resources, according to a new state-by-state report card from the American College of Emergency Physicians. Experts say the nation's emergency departments do not have the policy support they need to meet the demands.

The nation received an overall grade of D+ when measured on how well states are faring in categories such as access to emergency care, quality and patient safety, medical liability, disaster preparedness and public health and injury prevention. The national grade was a C- in 2009 when the last report card was issued.

“This is really bad news,” ACEP President Dr. Alex Rosenau said during a news conference Thursday to discuss his group's findings. “This report card is sounding an alarm,” he said. The country is in a period when hospital emergency rooms are facing increased demands but have fewer resources, he said.

Twenty-one states received F's in the access to emergency care category, 10 received F's in quality and patient safety, 10 received an F for the state's medical liability environment and 10 states received F's in public health and injury prevention, according to the report card.

The declines are attributed to emergency departments continuing to struggle with issues such as workforce shortages, limited hospital capacity, long ER wait times and increasing financial barriers.

“America's grade for access to emergency care was a near-failing one because of declines in nearly every measure,” said Dr. Jon Mark Hirshon, the chair of the task force that directed development of the report card. “It reflects that hospitals are not getting the necessary support in order to provide effective and efficient emergency care.”

Emergency visits are likely to increase as a result of the Patient Protection and Affordable Care Act, when millions of people added to the Medicaid rolls seek emergency care because they are unable to find physicians who will accept their insurance, according to the report card.

People are increasingly reliant on emergency care, Hirshon said, and primary-care physicians are advising their patients to go to the emergency department after hours to receive complex diagnostic workups and to facilitate admissions for acutely ill patients.

So, what will help to improve the score?

The report card recommended major policy changes, including support for the National Healthcare Workforce Commission in reducing shortages of nurses and physicians, effective low- and no-cost strategies to reduce hospital crowding and boarding of admitted patients in the emergency department, and the pursuit of state laws that help reduce preventable deaths and injuries such as traffic injuries and prescription drug misuse.

“We find this to be an exciting time because this is an opportunity for improvement,” Rosenau said. “In every category, at least one state was able to garner an A.”

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