ER backups not one problem, but many. (Perspectives).(Brief Article)

Publication: Medicine & Health

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This is the second part of a Perspectives series on emergency department overcrowding. The first part appeared in Medicine & Health's Feb. 25 edition.

With emergency department overcrowding a top health care concern around the country, it is clear that, at least in some ways, capacity in the current delivery system isn't adequate to meet demand, said researchers, emergency physicians, and others at a Jan. 22 conference hosted by the Council on the Economic Impact of Health System Change. But the problem results from a daunting number of intersecting trends, and teasing out key causes that might form the basis for a solution will not be easy, many participants said.

Job one, for the short term at any rate, may be to learn more about how predictable capacity needs can be managed to make it easier to meet unpredictable emergency needs, said some speakers.

"I think ... we need to start looking at the capacity measures [and the fact] that we've always thought of capacity as a single uniform measure," said Charlotte Yeh, MD, of the Massachusetts Department of Public Health. Unscheduled ED capacity and capacity in the rest of a hospital might be better gauged using different statistical models, she suggested.

Furthermore, "there's a lot more variation where I think we can do a far better job of calculating what are the capacity needs, taking into account the ... aging population ... etc.," said Yeh. "That's an area that I think we need to focus on because ... the health care industry responded extraordinarily well to the market forces [of the 1990s, dominated by managed care cost-trimming]....

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