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Institute of Medicine: ERs in Critical Condition

Three reports issued simultaneously in June by the Institute of Medicine (IOM) describe the nation’s emergency departments (EDs) as on the verge of collapse as a result of overcrowding, inadequate funding and poor coordination between providers, municipalities, states and federal officials. EDs are also overwhelmed by a dramatic increase in patient visits, partly because the ED has become the principal source of care for the country’s uninsured.
The reports focus on three area of emergency care: emergency departments, the emergency medical system and pediatric emergency care. Some of the key findings are:

  • Between 1993 and 2003, 425 emergency departments closed and the number of hospital beds decreased by 200,000.
  • During the same period, the number of ED visits increased 27 percent.
  • Only 6 percent of EDs have all the supplies required to provide care to children, although pediatric cases account for more than a quarter of all visits.
  • About half of ED visits are “urgent” and require lifesaving care, but many patients wait hours to be seen by a doctor and days for a hospital bed.
  • The emergency care system is not standardized; many ambulance services use radio equipment from the 1970s and cannot communicate effectively with hospitals and first responders.

The reports’ recommendations cover several major areas: improvements to hospital efficiency and patient flow; coordination and regionalization of the emergency care system; and additional resources and consideration for pediatric patients. The IOM calls on the U.S. Congress to take the lead in the restructuring that must occur if the situation is to improve. The IOM also asks Congress to significantly increase funding for hospital EDs through several programs, including a pool of at least $50 million to reimburse hospitals for uncompensated emergency and trauma care (beyond what is provided by Medicaid and Medicare) and $88 million in grants over a five-year period to test methods to improve coordination of emergency services.

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