How Does America's Emergency Care Compare?

247 Americans visit the emergency department every minute across the United States totaling more than 130 million visits in 2010.  Right or wrong, the emergency department serves as the source of primary care for many and for others a necessary medical resource in times of need.  Given not only the sheer number of individuals who visit the emergency department each year, but also the importance of high quality emergent medical care, our ED's must work flawlessly.  Unfortunately, a new 2014 report card released by the American College of Emergency Physicians shows they don't.

Overall, the United States earned a D+ for emergency care.  This is worse than the grade of C- awarded in 2009.  Which states fared the worst?  Wyoming was the lowest ranked state with an overall grade of F.  Arkansas, New Mexico, Montana and Kentucky followed closely behind Wyoming for the award of worse emergency department care with D grades across the board.  Washington D.C. was awarded the top grade of B- followed by Massachusetts, Maine, Nebraska and Colorado. 

In order to grade state's performance when it comes to emergency department care, the American College of Emergency Physicians (ACEP) evaluated 5 categories.  These categories included access to emergency department care, quality and patient safety, medical liability environment, public health and injury prevention and disaster preparedness. 

Why did our emergency departments score so poorly?  When it comes to emergency departments, our system is seriously strained.  The number of emergency departments has declined over the past 20 years while the number of emergency department visits has increased at a rate of twice the rate of the growth of the U.S. population.  There simply isn't enough room in our ED's for all the patients.  Inadequate access to primary care, and especially advice from primary care providers after hours leads patients to use the emergency department as a last resort.  Baby boomers are aging bringing more and more sick patients through the doors of the ED.

Once patients arrive in the emergency department, the crowds of patients cause problems.  Overcrowding delays care even for acutely ill patients.  Overcrowded hospital floors delay admitted patients from being placed in rooms.  They remain in the emergency department causing further crowding while also receiving a lower quality of care than on the hospital floor.  This low qulity of care happens because the ED is not set up properly for longer-term patient care.

Overall, it looks like our emergency medical system is quite a mess according to the 2014 ACEP report card.  What can we do to fix the problem?  ACEP offers a number of suggestions for fixing the problem of our broken emergency department system.  Increasing access to medical care by both adding more healthcare facilities and increasing capacity of existing hospitals will help with the problem of overcrowding.  Directing patients with non-life threatening medical conditions to healthcare facilities outside the ED will allow more effective use of emergency department resources.  ACEP also encourages states to enact strict laws to help prevent injuries such as helmet laws for motorcycle riders.  Prescription drug monitoring programs would also help prevent emergency department visits related to overdoses. 

There's no easy fix to the problems with emergency department care in America but something must be done to at least curb the decline of our ED's.  With Affordable Care Act still in it's early years, it remains to be seen how healthcare reform will continue to impact the system.

Is your emergency department overcrowded?  How have you seen overcrowding impact patient care?