The low national grades reflected in this Report Card confirm that the crisis facing the nation’s emergency patients continues, with growing pressures on multiple fronts. The force of these combined pressures is all the greater due to the interconnections and interdependencies across the different categories of indicators assessed in this Report Card. As a result, weaknesses in one system can exacerbate those in others. For example, poor access may compromise the Quality and Patient Safety Environment. Hospital crowding backs up the emergency department and affects not only access, but also surge capacity, Disaster Preparedness, and the Quality and Patient Safety Environment. A poor quality and safety environment exerts further pressures on the liability environment, which in turn creates additional stress on the providers, compromising workforce issues and health care access. The complexity of these problems requires multifaceted solutions across the multiple entry points and parts of the system.
Several of these recommendations are not new, but many of the recommendations of the 2006 Report Card, the Institute of Medicine Report on Hospital-Based Emergency Care, and other group and commission reports have yet to be implemented. While the nation waits, the emergency care system continues to deteriorate.
Recommendations based on the results of this Report Card include:
Create stronger emergency departments through national health care reform. Emergency departments provide a health care safety net for everyone and are a vital component of our nation’s disaster response capacity. Providing additional resources to ensure that patients have timely access to quality emergency medical care, including during times of disaster, must be a critical tenet of any health care reform program.
Alleviate boarding in emergency departments and hospital crowding. Many of the high-impact solutions to boarding and crowding are simple and involve little or no additional costs; for example, moving patients out of the emergency department to inpatient areas as soon as they are admitted, coordinating the discharge of hospital patients before noon to free inpatient beds, or distributing elective, surgical cases throughout the week to avoid backlogs.
Pass the Access to Emergency Medical Services Act (“The Access Act”). This bill recognizes the need to expand support for emergency care delivery. It calls on the Centers for Medicare & Medicaid Services to collect data on emergency department boarding so that standards and guidelines can be developed where appropriate. The Access Act also creates a commission to examine the factors that affect the delivery of emergency medical services and directs additional resources to emergency physicians and on-call specialists for providing EMTALA-related services to Medicare beneficiaries in hospital emergency departments.
Enact federal and state medical liability reforms that help states retain physicians and ensure that all patients have access to specialists who provide high-risk and EMTALA-mandated emergency care.
Infuse a greater level of federal funding and support into disaster preparedness targeted for emergency medical preparedness and response. The proportion (4 percent) of federal disaster funds dedicated to emergency health responses is inadequate. States need to receive and invest far greater resources in planning, coordination, communication mechanisms, and regionalized systems of response. They must also increase the levels, reach, and participation in advanced planning, drills, and training on the part of health care and emergency personnel.
Increase support for the nation’s health care safety net. Emergency departments absorb the pressures and problems of the broader health care system by providing an increasing amount of uncompensated and undercompensated care for individuals who have no other place to go. They also are serving as a safety net for everyone, as people find it more difficult to access medical care. Federal policies must be enacted to reimburse hospitals for uncompensated emergency and trauma care. In addition, federal and state policies must address the growing rates of uninsured adults and children in our nation.
Develop greater coordination of emergency services. The lack of coordination leads to redundancies and inefficiencies. A coordinated system with clear communication channels and plans would not only help mitigate crowding and inefficient use of resources but also lay the framework for stronger emergency response in the event of any disaster.
Increase the use of systems, standards, and information technologies to track and enhance the quality and patient safety environment and implement effective measures and responses to avoid errors and improve outcomes. It is important to ensure that the methods in place are user friendly and adapted to the health care environment and that physicians, nurses, and other hospital personnel are trained to use them easily and effectively.