Question

Hospital emergency departments continue to be used as important sources of primary medical care by large numbers of medically underserved populations. What are the implications of this for the patients, on healthcare costs, and quality of care? Suggest possible solutions to this situation.

Answer 1

Suggestions for patients ,

Patients who are underserved or on Medicaid are disproportionately seen in emergency departments, which have more than 120 million visits annually.

Many of these patients seek emergency care for medical conditions that should be treated in primary care settings.

Unnecessary visits to the emergency department by underserved patients are much more expensive than primary care visits, and the high cost of uncompensated care is affecting the bottom line for many hospitals.

But patients without a regular source of primary care often rely on the emergency room for routine care.

Need to invest more resources to increase primary care capacity and help underserved patients avoid unnecessary emergency department visits.

It's unusual for an emergency department to develop its own primary care service. But increasingly, insurers are saying they will only pay at a primary care reimbursement level for primary care diagnoses and services in an emergency department.

This has led some hospitals to have primary care providers in the emergency department, but doing that just perpetuates the problem by encouraging patients to go to the emergency room for all of their problems. Rather than offering primary care services in the emergency department, we as a nation should be ramping up primary care capacity in our communities.

This is especially important due to growth of the elderly population and the decreasing number of primary care physicians.

Providing onsite primary care also can lead to misleading results in terms of cost reduction.

The program reduced return visits to the emergency department for primary care, but the reported cost savings were attributed to reductions in primary care services in the emergency department. Such reductions are not true savings, because primary care should be provided in the community.

Programs should quantify the cost savings achieved by an intervention that transitions patients to primary care by measuring reductions in preventable emergency department visits and avoidable hospitalizations, as well as overall improvements in community health outcomes.

For hospitals and health care centers

According to Health care financial management system the suggestions are:

• Posting ED wait times on the hospital website so patients can access the information online or smartphone before deciding which hospital can accommodate them the quickest.

• Eliminating waiting rooms so patients are evaluated either in ED rooms after they register, or in other facilities. No room is used for nonurgent patients. They are treated and discharged efficiently, while patients with more complex cases are put in rooms.

• Conducting triage in teams that include an ED physician, a nurse, a scribe, an emergency technician, and a registrar. The scribe records the physician’s instructions. The technical assistant acts as a utility with multiple responsibilities. And the registrar streamlines the process for getting patients into the facility’s system. All of this expedites patient care, decreasing wait times as much as 64 percent.

• Establishing specialized emergency units, such as geriatric emergency departments and chest pain centers.

• Providing point-of-care testing in satellite labs can speed up the results and reduce the amount of time that patients are kept waiting.

• Creating a discharge lounge to free up beds in the ED more quickly and allow patients to move to a more private area to receive certain clinical care, as well as discharge instructions.