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Introduction
Most emergency rooms (ERs) in the US are in a quandary. They are witnessing a high number of patients which explains why issues of delays and diversions are more common. According to Moskop et al. (2019), most of the emergency rooms are overloaded beyond the required capacities. The authors further noted that ER visits in the US healthcare system account for 11% outpatient, 28% acute care visits and 50 % representing hospital readmission (Moskop et al., 2019). However, there is another group of patients that end-up in the ERs for non-urgent cases. To them, ER is the safety net of the safety net Americans view it as both first and last resort (Griffey et al., 2020, p. 192). The problem started with the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986 which made it compulsory for hospital to provide emergency services to anyone needed care (Brown and Brown, 2019). It therefore follows that ERs overcrowding should be addressed through telephone triage and community paramedics where many medical issues can be directed to urgent care clinics and by making visits to a primary care physician.
Short-Term Solutions
Firstly, addressing the issue of overcrowding starts with ensuring there is proper use of emergency room. ERs should focus more of its efforts towards providing care to patients that are in dire need of these services. In essence, much attention should be on patients with life-threatening issues. Some of these issues, as elucidated by Griffey et al. (2020), include severe asthma attack, head injury, severe allergic reaction, difficulty breathing, chest pain and diabetic emergency. For instance, head injury meets the emergency room intake procedures which examine the severity and the status of condition. According to Savioli et al. (2020), head injuries may cause bleeding in the brain and tissue and layers surrounding the brain these types of injuries are considered one of the main causes of disability and death in adults (p. 30). Additionally, by putting ER to proper use, there will be enough space and time to attend to mental-related and acute issues. Most cases reported in the ER relate to chizophrenia, bipolar disorder, anxiety disorders and schizoaffective disorder (Savioli et al., 2020). For example, bipolar disorder requires urgent care because it manifests through severe agitation, aggression and risk destructive behavior.
Secondly, some medical issues such as fever without a rash, dehydration, wheezing and abdominal pain can be addressed at urgent care centers or clinics. It is important to note that most urgent care centers have doctors and physicians assistants on stand-by to help any patient. As explicated in Raidla et al.s (2020) study, most of these doctors have adequate training in emergency and family medicine. In addition to this, most of them have a wide range of medical knowledge and skills to assist with diagnosing and treating a variety of illnesses. Bahadori et al. (2020), noted in their study that most of them will identify when a specialist is needed or when there is a potential emergency medical condition requiring an emergency room visit (p. 283). In essence, these facilities can help reduce congestion in the emergence room since most of them have X-ray machines, basic lab testing and equipment designed for minor issues such as stitching a wound and splinting a broken bone. Some states such as New York, New Jersey and Connecticut have technology-based care services which allow residents to book an appointment to see a care provider.
Thirdly, primary care clinics also play an important role in reducing overcrowding in the emergency room. According to Pinchbeck (2019) primary care is the first level of professional care where people present their health problems and where most curative and preventive health needs are satisfied (p. 105). Therefore, by consulting and visiting primary care physicians, patients will only call for emergency medical services (EMS) for valid reasons. Some of these reasons include life threatening injuries, acute issues and suicidal or homicidal feelings. Even some of these issues can be managed through primary care clinics which explain why it is important to seek their help before resorting to calling for EMS. As a matter of fact, most of these clinics provide first set of professional care to all patients by utilizing proactive approaches they help with the management of chronic illness as well as promoting self-care. Ideally, primary care clinic should be the first safety net because they have a team comprising of highly dedicated professionals who are ready to offer the best medical services.
Long-term Solutions
Emergency rooms overcrowding can be addressed effectively through the adoption of telephone triage. According to Katayama et al. (2022), many countries such as Canadaand Australia have well-established and dedicated telephone triage services. Telephone triage nurses in these countries have a software in place that help them examine patients state of emergency and in turn, provide necessary services such as sending a doctor. More specifically, in Japan, telephone triage service was added to emergency care in Tokyo and Osaka in 2007 and 2009 respectively (Katayama et al., 2022). In Osaka, once a telephone triage nurse assesses a patient, they may direct the caller to a nearby medical facility based on the triage results (Katayama et al., 2022). The main reason why telephone triage is regarded as a long-term solution is because it brings into focus the human aspect of care. This is necessary because some callers may be truly concerned about their symptoms and having access to a triage helps provide reassurance. Similarly, callers may overestimate the severity of their illness, especially those that require the help of urgent care clinics, and up spending a lot of money in ER.
Emergency medical services should consider implementing community paramedic programs to help deal with the issue of overcrowding. As explicated in Agarwal et al.s (2019) study, a well-developed community paramedicine (CP) program can lower ER visits, reduce 911 emergencies, and increase patients quality of life (p. 56). For instance, community paramedics helps reduce the workload as well as improve patient care. It is imperative to note that overcrowding emergency rooms tend to increase both patient and staff anxiety. In addition to this, CP targets those patients who require an Urgent Care clinic or primary care physicians it provides them with an alternative destination. Previously, ambulances were commonly used to transport patients to emergency room, but today PC programs have introduced an alternative transport destination aimed at improving patient care (Agarwal et al., 2019). CP also works closely with primary care physician to help treat patients without necessary transporting them to ER. Some of the in-home treatment offered by CP include: medication adjustment, blood draws, and wound care. Therefore, both physicians and EMS should collaborate in training community paramedics in an attempt to negate the need to visit ER.
Conclusion
Most emergency rooms in U.S are currently experiencing a surge in patients which explains why the issue of delays and diversions has become common. Most Americans view ER as both the first and last resort. As a result, these facilities end up being overcrowded by non-critical patients. As indicated above, telephone triage and community paramedics programs, once implemented, will help direct many medical issues to urgent care clinics or by visiting a primary care physician, this reducing the issue of ER overcrowding. it is imperative for patients to differentiate medical issues that require emergency services and those that could be addressed at urgent care clinics. For instance, ER should target mainly those patients with life-threatening issues such as asthma attack, head injury, severe allergic reaction, difficulty breathing, chest pain and diabetic emergency. Other medical issues such as fever without a rash, dehydration, wheezing and abdominal pain can be addressed at urgent care centers or clinics.
However, more emphasizes should be on the adoption of telephone triage and community paramedicine programs. These two, as cited above, are aimed at providing long-term solutions to the issue. On one hand, telephone triage service, once added to emergency care, allows nurses to assess patients, and decide whether they should visit ER or directed to urgent care clinics. Telephone triage is unique in the sense that brings into focus the human aspect of care. Community paramedic program, on the other hand, plays an important role of lowering ER visits, reducing 911 emergencies, and increasing patients quality of life. Overall, community paramedics work closely with primary care physician to help treat patients without necessary transporting them to emergence room.
References
Agarwal, G., Angeles, R., Pirrie, M., McLeod, B., Marzanek, F., Parascandalo, J., & Thabane, L. (2019). Reducing 9-1-1 emergency medical service calls by implementing a community paramedicine program for vulnerable older adults in public housing in Canada: A multi-site cluster randomized controlled trial. Prehospital Emergency Care, 12(3), 56-90. Web.
Bahadori, M., Mousavi, S. M., Teymourzadeh, E., & Ravangard, R. (2020). Non-urgent visits to emergency departments: A qualitative study in Iran exploring causes, consequences and solutions. BMJ open, 10(2), 282-357. Web.
Brown, H. L., & Brown, T. B. (2019). EMTALA: The evolution of emergency care in the United States. Journal of Emergency Nursing, 45(4), 411-414. Web.
Griffey, R. T., Schneider, R. M., & Todorov, A. A. (2020). Adverse events present on arrival to the emergency department: The ED as a dual safety net. The Joint Commission Journal on Quality and Patient Safety, 46(4), 192-198. Web.
Katayama, Y., Kitamura, T., Nakao, S., Himura, H., Deguchi, R., Tai, S., & Nakagawa, Y. (2022). Telephone triage for emergency patients reduces unnecessary ambulance use: A propensity score analysis with population-based data in Osaka City, Japan. Frontiers in Public Health, 10(5), 24-90. Web.
Moskop, J. C., Geiderman, J. M., Marshall, K. D., McGreevy, J., Derse, A. R., Bookman, K.,& &Iserson, K. V. (2019). Another look at the persistent moral problem of emergency department crowding. Annals of emergency medicine, 74(3), 357-364. Web.
Pinchbeck, E. W. (2019). Convenient primary care and emergency hospital utilization. Journal of Health Economics, 16(5), 102-242. Web.
Raidla, A., Darro, K., Carlson, T., Khorram-Manesh, A., Berlin, J., &Carlström, E. (2020). Outcomes of establishing an urgent care centre in the same location as an emergency department. Sustainability, 12(19), 81-90. Web.
Savioli, G., Ceresa, I. F., Luzzi, S., Gragnaniello, C., GiottaLucifero, A., Del Maestro, M., &Bressan, M. A. (2020). Rates of intracranial hemorrhage in mild head trauma patients presenting to emergency department and their management: A comparison of direct oral anticoagulant drugs with vitamin K antagonists. Medicina, 56(6), 30-80. Web.
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