Humpty Dumpty

Crisis Seen in Nation’s ER Care | WP | 6.15.06

Capacity, Expertise Are Found Lacking

Emergency medical care in the United States is on the verge of collapse, with the nation’s declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.

That’s the grim conclusion of three reports released yesterday by the Institute of Medicine, the product of an extensive two-year look at emergency care.

Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients. Once in the ER, patients sometimes wait up to two days to be admitted to a hospital bed.

As a system, U.S. emergency care lacks stability and the capacity to respond to large disasters or epidemics, according to the 25 experts who conducted the study. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money.

Fixing the problems is likely to cost billions of dollars and will require the leadership of a new federal agency, which Congress should create in the next two years, they wrote.

“This is a crisis that could jeopardize everyone in this room, and all their loved ones,” A. Brent Eastman, a surgeon and chief medical officer of the ScrippsHealth hospitals in San Diego, said at a daylong conference on the reports, which were prepared by the National Academy of Sciences’ Institute of Medicine.

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From 1993 to 2003, the U.S. population grew by 12 percent but emergency room visits grew by 27 percent, from 90 million to 114 million. In that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds.

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Emergency Care for Children: Growing Pains | IOM | 6.14.06

This report, Emergency Care for Children, offers an analysis of:

• The role of pediatric emergency services as an integrated component of the overall health system.
• System-wide pediatric emergency care planning, preparedness, coordination, and funding.
• Pediatric training in professional education.
• Research in pediatric emergency care.

Hospital-Based Emergency Care: At the Breaking Point | IOM | 6.14.06

The wide range of issues covered in this report, Hospital-Based Emergency Care: At the Breaking Point, includes:

• The role and impact of the emergency department within the larger hospital and health care system.
• Patient flow and information technology.
• Workforce issues across multiple disciplines.
• Patient safety and the quality and efficiency of emergency care services.
• Basic, clinical, and health services research relevant to emergency care.
• Special challenges of emergency care in rural settings.

Emergency Medical Services At the Crossroads | IOM | 6.14.06

By addressing the strengths, limitations, and future challenges of EMS, this report, Emergency Medical Services At the Crossroads, draws upon a range of concerns:

• The evolving role of EMS as an integral component of the overall health care system.
• EMS system planning, preparedness, and coordination at the federal, state, and local levels.
• EMS funding and infrastructure investments.
• EMS workforce trends and professional education.
• EMS research priorities and funding.

Perhaps the just released IOM reports will have as a great an impact as their 2001 release: Crossing the Quality Chasm: A New Health System for the 21st Century, else we are left with our present emergency response system as a true Humpty Dumpty .

Humpty Dumpty sat on a wall.
Humpty Dumpty had a great fall.
All the king’s horses and all the king’s men
Couldn’t put Humpty together again.