Care For PA

It's usually good news when a business is booming and customers are streaming in--unless it's a hospital with an overcrowded emergency department. This is a growing problem not only in Pennsylvania, but for hospitals throughout the United States as well. Last year, a survey by the American Hospital Association found that nearly half of all U.S. hospitals reported that they were "at�? or "over�? capacity.

Every day in the United States, nearly 314,000 patients request care from emergency departments--an increase of 8 percent from 2001-2005. Pennsylvania hospitals alone handle more than five million emergency department visits a year--an increase of 10 percent since 2001.

There has been no slowdown this year, and we're just reaching the flu season.

Reasons for Overcrowding

The problem of emergency department overcrowding is complex, but some key factors include:

• More patients--Hospital emergency departments are not only serving people with medical emergencies, they're also providing much of the care to the growing number of uninsured as well as to people whose physicians are unavailable evenings and weekends. In addition, reduced government support for community mental health programs means more patients with psychiatric problems are seeking care in hospital emergency departments.


• Less staff--Often physicians, especially specialists, are limiting emergency department calls to reduce their exposure to lawsuits because of sky-high medical liability insurance premiums. Staff shortages in other areas, such as laboratory and imaging, can also cause delays in providing treatment.


• Fewer beds--The number of emergency departments available to meet health care needs has declined, with 475 emergency departments across the United States ceasing operations between 1997 and 2005. In Pennsylvania, 27 emergency departments have closed since 1996.

Financial pressures add to the mix. Declining reimbursement by private insurers and Medicare and Medicaid, combined with the $543 million in uncompensated care "absorbed�? by Pennsylvania's hospitals for those without any insurance (in just 2005 alone), leave a majority of hospital margins razor thin. In addition, hospitals also now need to be prepared in the event there is a terrorist act or epidemic, but investment in necessary equipment and training is very costly.

How Hospitals Are Responding

Pennsylvania hospitals are trying to better manage the rising wave of individuals and increased community responsibility.

Among the responses:

• Many hospitals are building new emergency departments--or expanding existing ones--to accommodate more patients. Though finding the funding to cover such multi-million dollar projects is challenging.


• They also are working on changing emergency department procedures to better utilize limited hospital personnel, as well as processing information more efficiently.


• Hospitals are adding more beds in other areas, such as Intermediate Care and Telemetry units.


• Hospitals have stepped up recruitment of caregivers, and have had success in bringing more people into health professions by providing scholarships and other support.


• Hospitals also are sharing best practices and learning from experts as a result of a new statewide advisory committee. A major conference on the issue is planned for June 2007.

What Can You Do?

Even with hospital efforts to ease the congestion, many people still face long waits in emergency rooms. What can you do?

Reduce your emergency department visits.

• Seek care from a primary care doctor early, before an illness or injury worsens.


• Get a flu shot, especially if you are over 65 years old and have chronic health problems such as heart disease, diabetes, or asthma.


• Visit an "urgent care center�? if one is available near you, for conditions that are not true emergencies.


• Wash your hands frequently. Hand washing is the single, most important measure you have control over to prevent the transmission of germs.

Know when it's an emergency.

• An emergency is any sudden or serious problem that requires medical attention within minutes to several hours. These can include a sudden loss of breath, severe bleeding, chest pain, seizures, deep cuts, broken bones, poisoning from chemicals or drugs, or an overdose. Go to an emergency room immediately if you are facing any of these situations. Call 9-1-1 if your condition is life threatening.


• An urgent care need is any problem that you feel requires care within several hours, but is not life threatening. Typical complaints at urgent care centers usually include a persistent high fever, vomiting, a bad ear infection, a severe sore throat, a sudden rash, or insect bites.

If you do go to an emergency department, here are some helpful reminders:

• Emergency departments use a system of "triage�? that enables the hospital to treat the most critically ill or seriously injured first. A triage nurse is trained to know which symptoms or complaints are a priority and could be life threatening. If your condition significantly worsens, have someone alert the triage nurse. He or she can re-evaluate and determine how serious the injury or illness is.


• If you have time, bring your medicines. You can throw them in a bag before heading to the hospital.


• If possible, have your medical and insurance information up to date and on hand.

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