Overcrowding in an Emergency Room
My first visit in an emergency room was when I had taken my aunt who suffered a heart attack. On arrival, we thought we would be attended to immediately since we had called the hospital. A nurse, who first attended to my aunt, told us to join the queue for us to see a doctor. In the waiting area, there was a man who claimed to be suicidal. He waited for a counsellor whom he did not manage to see even after being patient for more than 12 hours; he just used his backpack strap and hung himself. It was very unfortunate since my aunt passed shortly after she was admitted. This is a sad story that shows that there is a real need to alleviate overcrowding in an emergency room, which is continuously causing avoidable deaths.
In my discussion about the overcrowding in the Emergency room in Canada health sector, I will first look into the structural organization of the Canadian health sector, factors that contribute to the overcrowding in Emergency rooms and finally, the possible ways to solve this issue of overcrowding.
The emergency room is a medical attendance room in which patient in need of acute care and who present with no earlier appointments come, either by an ambulance or by own means. It is in the primary care centre; it provides a wide range of initial care of injuries and illnesses of which some are life threatening and necessitate an immediate response. Overcrowding in emergency room refers to a state where the need for emergency services is greater than the ability to give care in a reasonable duration (McCabe, 2001).
This problem of overcrowding came up from past decisions when the largest responsibilities in the health care system were given to the hospitals. These decisions also have a negative effect on the primary care services that are keen on sensitive health problems.
Problems of Overcrowding in Emergency Room in Canada
Overcrowding in emergency rooms is in many countries of the world, and has been a major problem with the health systems. Canada has the largest rates in utilizing the emergency room than any other industrialized countries (Schull et al, 2006). This is both in numbers seeking the services and with people with chronic conditions. It also carries the largest proportion that uses emergency rooms for care that could be attended to by a regular doctor resulting in too long queues before getting care. Most of these patients who visit the emergency department presents with cardiac arrest, trauma, heart attack, asthma and COPD, and mental illness.
Structural organization of Health System in Canada
The health systems in Canada are classified into three; the primary, secondary, and tertiary care. The primary care is the entry point to the health system. They take care of basic curative, which requires simple diagnosis and the treatment. Secondary care deals with the complicated diagnosis as they have specialized care and treatment. The tertiary care centres have special equipments and specialized staff who offer specialized diagnostics and treatment services. In Canada, the emergency department is the entry point for all those clients without appointments, those with serious illnesses and in life-threatening conditions.
In Canada, health systems are publicly funded from income tax revenues, making access to health care free. The health services are mainly offered by private facilities. Canada’s system is also named single payer system since private doctors offer basic services and the government pays for these fees at the similar rates. The provincial medical association and the provincial governments annually agree on these rates, and most of these government funding is given at a provincial level (Ospina et al, 2006). The public hospitals are independent institution, which are managed within a budget and are as well under provincial corporation acts. Health systems are guided by 1984, Canada Health Act. They also ensure quality health services through centralized standards. The patients’ health information is never disclosed even to the government and this is kept between the patient and the physician. Their health care systems are based provincially; they are very cost-effective due to their simple administration.
According to Schull et al (2002), each doctor in a particular province takes care of the insurance compensation against a provincial insurer. This saves the persons seeking health care trouble of billing and reclaim. This makes the private insurance become a very small part in the general health care system. The provincial Ministry of health issues a health card to every person who enrols in a program and these people are entitled to equal health services. All the basic health care is provided except for issues such as vision and dental care, which are not covered in some provinces but may be covered by employers for those in private companies. In some provinces, there are plans for those who may prefer a private room if hospitalized.
Canada is the most overcrowded among other developed countries. Life threatening cases are attended to immediately and the non-urgent services are seen at another appointment. The average wait time to see a specialist physician can go for four weeks and at least 89.5% waiting no longer than 90 days. Those seeking for diagnostic services like CAT and MRI scan having to wait for two weeks and 86.4 % having to wait for not more than 90 days. For surgery services, one may be required to wait for four weeks and 82.2% waiting for not more than 90 days. An estimate of around 24% of all Canadians, wait for more than four hours in the emergency room (Ospina et al, 2006).
What contributes to Overcrowding in Emergency Rooms?
Patients coming to the hospital emergency room habitually wait for a long time in the ER waiting area. Waiting resulting from long queues is because of triage process, which is important for hospital admission, waiting for an in-patient vacant bed, shortage of enough physicians to examine the large numbers of people flowing in the facility and increased emergency cases such as accidents and disaster (Rowe et al, 2006). In Canada, the number of emergency rooms has also decreased since some them have been closed down, they have decreased the number of physicians and as well the inpatient beds while as the community population remains the same. This has however led to the automatic crowding in emergency rooms. Some of the other factors that contribute to overcrowding in the ER are:
According to Rowe et al (2006), lack of enough inpatient beds may result from the inadequacy of nursing home facilities, which on the other hand makes it difficult to discharge patients hence keeping the beds occupied. This leaves the new admissions with no place to go forcing the nurses to use the hallways, offices, and conference rooms, which are uncomfortable for both the patient and the nurse.
Lack of enough community resources that would support community based health care and other long- term care alternatives. Shortages of physicians, nurses and other health care providers, which has led to the closure of some emergency beds and reduction of inpatient beds in order to have manageable numbers of inpatients (Bond et al, 2006).
Use of poor strategies in disease prevention and health promotion and this may contribute to the rise to the numbers of inpatients since patients seek medical attention when their health status has deteriorated (Ospina et al, 2006). Higher disease severity is another factor as there is an increase in the aging population, which comes with complex medical problems in illness among the emergency department patients. This is one of the major determinants of overcrowding in emergency rooms.
Hospital system restructuring whereby some of the emergency departments are eliminated resulting in increased numbers of patients visiting the neighbouring ones.
Possible Ways to Alleviate Overcrowding in Emergency Rooms
Overcrowded ER is a threat to timely care delivery and this compromises compliance with the core standards. Approximately more numbers of people are dying because of overcrowding which is avoidable compared to the numbers of people dying from road accidents (McCabe, 2001).
Overcrowding in the emergency room is also a significant challenge to people’s confidence with a health care system. This problem is not entirely a failure of the emergency department but also outside the emergency department. If these problems were addressed, we would not only reduce or avoid overcrowding but also enjoy a proper and responsive health care. This is because some of the people coming to seek care in the emergency room do not necessarily require hospital admission or even emergency services. Some of the possible ways to alleviate overcrowding are as follows (Bond et al, 2006).
Consider the proper management of chronic diseases in effective manners that reduce readmission and frequent visits to the emergency departments. . Also, increase access of primary care services, which will reduce the number of people visiting the emergency rooms with minor illnesses.
Create access to community based health care, resources, other alternative care services like home based care, and others that support caregivers and families to minimise chances of hospitalization. Build capacity in people to take care of them, in taking care of the patient, family members, and caregivers would also play a different but a very important role as they give hope and assure recovery of the patient from their life experiences or learnt practical advice. This is incorporated in discharging plans and it reduces the times that this patient is likely to visit the hospital (Rowe et al, 2006).
Recruiting and retaining a great number of nurses to ensure proper care of the inpatient and this would speed up the discharge process as well. At the same time, improve the promotion of health and disease prevention strategies that would prevent, or minimise disease progress and the overall need for emergency services (Bond et al, 2006).
The physicians should be keen when assessing and planning for discharge and in follow-up to avoid readmission of the patient. Consider innovations in health care of the elderly since they are much vulnerable to disease and a great number of them frequent the emergency room. Increase government funding in the health sector that ensures coordination between the private and public sectors with a goal to reduce overcrowding in the ER. Also funding the construction and equipping residential health facilities, which will attend to first hand emergency cases. Allow nurse practitioners, volunteer programs, take part in tertiary and primary care to allow quick and efficient attendance to the patients in the ER.
In conclusion, we cannot afford to go on with the present overcrowding of emergency rooms. This has the potential to affect anyone who experience unexpected injuries or severe illness that require immediate emergency attention. ER overcrowding is therefore a threat to public health as it compromises the patient safety and put in question the dependability of the entire emergency care system. The overcrowding is an indicator of healthcare system as a failure on multiple levels. Alleviating the overcrowding problem will necessitate a multi-disciplinary system approach to be able to curb its main causes, which are inadequate inpatient capacity, inadequate funding from the government for health facilities in the residential areas to deal with first hand emergency, and increase in disease severity due to the aging population and current lifestyle.
References
Bond, K., Ospina, M. B., Blitz, S., Friesen, C., Innes, G., Yoon, P., et al. (2006). Interventions to reduce overcrowdingin emergency departments (Technology report no. 67.4).Ottawa: Canadian Agency for Drugs and Technologies in Health.
McCabe, J. B. (2001). Emergency Department Overcrowding: A National Crisis.National Policy Perspectives, 76(7), 672-674.
Ospina, M. B., Bond, K., Schull, M., Innes, G., Blitz, S., Friesen, C., et al. (2006). Measuring overcrowding in emergency departments: A call for standardization (Technology report no. 67.1).Ottawa: Canadian Agency for Drugsand Technologies in Health.
Rowe, B. H., Bond, K., Ospina, M. B., Blitz, S., Friesen, C., Schull, M., et al. (2006). Emergency departmentovercrowding in Canada: What are the issues and what can be done? (Technology overview no. 21).Ottawa: CanadianAgency for Drugs and Technology in Health.
Schull, M. J., Slaughter, P. M., & Redelmeier, D. (2002). Urban emergency department overcrowding: Defining theproblem and eliminating misconceptions. Canadian Journal of Emergency Medicine, 4(2), 76-82.
