Emergency Rooms: The Canary in the Health Care Coal Mine

By Megan McArdle

Interesting piece on managing wait-times in Canada:


On Monday, Auditor General Jim McCarter released his annual report which found that despite putting an extra $200 million into shortening emergency room wait times over the last two years, "significant province-wide progress has not yet been made."

"Complaints about overcrowding and delays in hospital emergency rooms have persisted for years," McCarter told a news conference on Monday.

Emergency room waits for people with serious conditions sometimes reached 12 hours or more, the report said. That is far greater than the province's 8-hour wait time target, the report found.

And for emergency patients who need a hospital bed, they waited on average for about 10 hours but some waited 26 hours or more, according to the 2010 Annual Report.

"Our audit found that wait times for patients with less serious ailments have been reduced somewhat," McCarter said. "However, there has been only minimal progress in reducing wait times for patients with more serious conditions."

Health Minister Deb Matthews defended the province's ER wait times strategy, saying Ontario is the first province to set targets and measure waits.

"When we started, about 81 per cent of people who went to emergency departments were seen within the target," she said. "Now we are at 85 per cent . . . a lot of hard work goes into getting those wait times down."

McCarter's report shows the real problem with ER waits doesn't necessarily start in the emergency department.

A big part of the problem is the lack of in-patient beds, which forces admitted patients to be housed in the emergency departments, the report said.

The lack of in-patient beds is influenced by two things, McCarter found. Beds are being blocked by patients who no longer require hospital care but who are waiting for a long-term care bed and by "less-than optimal practices" by hospitals in managing patient flow to free up space.

"There is no question; the ER is the canary in the coal mine. When something isn't being properly being managed anywhere in the health system, the problems then show up in the emergency department," Matthews said, adding that is why the Liberals are expanding homecare initiatives.

Things to look for as our adventures in health care reform continue.  The subject of the article is a woman who died while waiting to be seen.  I've spent a lot of time in some pretty crowded ERs in some pretty poor areas, but I've never experienced a 12 hour wait time.  Any other US readers who have?


This article available online at:

http://www.theatlantic.com/business/archive/2010/12/emergency-rooms-the-canary-in-the-health-care-coal-mine/67781/