Report links ED expansion, increase in insured patients

Growing pressures also cited

Given the high rates of admission through emergency departments, having a large or full-service ED is one way to ensure a steady flow of insured inpatients and make a hospital appealing to clinicians and patients, according to a recent report from the Center for Studying Health System Change.

With that in mind, the report states, many hospitals in the 12 U.S. communities visited during the study are expanding or renovating their EDs. These improvements are being made despite success in reducing ambulance diversions via more efficient management of patient flow from admission to discharge and enhanced emergency services coordination, the report says.

In general, ED expansions appear to be motivated by competition for well-insured patients, particularly in affluent locations, the report goes on to say, an occurrence that was particularly notable in Indianapolis, Miami, northern New Jersey, Phoenix, and Seattle. However, the study notes that some safety net hospitals are renovating, in part, to attract more insured patients.

ED directors and hospital CEOs cited changes to architectural appearances and patient flow, increased numbers of beds, decreased waiting times, and greater use of state-of-the-art technology as examples of improvements being made.

Another development at some hospitals that has improved flow through the ED is the creation of adjacent admissions units. Staff transfer patients from the ED to these units as soon as the decision to admit has been made. Once in the admissions unit, the initial set of clinical orders can be carried out, including lab testing, radiology services, and drug administration, if necessary.

In some sites, the report states, respondents indicated that these various efforts have already increased rates of insured inpatient admissions.

The report also addresses what it describes as growing pressures on hospital EDs — from persuading specialists to provide on-call coverage to dealing with an increasing number of patients with serious mental illness — and says these factors could compromise access to emergency care and add to rising health care costs.

The rising pressures are a result of larger forces throughout the health care system, including financial incentives that reward specialist physicians for performing more procedures outside general hospitals, diminishing access to primary care, and declining funding for community-based mental health services, the study indicates.