29 April 2009

Safety valve or competitive threat?

A good point on ERs from the LAT (which has been running a nice series on ERs lately)

ERs face a new urgency - Los Angeles Times
As emergency room visits in the United States have ticked steadily upward, reaching 119.2 million annually, waiting for treatment has become a central feature of emergency-department care.

Patients spend an average of 3.3 hours to be seen, treated and discharged, according to a 2006 report by the federal Centers for Disease Control and Prevention. [...] Instead, a growing number appear to be voting with their feet. Those walk-in patients are fueling the growth of a kind of healthcare provider now making a comeback -- the urgent care center -- and at some hospitals, a flurry of efforts to improve the ER experience.
Since the "walking wounded" are generally the easiest, fastest and most profitable cases in the ER, it behooves a hospital to have a functioning fast track to shuffle them through quickly.  It decompresses the waiting room, improves patient satisfaction, and frees up resources for the truly ill.

Urgent care centers have the ability to skim off only the paying patients, since they have no EMTALA obligation, and some are well-equipped with all the ancillary tests available at an ER -- up to and including CT scans.  In fact, the ancillary tests are the profit centers of an UCC, with the clinic itself being something of a loss leader.  It's an attractive option for patients -- cheaper, faster, more service oriented.  It's probably better policy on a national scale, since it's a better use of resources.  But if all the fast track patients leave the ERs and go to UCCs, then something would have to change.  Some new source of funding would have to be found to support the newly financially unviable ERs.


  1. Bastiat's Ghost4/29/2009 12:54 PM

    Repeal EMTALA and let the chips fall where they may

  2. Wow, this is not at all representative of my area (MI). I'm a part-time ED pharmacist and this past winter when I injured my back shoveling, I damn near went to the ED (and would have requested fast track, thank you very much) due to the overcrowding at our UCCs. I ended up wishing I had, as I spent over an hour in the waiting room. The entire time I waited, not one single person was called back to be seen. The one other time I tried to go to an UCC for an unrelated problem they estimated a 3 hour wait. Even on our busiest days in the ED, I probably could have gotten a place in Fast Track quicker than that. I guess what I'm saying is our UCC suck!

  3. "It's probably better policy on a national scale, since it's a better use of resources."

    How do you get to this logic?

    A country spending more money on xray machines, labs, buildings etc... on top of the tons of xray machines, etc... it already has in EDs is not better use of resources at all.

    Moving patients to urgent care centers from EDs will not lessen the need for EDs to still have xray machines, labs, etc... nor will it change the fact that these will need to be open 24 hours a day.

    All it will do is create even more inefficiency in the system as now we have 2 machines. One still in use 24 hours/day, but now less productive than it was before and the other open (say) 12 hours a day and idle the other 12.

    Your logic is most definitely incorrect. If we want to spend more money on health care, great, but call a spade a spade.


  4. The new UCTALA Laws will take care of that. Urgent Care and Active Labor Act. Not that the labor part would be needed, but it wasn't needed on the initial law. It was just there for appearances, since it is all about the appearances.

    The could even get their own JCAHO/TJC and Press Ganey. This is a win for legislators and bureaucrats everywhere. Let's party.


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