Are More Smaller Emergency Departments Better than Fewer Big Ones? (Adobe Stock)

When I first became an emergency physician over 30 years ago, we were already seeing the beginnings of the emergency care crisis that we find ourselves in today. The number of emergency departments (EDs) was decreasing while the number of ED visits per year was increasing—a trend that has continued at a concerning rate.

As early as 1990, the American College of Emergency Physicians (ACEP) “Overcrowding Task Force” published results stating that Americans faced a healthcare crisis with overcrowding, limited access, and the quality of emergency care. In 2006, the Institute of Medicine released a national report that stressed hospital EDs were “at a breaking point.” A recent ACEP report in 2014 indicated that the state of EDs across the country has deteriorated to a near-failing grade. The bottom line is that our current emergency care model is broken, and an overhaul of how we meet patients’ needs is long overdue and absolutely necessary.

Centralized hospital-based EDs will always be the foundation of emergency medicine, but the limited number of hospital EDs are overburdened and need relief. That’s why hospital-satellite emergency departments (HSEDs), a more distributed access model of emergency care, should continue to be integrated into the healthcare system.

HSEDs are structurally separate from a hospital, but offer patients emergency services that are equal to or surpass hospital-based facilities. The acuity levels for patients seen in HSEDs are similar to hospital-based EDs as well (broken bones, burns, chest pain, abdominal pain, pulmonary symptoms, head traumas, and concussions). In short, when it comes to treatment, there is little to no difference between EDs and HSEDs, but HSEDs have the ability to decrease overcrowding, expand access, and ensure timely high-quality care.

 

Eliminating overcrowding

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I know firsthand that time is critical when dealing with medical emergencies, and centralized hospital-based EDs often require extended wait times for many patients, with delays in diagnosis and treatment. This has led to an epidemic of overcrowding in EDs across the country. Hospitals have repeatedly expanded emergency departments, added more staff, and built larger waiting rooms. And, of course, they accept patients at any time of the day or night. But simply making the existing model of centralized care “bigger” has not provided lasting relief nor addressed the underlying issues of timely access.

The HSED distributed model of care eliminates overcrowding by combining lower patient volumes with shorter wait times, leading to more timely and efficient diagnosis and treatment by emergency physicians. With multiple facilities in the community, there are multiple access points to receive patients all day and night. HSEDs offer little or no delay in evaluation and care, faster diagnostics, and early clinical intervention. And using electronic medical records and digital imaging allows care coordination across settings and physicians that may be required for consultation, follow-up care, or admission.

 

Expanding access to care

Just as the creation of EMS brought emergency care closer to home, the spread of HSEDs expands access to care in communities and allows patients to travel shorter distances to see a board-certified physician. Too many times have patients told me that they had difficulty accessing a centralized ED due to lack of transportation or being overwhelmed at the thought of navigating a large hospital. HSEDs alleviate both of these patient issues by locating at easily spotted facilities in communities close to home.

 

Providing high-quality care, every day

As a physician, my first priority is to provide the best care possible to each individual patient. To do so, all physicians need the appropriate amount of time to diagnose a patient and perform the necessary treatment. ED physicians are under immense pressure with a constant high volume of patients, putting any capable physician at risk of making a mistake. The spread of HSEDs helps to relieve patient volumes per physician, giving more time to provide the best quality of care available. Having multiple locations to treat emergencies allows all facilities to provide a high-quality of care, every day, regardless if they are a hospital-based ED or HSED.

It should be noted that hospital-based EDs and HSEDs are working together to address the rising need for more distributed emergency care. HSEDs partner with leading hospital networks across the country to redesign emergency care. With more HSEDs, healthcare professionals can collectively build a new future of emergency care for all patients in their communities.



Ricardo Martinez, MD, FACEP
Dr. Ricardo Martinez is a nationally recognized board-certified emergency physician and has practiced emergency medicine clinically for more than 30 years, and held senior roles in business, academia, and the federal government. Before joining Adeptus Health, Dr. Martinez was Chief Medical Officer of North Highland Worldwide Consulting, where a major focus of his work was collaborating with physician leadership to enhance their effectiveness in providing high-value care, building data-driven patient-centered teams, and driving cultural change. Dr. Martinez also served as the Executive Vice President of Medical Affairs for the Schumacher Group, a leading emergency medicine practice management company, and was previously appointed Federal Administrator of the National Highway Traffic Safety Administration (NHTSA) by President Clinton. He currently serves as faculty at Emory University School of Medicine and previously held roles at Stanford University School of Medicine and as Executive Director of the Medical Leadership Academy. Dr. Martinez has been a senior medical advisor to the National Football League since 1988, facilitating medical care, emergency planning, preparedness, and public health for The Super Bowl. He was elected to the Institute of Medicine of the National Academy of Sciences in 2004 and served on the Board of Directors of the Public Health Foundation. Martinez pursued undergraduate studies from Louisiana State University, an M.D. from Louisiana State University School of Medicine, and his residency at LSU-Charity Hospital at New Orleans, where he was Chief Resident.

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