Overcrowding in emergency departments: effects on patients.

The California Journal of Emergency Medicine I:1 July 2000 page 2 President’s Message continued Overcrowding in Emergency Departments: Effects on Patients Robert W. Derlet, MD U.C. Davis School of Medicine Recently there has been increased discussion on the overcrowded conditions in many of California’s emergency departments. 1,2,3 A recent article published in the Western Journal of Medicine details the result of a comprehensive survey among directors of California EDs. 1 Over 96% reported episodic overcrowding in EDs and some reported nearly daily overcrowding. The results are also similar to that conducted in a survey nationally that included both teaching and non-teaching hospitals. Although the causes of overcrowding are complex and multifactorial, the key reason for overcrowding is because EDs are too small and understaffed for the population they serve. The impact of overcrowding deserves discussion. There are multiple effects of overcrowding and it is unfortunate that our patients have to suffer because EDs do not have the capacity to serve the public. Some of the effects of overcrowding that I have discovered in my discussions with emergency physicians throughout the state include the following: 1. Long waits for care. Long waits are the most common complaints from ED patients. A consequence of these delays includes the potential for minor medical problems to become more serious. Patients are unhappy with long waits and this dissatisfaction is reflected in an increasing number of patients who leave without being seen. 2. Prolonged pain and suffering. As a result of overcrowding, patients may experience prolonged pain and suffering because they are at the “back of the line.” (Cont. on page 3) Here is why we have founded CAL/AAEM: to complement CAL/ACEP’s efforts in conditions where its comprehensive strategy cannot effectively serve the rank and file EP. Concerns of antitrust and about the divisiveness of certain issues limit the ability of CAL/ACEP to move in specific arenas, the way CAL/AAEM can. In addition, national strife between ACEP and AAEM resulted in many of our members choosing not to join CAL/ACEP due to the mandatory requirement to join national ACEP. Many EPs perceive the national organization to be staff-driven (as opposed to physician-driven), and to be unevenly influenced by corporate strategies on practice issues specifically. Others see it as slow in its response, or as a trade organization that does not consistently or effectively represent the individual needs of the rank and file emergency physician. We certainly look forward to the national reunification of the voice of EM. CAL/AAEM will actively seek to work with CAL/ACEP to reunite the national house of EM. In the meantime, we shall encourage our members to participate, belong and/or contribute to CAL/ACEP and to CAL/AAEM. Dual membership is certainly making us stronger in our effort to reunify the house. Perhaps what is most important is to work together and to contribute to our California EMPAC funds. Until the national groups are able to reunite, we hope CAL/ACEP will continue its effort working with us to minimize the divisiveness in the voice of EM at the state and national level. CAL/AAEM believes that the current open channels of communications and mutual appreciation would help. At other times, such divisiveness may be necessary and yet possibly constructive. It will certainly be conducted with respect and courtesy. CAL/AAEM will seek to address only a limited number of practice issues. It will attempt to do it with and through CAL/ACEP. And it will do it alone only when it finds the best interest of the rank and file EP is being inadequately represented due to anti-trust concern or national restrictive policies. Most of all, we shall focus most of our effort on the struggle to protect the practicing EPs from the continuing dangerous trend of “Exit Strategies.” While vested equity in a group is legitimate, we strongly oppose the current forms of sale of contracts to corporate entities: the future income potential of practicing EPs is being robbed. The wellbeing of patients and physicians is being jeopardized. We basically shall not avoid taking stances on issues of importance because it may offend some powerful entities, other EPs, or certain non-democratic groups, their leaders or their owners. We shall seek what is right, fair and ethical. About CAL-AAEM Address: CAL/AAEM 26500 W. Agoura Rd. #680 Calabasas, CA 91302 1-877-4CA-AAEM Phone: Officers: President: A. Antoine Kazzi, MD e-mail: akazzi@uci.edu Robert W. Derlet, MD e-mail: rwderlet@ucdavis.edu William Durkin, Jr., MD wtdjmd@pol.net Vice-President: Secretary/ Treasurer: Board Members: John Christiansen, MD Howard Davis, MD Drew Fenton, MD Brent Fisher, MBA Bryan Hoynak, MD Medical Student Section: Andrew Nevitt, MD Mitesh Patel, MD Peter Rosen, MD Marie Russell, MD William Teufel, MD Boris Lubavin A. Antoine Kazzi, MD, FAAEM, FACEP CAL/AAEM President The American Academy of Emergency Medicine Associate Chief, Emergency Medicine University of California, Irvine Editor of The California Journal of Emergency Medicine: Robert W. Derlet, MD (916-734-8249) Statements expressed in this journal are those of the authors and do not necessarily reflect those of the American Academy of Emergency Medicine or the California Chapter. Dr. Kazzi is also a member of the Boards of the American Academy of Emergency Medicine, and the California Chapter of the American College of Emergency Physicians.