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March 10, 2023

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Improving emergency department systems can solve healthcare’s toughest problems

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As a practicing emergency department clinician, I have seen first-hand how our healthcare system is stretched to the limit. Emergency departments must deal with volatile patient volumes, clinicians are leaving the profession in record numbers and reimbursements are declining despite record inflation.

With all the uncertainty in healthcare today, one thing that is certain is that we can’t continue to do things the way we’ve always done them. We have to embrace innovation in healthcare processes and traditional roles in care delivery and we must ensure the proper payment for services provided by our healthcare system and its clinicians.

Fluctuating Patient Volumes

Before the pandemic, emergency rooms saw relatively predictable patterns of growth and variation in daily and seasonal patient volumes but often failed to adjust capacity to compensate for these controllable sources of variation. However, nationwide lockdowns and subsequent re-openings employed to combat the spread of COVID-19 resulted in never-before-seen waves of patient influx and retreat. The ups and downs of these unpredictable waves came too rapidly for hospitals to ramp up staff in time to treat patients. Hospitals that quickly accumulated staff were then overstaffed once this volume disappeared. These massive volume swings wreaked havoc on our healthcare system, which left many patients without the care they desperately needed and contributed to physician burnout reaching historic levels.

Hospitals must proactively design systems that are able to address controllable variation seen daily or seasonally and must align resources with demand to the greatest extent possible to buffer the impact of these less-controllable surges. To be prepared for the next public health crisis, we must better understand seasonal demand and the connectivity between the operating room schedule, emergency department volume and referrals to long-term care facilities. Collaborating and sharing information between institutions will allow hospitals to better predict the need for post-acute beds and to better handle periods of increased demand.

Combatting Clinician Burnout and Attrition

An estimated 10% of physicians have stopped practicing since the onset of the pandemic. At the same time, our system is experiencing the worst nursing shortage in history. Recent studies from Medscape show that 53% of physicians have reported burnout and 23% have reported symptoms of depression. Meanwhile, there have been record numbers of reported assaults on healthcare workers and increased patient dissatisfaction due to excessive wait times and unorganized care procedures. This negative feedback loop causes even more of our best and brightest to leave the field.

Before we improve patient outcomes and satisfaction in the emergency room, we must first combat the declining number of healthcare workers. We can do this by improving working conditions, offering mental health support and ensuring ample resources to our frontline healthcare heroes. To alleviate difficult conditions, we must redesign emergency department systems to better manage patient intake, treatment and discharge that prioritize superior and efficient care. Systems unable to recruit and retain RNs and BSNs can benefit by incorporating licensed practical nurses, paramedics and other support staff into their skill mix to enable nurses to perform at the top of their license. In systems struggling to fully staff physicians, physician assistants and nurse practitioners can be an important support to enable physicians to work at the top of their license. We expect the workforce shortages to continue into the immediate future, so it’s important to support the emergency room staff during high patient volume periods, alleviate pressure and help streamline tasks in the interest of providing the highest quality of care during these difficult times.

Compensating Clinicians for Life-Saving Care

Frontline clinicians are facing a financial crisis. Over the past year, Medicare has slashed physician reimbursement by four percent, even as record inflation has driven up costs. Emergency department physicians are morally and legally bound to treat all patients, regardless of their ability to pay. And large profitable health insurers are reimbursing doctors for this care at historically low levels even as these companies bring in record profits. Hospitals and health systems must engage in an expensive and time-consuming arbitration to collect extremely low reimbursements.

These are not simple problems to solve, but there are solutions. The federal government, led by Congress, must increase the reimbursements clinicians receive for treating patients covered by Medicare. Large profitable health insurers must understand that their beneficiaries depend on a strong and resilient emergency care system. Health insurers should go in-network with providers at rates that protect our healthcare safety net. Emergency rooms must be protected as the first line of defense for life-threatening illness and injury and a safety net for uninsured patients facing poverty.

Solving Healthcare’s Toughest Problems

As healthcare providers and patients become more frustrated with the current systems, it is clear something needs to change. We must invest the time, effort and resources to help improve patient care, support healthcare workers and combat regulatory decisions the place the safety net at risk.

Dr. Crane recently joined Lean Blog’s Mark Graban to further discuss this topic. Listen to the podcast here.