Medical Device Daily Washington Editor

WASHINGTON - With the flu outbreak now reported in all 50 states, a new poll highlights a critical bottleneck between emergency departments (EDs) and available beds within the hospital.

EDs nationwide are under stress from increased demand for services, but they have a limited ability to move patients from the ED to an acute or critical care bed, according to the poll of more than 100 ED managers. The newly published poll was conducted by VHA (Irving, Texas), a for-profit hospital cooperative.

The increased demand for service also is compounded by uninsured patients who use the emergency department for primary care, the respondents said.

The emergency department is traditionally the hospital door that is always open. Now many hospitals are struggling to keep those doors open, said Jeanne McGrayne, RN, director of emergency department consulting for VHA.

Average waiting times for patients to see a physician was between 30 minutes and one hour, according to respondents. Additionally, 65% said their hospitals never turn ambulances away due to not having room in the ED, also known as diversion.

Other results from the poll:

• Respondents rated patient violence as the greatest threat to ED personnel for the third straight year. Hepatitis ranked second and HIV placed third.

• Almost half of the respondents 46% said that their hospital was planning to expand its ED within the next 12 months.

• Uncompensated care, especially for those who are uninsured, increased during the past year, according to 41% of the respondents.

• Two-thirds of EDs have made special accommodations, such as gurneys with higher weight limits and lifting devices, to handle and treat obese patients.

The survey results show that issues such as inpatient bed capacity and patient volume are affecting emergency departments ability to deliver care, in spite of the staff members dedicated efforts, McGrayne said. Hospitals need to address issues that affect the organization as a whole to truly improve the delivery of care in the ED.

VHA says it is focused on leveraging the strength of its members to improve clinical, operational and financial performance. It has 18 local offices across the U.S.

Published: December 15, 2003