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Hospital emergency departments vary
greatly across country
New database reveals great diversity
in patient volume, could help guide future planning efforts
BOSTON - December 4, 2006 - A large percentage of hospital
emergency departments across the U.S. are very different from the
high-intensity setting familiar to viewers of the television program
"ER." A database developed by a research team based at
Massachusetts General Hospital - the first comprehensive list of
emergency departments (EDs) across the country - shows that one-third
of all EDs care for less than one patient each hour, on average.
Based on information from 2001, the database is the first step in
a process that may lead to the development of an ED classification
system, similar to what currently exists for trauma centers. The
creation of national standards for ED categorization was recommended
in the 2006 Institute of Medicine report "The Future of Emergency
Care in the U.S. Health System."
"Our results suggest that EDs are quite different from one
another and that we may need to consider a variety of approaches
to ensure access to emergency care for all Americans," says
Ashley Sullivan, MS, MPH, of the MGH Department of Emergency Medicine,
lead author of the report in the December Annals of Emergency
Medicine.
The new database - known as the National ED Inventory (NEDI) - is
a project of the Emergency Medicine Network (EMNet, www.emnet-usa.org),
180 medical centers that focus on public health research in emergency
medicine. To conduct nationwide investigations of emergency services,
the EMNet team needed an accurate, comprehensive listing of all
EDs in the U.S. Combining material from two existing but conflicting
databases, the team gathered additional information to characterize
all US hospital facilities that were open 24 hours a day, 7 days
a week, accessible to the general public and not limited to a particular
specialty.
The information compiled on almost 4,900 hospitals revealed a wide
range of patient visits per year. One third of EDs receive fewer
than 8,760 visits a year - an average of less than one patient each
hour. Higher volume facilities - which account for 94 percent of
all visits nationwide - are concentrated in metropolitan areas,
while most lower volume EDs are in rural settings.
While the Northeast had the fewest EDs, 89 percent of facilities
in the region were higher volume. Higher volume EDs accounted for
72 percent of the facilities in the South, 66 percent in the West
and only 55 percent of EDs in the Midwest. Regional patient visits
per capita, which account for differences in population density,
were highest in the South and lowest in the West. These differences
could reflect factors such as patients' need for 'safety net' medical
services, the availability of community primary care physicians
and the challenge of traveling long distances to reach the nearest
ED, the research team notes.
"We were struck by the different visit volume of the average
U.S. ED, which sees about 16,000 patients per year, compared to
sites where future emergency physicians are trained, with average
volumes of 49,000 visits per year," says Carlos Camargo Jr.,
MD, DrPH, of MGH-Emergency Medicine, director of EMNet and senior
author of the Annals report. "We need to confirm that
we are giving our emergency medicine residents the best training
for future work in these smaller EDs. We also may want to re-examine
other pathways to ensure continued emergency care in smaller EDs,
which face many challenges in the recruitment and retention of physicians."
Camargo is an associate professor of Medicine at Harvard Medical
School.
The MGH-based group will be updating the NEDI every two years to
monitor national trends; information has been gathered for 2003
and is currently being compiled for 2005. To broaden the type of
data gathered for NEDI, the team will conduct additional surveys
to examine likely differences among EDs regarding the types of conditions
cared for, staffing and available consultants, and the availability
of diagnostic and therapeutic services. They also have launched
a pilot survey of EDs in Singapore that will be followed by similar
surveys in other countries.
"We need to further examine the characteristics of EDs to better
understand the landscape of emergency medicine in the U.S.,"
Sullivan says. "NEDI provides a way to better understand the
literally thousands of smaller EDs that may be overlooked in the
development and implementation of policy decisions affecting emergency
medicine."
Additional co-authors of the Annals of Emergency Medicine
report are Ilana Richman, Christina Ahn and Sunday Clark, MPH, ScD,
of the MGH; Bruce Auerbach, MD, Sturdy Memorial Hospital, Attleboro,
Mass.; Daniel Pallin, MD, MPH, Brigham and Women's Hospital; and
Robert Schafermeyer, MD, Carolinas Medical Center in Charlotte,
N.C. The study was supported by an EMF Center of Excellence Award
and a grant from the Agency for Healthcare Research and Quality.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
computational and integrative biology, cutaneous biology, human
genetics, medical imaging, neurodegenerative disorders, regenerative
medicine, transplantation biology and photomedicine. MGH and Brigham
and Women's Hospital are founding members of Partners HealthCare
HealthCare System, a Boston-based integrated health care delivery
system.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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