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Hospital emergency rooms are California’s health-care safety net

California’s emergency rooms have become the healthcare safety net and are the front lines of any public health emergency. Overcrowding in California’s emergency rooms is a real and continued threat to the health and safety of patients in need of care.
California is currently last in the nation when it comes to the number of emergency rooms available per capita, providing only six emergency rooms for every one million residents.  

With record high unemployment rates, the loss of health insurance and the uncertainty of economic recovery, the emergency room safety net is being stretched to its breaking point.  In fact, recent media reports indicate that the number of uninsured patients being admitted to emergency rooms has increased significantly since last Fall. Emergency room overcrowding is no longer simply an uncomfortable and time-consuming endeavor for patients.   Waits can be so long they are putting the lives of Californians in peril.

The good news is that California has an opportunity that’s simple and proven to help emergency room overcrowding.

AB 911 (Lieu) will require hospitals to develop and implement a response plan to alleviate the overcrowding based on a real-time calculator that measures how crowded the emergency room is every four hours. This plan allows for rapid response with practical solutions based on the ever-changing conditions in the emergency room. Each hospital develops an individualized plan that allows for flexibility in the design that suits each specific hospital.

Awaiting signature by the Governor, AB 911 will complement any other healthcare related bills the Governor signs into law. The program in AB 911 has a proven successful track record and doesn’t require additional funding from the state or from the hospitals. In fact, LA County’s USC hospital, with the largest emergency room in the state, implemented this approach at no additional cost and experienced a 38% decrease in the amount of time they operate at high levels of overcrowding.

Other hospitals across the nation have implemented a crowding score that triggers a full capacity protocol and have seen a dramatic decrease in emergency room crowding, a decrease in costs associated with overcrowding, and improved patient outcomes by reducing wait times.

Taking into account the threat of a surge of Californians with flu-like symptoms fearing the H1N1 virus, and the increased demand due to other healthcare cuts, AB 911 is a common-sense policy approach to improving California’s healthcare system. Especially in light of a recent Trust for America’s Health study, “H1N1 Challenges Ahead,” that states, ‘[an] estimated 68,025 people in California may need to be hospitalized as a result of H1N1. This would mean 125 percent of the state’s hospital beds would be filled at the height of the outbreak, exceeding the state’s available number of beds.’ Broken down even further it is likely that the majority of those cases will have to be admitted through the hospital’s emergency room doors, further impacting the overcrowding situation.

The California Chapter of the American College of Emergency Physicians (CAL/ACEP) sponsored the legislation. These are emergency room doctors like myself, who see first hand the effects overcrowding has on patient care. Hospitals that have implemented what we are proposing in AB 911 have seen a decrease in patients waiting in hallways, lower emergency room wait times, decreased patient length of stay once admitted to the hospital and increased patient satisfaction.

AB 911 has received bi-partisan support and offers the Governor an opportunity to sign a law that will improve California’s emergency preparedness and healthcare system.  AB 911 will simply result in good public policy and will ensure that emergency rooms that are on the front lines of any public health emergency to manage the flow of patients.  It is crucial to California’s efforts to relieve emergency room overcrowding and improve healthcare treatment in California.


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