Crisis for nation's EDs

The AMA recommends several strategies to tackle the emerging trauma services calamity.

Editorial. Jan. 15, 2007.

Emergency departments are in need of their own triaging and plan for recovery. There were 114 million visits to EDs in 2003, an 18% increase from 1995. The uninsured, Medicaid beneficiaries, patients needing primary care and those with serious mental illness account for the growing number of visits due to those patients' limited access to other physicians, according to published studies, including the 2006 Institute of Medicine report Hospital-Based Emergency Care.

The subtitle of that report?

"At the breaking point."

Chances are the subtitle wasn't a shock to physicians. Specialty societies with stakes in the ED have conducted a number of studies in recent years showing just that. In 2005, 73% of ED medical directors told the American College of Emergency Physicians that there was inadequate specialist on-call coverage. That's up from the 66% of ED medical directors who answered that way just a year earlier.

Surveys that the American College of Surgeons, American Assn. of Neurological Surgeons and American Society of Plastic Surgeons conducted in 2005 and 2006 found that a majority of surgeons take ED call five to 10 days a month, and many surgeons provide on-call services simultaneously at two or more hospitals.

The American Medical Association, at its Interim Meeting in November 2006, recommended several strategies to meet the problem head on. The strategies are a result of a work group that included the AMA and representatives from 10 specialty societies.