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12 August 2008

How Hospitals Are Killing ER Patients

In June, Esmin Green, a 49-year-old mother of six, tumbled off her chair and onto the floor of the Kings County psychiatric ER waiting room in New York City. She'd been waiting for a psychiatric-unit bed to open up for more than 24 hours. Members of the hospital staff saw her lying there but did nothing for about an hour.

When Green was finally brought into the ER, she was dead. An autopsy revealed that she died from a pulmonary embolism, a blot clot in the legs which traveled to her lungs.

Why was Green sitting and waiting for so long while blood pooled in her legs? Despite increasing evidence that crowded ER’s can be hazardous to your health, hospitals have incentives to keep their ER patients waiting. As a result, there has been an explosion in ER wait times over the past few years, even for those who are the sickest.

A major cause for ER crowding is the hospital practice of boarding inpatients in emergency departments. If there are no inpatient beds in the hospital then the patient stays in the ER long past the completion of the initial emergency work. The problem is that boarding shifts ER resources away from the new patients in the waiting room. A recent study found that critically ill patients who board for more than six hours in the ER are 4 percent more likely to die.

Why hospital would promote such a practice? Those that make money off of it. There are two competing sources for inpatient beds. The first source is patients who come in through direct and transfer admissions. They are more likely to come with private insurance and need procedural care, both of which maximize profits. The second source is ER patients, who are more likely to be uninsured or have low-paying Medicaid.


* Slate July 24, 2008

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