Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The U. S. health care system continues to rely on a diverse and poorly organized health care safety net to provide care for its uninsured and underinsured residents. ⋯ This paper reviews the findings of the IOM report, highlighting the key issues for emergency medicine. In response to the IOM's challenges, emergency departments should be used more effectively to monitor local safety net viability and to enhance the integration of community health care safety net delivery systems.
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Comparative Study
Rochester, New York: a decade of emergency department overcrowding.
Overcrowding is common in emergency departments (EDs) throughout the United States. The history of ED overcrowding in Rochester, New York, is notable due to its unique health care system that introduced the concepts of managed care as early as the 1950s. An effect of this system was to intentionally restrict resources and allow the issue of access to limit utilization. Overcrowding in EDs was severe in the late 1990s-2000, and became an accepted local standard of care. ⋯ Emergency department overcrowding is the end result of a variety of factors that must be addressed system-wide.
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To assess the impact on the emergency department (ED) of recently discharged inpatients and how they contribute to and worsen the current situation of ED overcrowding. ⋯ The ED is appropriately utilized as a safety net for discharged inpatients. Though "returns" are a small percentage of ED patients, they have longer LOSs, have higher ED charges, and are more frequently admitted. Returns increase the strain on an already overcrowded ED.
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Comparative Study
Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years.
Hospital restructuring often results in fewer inpatient beds, increased ambulatory services, and closures of hospitals or emergency departments (EDs). The authors sought to determine the impact of systematic hospital restructuring on ED overcrowding. ⋯ Hospital restructuring was associated with increased ED overcrowding, even after controlling for utilization and patient demographics. Restructuring should proceed slowly to allow time for monitoring of its effects and modification of the process, because the impact of incremental reductions in hospital resources may be magnified as maximum operating capacity is approached.
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Comparative Study
Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion.
To determine the impact of an inpatient, emergency department (ED)-managed acute care unit (ACU) on ED overcrowding and use of ambulance diversion. ⋯ An ED-managed ACU can have significant impact on ED overcrowding and ambulance diversion, and it need not be located proximate to the ED.