It’s hard to believe that in New York City, which boasts some of the nation’s best hospitals, wait times in some city hospital emergency rooms can go beyond 24 hours. This has disastrous implications on the quality of patient care as well as illness prognosis. In some cases, patients have been found deceased in the emergency waiting room long periods without medical attention. At some hospitals across the city, like Kings County and New York Presbyterian-Columbia Medical Center, patients wait on average more than 12 hours to be admitted to the hospital upon initial assessment. This has become a widespread pattern across city hospitals due to overcrowding which is caused by staff shortages, high patient volumes, and lack of bed availability.
An important facet of this problem is the relationship between hospital overcrowding and demographic composition of the patients who visit the hospitals. For example, at Lenox Hill Hospital on the Upper East Side, one of the country’s most affluent neighborhoods, the average wait time to be seen by a doctor is 18 minutes, whereas the Harlem Hospital Center, which is located in one of the poorest neighborhoods, has a wait time of nearly an hour and a half. Although there are myriad reasons for this disparity, one is that the patients in poorer neighborhoods are more likely to visit the emergency room for non-urgent problems due to lack of access to primary or outpatient care, which contributes to hospital congestion.
Emergency room overcrowding is expected to worsen as millions of individuals gain health coverage through the Affordable Care Act (also known as “Obamacare”) and are more easily able to visit the hospital, even for non-urgent medical problems. A recent study conducted by the American College of Emergency Physicians (ACEP) reported that nearly half of physicians witnessed a rise in ER visits in the first few months of the ACA rollout and 86 percent expect the trend to continue in the next three years. Enacted in 2010, ACA can cover up to 40 million Americans—an additional burden on the already strained health care system. This is further compounded by the chronic primary care physician shortage in the United States. In fact, it is estimated that there will be a shortage of around 52,000 primary care physicians by 2025—just ten years away.
There is no easy fix for hospital overcrowding as it would be difficult and wholly unrealistic to drastically expand hospital facilities, or train and hire thousands of new doctors in a matter of months or even years. Yet it is clear that without a viable plan, hospital overcrowding will begin to seriously compromise patient care quality and impose an economic toll on the community as it often bears the costs of uncompensated care from emergency room visits. Possible approaches for tackling the issue of overcrowding are expansion of outpatient care centers in areas of high patient volume, and community based health programs where hospitals employ outside health social workers who help patients navigate the healthcare system while avoiding trips to the emergency room for non-urgent reasons. Such “care coordination” programs have already been implemented in other cities and have been highly successful in Oregon where one hospital was able to reduce its ED visits by 49% over the course of a year. Surely, there is no one-size-fits-all plan especially considering the heterogeneity of New York City communities; however, it is clear that the current state of medical treatment in emergency rooms is headed down a dangerous road. With many city hospital emergency rooms struggling to provide adequate care, it may be wise to consider how community-based health services and facilities may help mitigate the problem and ultimately improve the quality of life of New Yorkers.
This post was written by a student enrolled in the Capstone Seminar course in the undergraduate program in public policy at Hunter College. Any opinions expressed here are solely those of the student.
