Emergency rooms are not okay

The title should be changed. This has nothing to do with ER capacity (or the pandemic, for those commenters already leaping to that conclusion), and the author admits 3/4ths of the way down the article that ER capacity is not the problem:

> The primary problem is not the number of patients coming to the ER. It’s the lack of open beds upstairs.

She goes on to explain that most of the problem is that hospitals keep their beds full so as to maximize profits, with a variety of reasons ranging from nursing home shortages to hospitals' tendency to prioritize elective surgeries (these make more money).

In fact, this entire article is very bad. The author asserts a problem, but provides no actual data to support the assertion, other than linking to some tweets of other people's opinions (edit: I shouldn't have said tweets; these are mostly links to pop journalism and editorials). Here's a paper quantifying the boarding problem in hospitals in the US, during the worst part of the pandemic:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9526134/

to wit:

> Occupancy rates and boarding time had a threshold association: when occupancy exceeded 85%, boarding exceeded The Joint Commission 4-hour standard for 88.9% of hospital-months (Figure 1). In those hospital-months, median ED boarding time was 6.58 hours compared with 2.42 hours in other hospital-months (P < .001). Across all hospitals, the median ED boarding time was 2.00 hours (5th-95th percentile, 0.93-7.88 hours) in January 2020, 1.58 hours (5th-95th percentile, 0.90-3.51 hours) in April 2020, and 3.42 hours in December 2021 (5th-95th percentile, 1.27-9.14 hours).

It's also that so many people who go to the ER don't really have an emergency. Sometimes these are people who just don't want until the next day (or week) to see their regular doctor. Sometimes they are people who have nowhere else to go, and they know the ER can't turn them away.

I avoid the ER unless I think I am putting my life at risk by not going. I cut my finger open earlier this year, it probably could have used stitches but I was not going to subject myself to the ER experience for that. I taped it up, kept it clean, and it healed. There's a scar, but I'm not a hand model.

It is unprofitable to provide "perfect service", because in order to provide perfect service you need people on hand that aren't doing anything that can spring into action during surge events.

Someone's going to stand around when there's an imbalance between demand and labor supply. At our local grocery store, they overhire high school kids to stand around waiting to check people out. I've never waited in line for more than 3 minutes there. If they cut costs by firing the extra labor, I'd have to stand around and wait for the "optimized" labor force to attend to me.

I’m surprised to see no mention of Certificates of Need: https://en.wikipedia.org/wiki/Certificate_of_need. In most of the US hospitals need to have a license for their number of beds, the idea being that regulators don’t want there to be too many beds because hospitals tend to find ways to fill them unnecessarily. I’m not familiar with the literature about how good of an argument that is. Intuitively you can see how that could be an impediment when there is a greater need for hospital beds.

Hospitals need to be BIG. Basic logic does something like “population * sickness-rate = mean required beds for hospital budget”, but this is logical for lossy services, not mandatory ones.

Not to get political, but when a service goes from being a luxury to being considered a human right, our tolerance for failure changes immediately. Anyone who works in reliability knows that the budget for “will never fail” is exponentially higher than “almost never fails”.

As we transmute more services to “fundamental right”, we need to expect costs to grow non-linearly, regardless of who is paying. None of this is a bad thing, we just need to be building freakin’ massive hospital buildings!

How is discouraging people who don't actually need an ER from showing up at an ER a bad idea? If I have something urgent but not an emergency, I could either do ER or Urgent Care. If I'm pretty confident Urgent Care can handle it, it might make more sense to do 1-2h to go to an urgent care option vs. 10 minutes to ER and 4h wait (for care which exposes me to lots of other risks).

There are a bunch of things where I'd rather wait 8-24h at home, even in pain, than go to an overloaded emergency room.

> Prioritizing elective surgeries. Elective surgeries bring in more money, so sometimes hospitals prioritize beds for surgeries instead of sick patients waiting in the ER.

Why aren't there facilities out there that just specialize in the elective surgeries and don't have ERs and other things that are money-losers?

Seems like you could provide all the money-making services without the money-losing ones.

They will not fix this. Indeed, regulation is required, but meaningful change requires a functioning, coherent government with institutions that are not fully enclosed in regulatory capture.

The United States is falling apart, and it is no longer capable of solving its own problems. Now, inertia keeps legacy systems functioning, until fascism and/or balkanization a-la USSR takes over.

Survey is no longer available

> The emergency room (ER) is the front door of the hospital. Patients come and are quickly seen by a physician, who addresses medical emergencies and other needs.

There it is. The ER, even with its shortcomings, is a better user experience. You have a medical concern, and you get it addressed in a reasonable time— not the weeks or months you need to wait for your primary care or a specialist to be bothered to see you.

It’s safe to stop reading any article at the point they say something like this:

> Year 4 of a pandemic