'a vicious cycle': study shows overburdened hospital er affects wider health-care system
in june, the alberta medical association said that a high volume of patients and depleted staff have led to "disastrous overcrowding" of emergency rooms in the province.
3 minute read
mohamad soltani, an assistant professor with the university of alberta's school of business, led a study that shows how an overburdened emergency room can affect the larger health-care system.
shaughn butts
/
postmedia
a hospital emergency room may be a port in a medical storm, but research shows it doesn’t exist in a vacuum, and when overburdened it can add strain to an already taxed health-care system
while spending several weeks observing a midwestern-u.s. emergency room in 2019, mohamad soltani, an assistant professor with the university of alberta’s school of business, led a study that found a five per cent increase in medical services for discharged er patients when the department’s workload increased. the research also drew upon four years of health-care system billing records.
both supply and demand problems (from an aging population to hospital staff shortages) can lead to an overextended er, and result in busier doctors who can’t spend as much time with patients, soltani told postmedia in a phone interview.
“to replace this direct time, they order more tests to make the diagnosis,” said soltani, who studies health-care operations. “when you order more tests, you eventually find something, and the patient needs follow-up care outside the er.”
unrelated conditions can bog the system
that’s not to say post-er care isn’t necessary, he warned. rather, tests and medical imaging in lieu of face time with a physician can bog down the system by flagging unrelated and benign conditions that are referred to specialists and family doctors for further investigation, he said.
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“if you find something, you need to co-ordinate follow-up care, and you need to recommend the patient do something about it,” soltani said.
on top of existing emergency room demands, family doctors who are stretched too thin, or simply seeking a quick turnaround time on unique diagnostic tests, are adding to the problem by referring patients to the er, he said.
“physicians are admitting more patients to the hospital, and the patients need more follow-up care, so they are coming back to the family physicians, specialists, and the emergency department itself,” soltani said. “this becomes a vicious cycle that goes on and on.”
in june, the alberta medical association said that a high volume of patients and depleted staff have led to “disastrous overcrowding” of emergency rooms in the province. at the time, alberta health services attributed the pressure to fallout from the covid-19 pandemic and seriously ill patients.
as of tuesday afternoon, the province’s health authority estimated er wait times to see a physician at more than two hours for the stollery children’s hospital and grey nuns community hospital. estimated wait times exceeded five hours for the royal alexandra hospital, misericordia community hospital and northeast community health centre, and more than six hours for the university of alberta hospital.
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soltani was careful to note that the study was conducted before the added pressure from covid-19, and hospitals across north america have been struggling with overcrowding well before the pandemic.
overcrowded ers in alberta
a 2020 study on emergency department volumes in alberta from 2010 to 2015 determined crowding in high-volume ers frequently exceeded national recommendations, “and urgent actions are required to avoid the adverse consequences that portend overcrowding.”
soltani said his study recommends hospital managers consider the larger health-care system when staffing ers, and that policymakers improve access to outpatient care, such as urgent care centres.
as for patients, he said, they should consider whether the er is the best place to address a medical concern, or whether an urgent care centre or waiting for an appointment with a family doctor will suffice.
“with such changes, you may improve your health outcome, as well as the pressure that you put on the whole healthcare system,” soltani said.
the academic journal manufacturing and service operations management published the study in may.
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