by Candice Owley

This winter, in cities across country, emergency rooms were so full that ambulance workers were routinely told to take patients across town to competitor facilities. The situation became so severe in some cities that local health officials went on television to urge physicians to keep their offices open later and to tell citizens to avoid using emergency rooms unless they were truly sick. National news programs ran special segments on the nationwide crisis, which was being blamed on the flu. The truth, however, was that a serious flu season exposed deep problems in the health care system created by years of cost cutting, hospital bed closures and an increasing number of uninsured.

In looking beyond the recent publicity about ambulances hunting for open emergency rooms, it is clear that the bed shortage problem has existed for quite some time in many cities and has been getting progressively worse. It was once a rare occurrence for a hospital to announce that it was closing its emergency room: a procedure known as "diverting." Diverting means a hospital will take only life-threatening emergencies and that all ambulance patients must be taken to other facilities. Today, in far too many cities, hospitals are diverting on a daily basis. The search for an open emergency room means that patients must travel farther and wait longer for care. In addition to diverting, many hospitals have begun to stack patients in already overcrowded emergency rooms while waiting for hospital beds to become available, creating unsafe situations for already overworked emergency room staff.

Today's crisis has been brought about for a number of reasons. First, in many cities hundreds of beds--in some cases many hospitals--have been closed over the last decade. As managed care began forcing patients out of the hospitals more quickly and reducing the total lengths of stay, hospitals began to cut back on beds. In some cities, it is evident that the rush to close hospitals and beds has gone too far.

A second factor contributing to the crisis is a lack of nurses. Again, in the move to cut costs, hospitals have created such bare bones staffing that any increase in patient admissions creates a crisis. The understaffing has also led to high workplace dissatisfaction, which is driving experienced nurses out of hospital service and creating a severe nursing shortage. Hospitals are now having to close whole nursing units because they do not have the nursing staff to provide even minimal, safe care.

Another major factor contributing to emergency room overcrowding is the ever increasing number of uninsured. In spite of our booming economy and low unemployment, the number of insured is at a record high of over 44 million Americans. The uninsured have little choice but to wait until their illness reaches the point where they must go to emergency rooms for care.

To the nation, it seemed as if the winter flu created a crisis in emergency care. To the frontline workers, the crisis was created by a system that for too long has focused more on cutting costs then on guaranteeing quality care. It is scary enough to be transported in an ambulance without wondering if a hospital will open its door and admit you for care. Let's hope the most recent crisis forces the system to make needed changes.