Nation’s Emergency Care System in Crisis

The nation’s emergency medical system is overburdened, underfunded and highly fragmented, according to a recent report by the Institute of Medicine, an arm of the National Academies, which provides research-based advice on science and health matters to policymakers and others.

The report notes that a lack of funds and an increase in uncompensated care have sapped the capacity of the emergency system. As a result, ambulances are turned away from emergency departments once every minute on average; patients must wait for hours or even days for hospital beds; and the system is ill-prepared to handle disasters such as hurricanes, bombings or disease outbreaks.

The IOM report calls on Congress to allocate funds to ensure that emergency departments, trauma centers and medical first-responders are fully equipped and ready to provide necessary care. The report also calls on federal agencies to assess emergency and trauma workforce capacity as well as trends and future needs in order to develop strategies to meet those needs. In addition, the report calls for actions to reduce emergency room crowding and to boost the number of emergency care specialists.

Hospitals Taking Steps to Reduce Lab Errors

Some of the most devastating medical mistakes can start in the lab, reports the Wall Street Journal. A June 14 article points out that 3 percent to 5 percent of specimens taken each year are defective.

In an effort to bring more rigorous standards to pathology labs, hospitals and health-quality groups are working together to redesign “error-prone” systems for collecting, labeling, handling and interpreting blood and tissue samples. Not only is patient safety at stake, the article says, but so is preventing the huge costs of mistakes and delays.

Quality control methods such as checklists and automated specimen processing have been successful, the article notes. One of the most persistent problems is the poor quality of specimens to begin with. Many, but not all, mistakes are caught by nurses, doctors and others in time to avoid patient harm.

Needle-Stick Injuries Still a Concern for Healthcare Workers

Nurses overwhelmingly say there is room for improvement when it comes to the current design of safety syringes. In fact, a nationwide survey of nurses conducted in May 2006 found that 64 percent of  nurses have been accidentally stuck by a needle while working and 47 percent of nurses have been stuck by a contaminated needle. Safety syringes with retrofitted designs, which account for 95 percent of the market, are not the most effective design to protect clinicians, say nurses.

Nurses believe that needle-stick incidents often go unreported, either because clinicians are too busy to report them, because follow-up time takes too long, or because clinicians may be afraid of the workplace consequences of reporting needle sticks. 

Short-Term Steps Ease Nursing Shortage, But Worries Persist

When it comes to the nursing shortage, short-term measures such as higher pay and temporary staff have helped to ease the problem. But a study by the Center for Studying Health System Change reveals serious doubts about the ability of healthcare facilities to meet future nursing needs.

Hospitals are pursuing longer-term strategies to address the shortage, including investing in nurse education and improving working conditions. The lack of nursing-school capacity, however, is a serious barrier to meeting nursing needs, the study points out.

“Higher pay and increased use of temporary nurses have helped nurses in the short run, but these are high-cost, stopgap solutions, and many hospitals believe longer-term strategies in nurse education will provide greater return on the investment,” says Jessica May, health researcher and lead author on the study.

The study, “Hospitals’ Responses to Nurse Staffing Shortages,” is based on site visits to 12 nationally representative communities over the past 10 years. It appears on the Web site of the Health Affairs journal, www.healthaffairs.org.