Emergency care should use trauma as example

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Most U.S. hospital emergency rooms are ill-equipped to handle an epidemic, but better coordination and sharing specialist doctors could help mend the tattered system, experts said on Friday.

A model for emergency care for the 5,000 overwhelmed emergency rooms exists: the 1,000 designated U.S. trauma centers that meet guidelines for the number and types of surgeons present, equipment and training, doctors said.

Trauma centers, specialized units to handle the seriously injured, can coordinate care when an average of one ambulance per minute is sent away from one overtaxed hospital emergency room and diverted to another.

"It’s time we re-engineered the way hospitals work in this country,” said Brent Asplin, head of emergency medicine at Regions Hospital in St. Paul, Minnesota.

Doctors gathered to discuss a series of reports by the U.S. Institute of Medicine, an independent body that advises the federal government, whose major findings were: that ERs are understaffed, overwhelmed and not prepared for a crisis.

About 40 percent of all patients that come to a U.S. hospital enter through an emergency room. Visits to ERs rose to 114 million in 2003 from about 90 million a decade earlier, according to the institute. At the same time, hospitals are scaling back emergency departments.

About 1,000 hospitals around the country are designated by the American College of Surgeons as trauma centers, efficient at coordinating care and referring patients to the right hospital.

The 5,000 emergency rooms around the country need to coordinate care so patients do not wind up “boarded”—waiting in beds in hallways without a room, or diverted from the original hospital destination.

One idea is to have regional specialists on call to spread their expertise across a greater geographic area. Specialists like neurosurgeons are in short supply.

“Trauma systems save lives by regionalizing care,” said J. Wayne Meredith, chairman of general surgery at Wake Forest University School of Medicine. “We have to design the system so that patients have access to the right hospital.”

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