Emergency department visit. Stay at hospital or go home? 4

Emergency medicine. Stay at the hospital or go home? This is a key decision that emergency medicine physician has to make for each patient. What are decision rules to admit patients to the hospital or send a patient home? What are challenges facing Emergency Departments on better treatment of patients? How to deal with boarding and overcrowding in Emergency Department? Which patients should stay and which patients should go home?

Emergency medicine. Stay at hospital or go home. Video interview with top expert in Emergency Medicine. Significant problem in the US Emergency Medical services is overcrowding and boarding. Patients who are admitted to hospital cannot go to their service because there are not enough beds. Hospitals are trying to cope by faster inpatient discharges. Medical second opinion helps to make sure preliminary diagnosis is correct. Medical second opinion also helps to choose the best treatment for your medical condition before it becomes an emergency. Seek medical second opinion on your medical problem to avoid visit to Emergency Room later. There is a federal law in the US. It is called “EMTALA”. It says that Emergency Departments must accept all patients who seek medical care. This is great for access to medical care but it leads to Emergency Department overcrowding. Emergency medicine: stay at hospital or go home. Dr. Anton Titov, MD. Sometimes a patient is admitted to the Emergency Medicine department, emergency medicine physician evaluates the patient and orders medical tests. What are important factors to decide whether the patient should go home or get admitted to the hospital? What are the challenges that Emergency Medicine system in the US faces? Dr. Sam Shen, MD. Director of Emergency Medicine, Stanford University. To decide if the patient can go home or needs further care in the hospital is important decision. The main reason for patient to stay in the hospital is requirement for 24-hour monitoring. Patients should stay in the hospital if they require particular service that cannot be provided at home. Or if the patient is just too sick to be cared for at home. Or if the patient is not able to independently care for themselves at home. Or if the patient does not have the appropriate patients around them to assist. Emergency Medicine physician makes a decision to admit patient to the hospital. Then emergency medicine physician talks to the hospital specialty service that is going to admit the patient. For example, Medicine, Orthopedic surgery or Neurosurgery. Sometimes patient is accepted to the hospital by appropriate service. Then patient will stay for 2, 3, or 4 days typically. Emergency Medicine departments have two main challenges in recent years. One challenge is overcrowding. Another challenge is called “boarding”. In the last 20 or 30 years the number of hospitals has decreased. Fewer hospitals means fewer Emergency Medicine departments. There is more and more patients who try to get treatment at fewer and fewer Emergency Departments. You have a situation when growing population tries to get medical service at fewer Emergency Departments. Hospitals and Emergency Departments are working at maximum capacity levels. It is not uncommon to see sometimes patients in the hallways. More and more patients are in the medical system, so it creates congestion. The patient could already be admitted to the hospital. But the patient cannot go upstairs to their inpatient bed because there are too many patients in the hospital. the patient has to “board” in the Emergency Department. This situation (“boarding”) is a challenge nationally. Many hospitals are trying to solve strategically the problem of congestion, “patient boarding”. We understand that if patients are staying too long in the emergency department while waiting for their bed upstairs, the rates of complications rise. We made the decision to admit the patient to the hospital. The next the goal of Emergency Department physician is to facilitate the process of getting the patient upstairs as soon as possible. that appropriate specialty medical service cares for medical problem of the patient. Dr. Anton Titov, MD. This challenge of congestion and boarding in the Emergency Medicine department is explained partially by the way medical care functions in the United States. Unfortunately a lot of patients in the US do not have health insurance. People without health insurance have only one option to access medical care. It is done through the Emergency Medicine department of a hospital. They use Emergency Medicine physicians as primary care doctors. Dr. Sam Shen, MD. There is a federal law in the United States called “EMTALA”. This law demands that if Emergency Medicine departments receive money from the government, Emergency Departments must accept all patients who seek medical care. All Emergency Departments have to provide a medical screening examination to everyone who seeks medical care. This is a great thing for the population in the US. It allows everyone to have access to a physician when they want or need to see a doctor. Sometimes you walk into Emergency Department you will be seen by a licensed medical practitioner. Doctor will evaluate you for a life-threatening emergency. The positive side of this is good access to modern medicine for patients without regard of their financial situation. The downside of that situation is that EMTALA law requires hospitals to dedicate resources to see everyone who walks into Emergency Department. This results in overcrowded Emergency Departments. As you stated, there are a lot of factors that influence overcrowding of Emergency Departments. Lack of good access to appropriate primary care doctors is one of such reasons. Health insurance coverage and ability to access other types of medical care are also important reasons for overcrowding of Emergency Departments. It is a very complicated situations with many factors that influence it. We certainly see the impact of these challenges when we provide medical care to a lot of patients. we have a limited capacity to provide medical care to them. Emergency medicine. Stay at hospital or go home? Video interview with top expert in Emergency Medicine. 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