Patient Flow Enewsletter
Volume 1, Issue 1
Thursday, December 11, 2003

Perspectives
It’s Time to Share Tools to Mend the Safety Net

For many American communities, the local hospital emergency department has become the linchpin of the health care safety net. With a legal obligation to see all patients at all times, and with more and more people seeking its services, the ED may now be the most critical health care access point. The ED also reflects the overall capacity of a local health system. Recent surveys conducted by the federal government indicate that the ED is showing signs of strain in many localities across the nation - especially urban areas with a high number of uninsured patients.

This first newsletter is a project of Urgent Matters, an initiative to strengthen health care safety nets in our communities. Spearheaded by a team at The George Washington University, and supported by a grant from The Robert Wood Johnson Foundation, Urgent Matters has a three-pronged commitment: to provide valuable management tools for America's hospitals; to assess and highlight the state of the safety net in 10 communities; and to share our lessons with a national audience. This issue and future issues will feature successful strategies from participating hospitals, the state of the safety net in their communities, and those who are leading the way in promoting innovative approaches.

Why Now?

A Centers for Disease Control and Prevention study released in June of this year found that the yearly number of ED visits climbed 20% from 1992 to 2001, while the number of EDs actually declined 15%. A 2002 General Accounting Office survey showed that in fiscal year 2001, two out of three hospitals were forced to ask ambulances to divert patients to other hospitals. Given increasing numbers of uninsured Americans, increasing reliance of the insured on EDs, staffing shortages and the decrease in inpatient beds, none of this should be surprising. But, in an era when hospitals are being forced to do more with less funding, overwhelmed EDs and strained safety nets are a harbinger of declining quality and access to health care for all Americans.

Urgent Matters is designed to develop practical tools to help hospitals manage this rising tide. It also seeks to put this issue in a broader context by examining and raising awareness of conditions in a community's health care system that may serve as barriers to change. Clearly, many of the factors driving our overcrowded EDs are rooted in broader, social issues. However, our own experience in examining conditions in dozens of hospitals shows that hospitals can take tangible actions to help improve the delivery of care. Sharing tools, best practices, and innovations that will allow hospitals to maximize all of their resources are now essential, as there is no relief in sight from the crisis of the uninsured and the impact of state and federal cuts in funding.

Our program currently has three major components:

• A coast-to-coast hospital Learning Network, using quality improvement techniques to improve emergency department and hospital patient flow and health care outcomes;
• A series of special demonstration grants pioneering cutting-edge innovations in these areas;
• Safety Net Assessments in these hospitals' communities, seeking to educate key local leaders about the challenges faced by their local health care system.

Welcome to Urgent Matters, and thank you for joining us in working to strengthen the health care safety net for all Americans.

Fast Facts Insured Americans accounted for most of the 16% rise in emergency department visits between 1996-7 and 2000-1. Privately insured and Medicare beneficiaries accounted for about two-thirds of this rise, with privately insured people alone accounting for more than half of the total increase. Peter J. Cunningham, Jessica H. May,"Insured Americans Drive Surge in Emergency Department Visits", Issue Brief No. 70, Center for Studying Health System Change, October 2003.

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Bruce Siegel, MD, MPH
Director, Urgent Matters
Research Professor, The George Washington University
Washington, DC