State Orders Crackdown On Emergency Room Crowding

It revealed that many patients wait upwards to 28 hours in the ER before a bed opens up. The article cites Dr. Joel Cohen of Bayside, author of a new book, "Enter at Your Own Risk: Dangers inside Your Emergency Room."
Cohen said the ER crisis has been worsened by the introduction of managed care, a shortage of doctors, and nurses, overcrowding and severe financial restraints on hospitals.
"This results in tough going for patients who urgently need medical care," he said.
On Monday, DOH released a three-point policy to extricate patients from crowded emergency rooms into inpatient beds more quickly and end diversion of ambulances to other hospitals.
It urged hospital administrators to:
.Use all available inpatient beds to move patients out of the emergency department.
.Designate an individual to monitor that all available beds are made available for admissions from the emergency department.
.Assure that ancillary services are available to the emergency department.
To assist hospitals, the DOH said it is prepared to grant emergency approval to increase bed capacity, as long as there is sufficient staffing available. It warned, however, that the Department will continue to monitor emergency departments to identify and target problem areas.
In another enforcement action, DOH said it will activate a "best practices" work group to examine additional strategies for addressing overcrowding issues.
"Emergency department overcrowding is emerging as a national and statewide health issue that requires our full attention," Novello said. "In continuing both short-term and long-term solutions to this issue, we will continue to work with hospitals and Emergency Medical Service (EMS) providers to address emergency department volume and diversion practices."
Dr. Thomas Kwiatkowski, Chair of the Long Island Jewish North Shore Health System, said that much of the overcrowding problem is due to managed care. He said it has "exacerbated reimbursement problems" and led to bed shortages and hampered the ability of hospitals to hire needed staff.
Kwiatkowski disputed DOH offers to provide additional beds "because we cant afford the new staffing it requires."
At Long Island Jewish, which has one of the areas largest emergency rooms, patients can wait several hours before a bed opens up.
"We have added 17 beds recently and 14 more are on the way," Kwiatkowski said. "We planned the new beds because we knew the flu season was upon us."
He said the new beds would reduce the number of ambulance diversions to other hospitals.
"Emergency room overcrowding has been a longtime fixture in New York City and is cyclical in nature."