Balancing public demand for high-quality, low-cost health care in the ED

Not a day goes by when emergency medicine is not in the news and not necessarily in a positive way. The mantra that the emergency department is expensive and, in fact, the “wrong” place to obtain care seldom gets challenged on the evening news and seemingly rarely by health care policy wonks.

Much of the care can be provided in a less-expensive setting. If only people would go somewhere, anywhere else for their care—primary care physician offices, urgent care centers, free clinics, after-hours clinics, clinics run by private enterprises, Walmart, Revco, settings staffed by physician extenders, shamans, telemedicine from third-world countries—all of society’s financial ills would be cured. Budgets could be balanced; taxes could be lowered; health care reform could proceed in a fair, impartial way without impacting negatively on any other aspect of our otherwise efficient and streamlined health care system. Our infrastructure could be rebuilt, the Cleveland Browns would win the Super Bowl, and Elvis would reappear.

Then I pass billboard signs on the interstate and elsewhere: “Come to St. Elsewhere right now. The wait to be seen in our emergency department is currently nine minutes.” Say what? Many people would be thrilled to be seen by their doctor within nine minutes of a scheduled office visit. I don’t see signs on the highway advertising that the wait to be seen by a teller at the local bank is nine minutes, nor for that matter at any fast food restaurant, supermarket checkout line, hairstylist, or muffler shop. Why us, especially when the cure for all of our health care system’s ills lies in keeping nonurgent visits out of our EDs?

By the way, there is no mention of board certification, skill set, or knowledge base on these billboards. Did the providers who will see you within nine minutes score over 90 percent on their boards? There is no mention of clinical acumen, only of time. We may or may not want filet mignon, but we definitely want Burger King speed.

There is no doubt that people who are having an ST elevation myocardial infarction should be evaluated quickly—in the single digits of minutes—and certainly for a 12-lead ECG. Many are on board with rapid evaluation for suspected strokes. No hospital in the country is going to have a patient who has just been shot in the chest or a child who was run over by a neighbor’s SUV wait around for more than 10 minutes to be seen by a provider. In fact, no matter how busy an ED is, that cyanotic, apneic patient getting wheeled down the hall gets seen rapidly.