Emergency Room Overload !

Visit the emergency room in any public hospital and you will most likely find a room full of people awaiting treatment.  Shortly after arrival you will be interviewed by a triage nurse and the severity of your condition will determine what happens next.  Should you have extreme bleeding or be suffering chest pains you will probably be put on a gurney and immediately taken for treatment.  Life threatening symptoms go to the head of the queue - and severity tapers downward from there.

That is exactly the way an emergency room is supposed to work, and yet we have overload because a lot of people choose to use this facility for injuries that could be treated by their general practitioner or by the local chemist.   Numerous surveys have examined ways to reduce the load, but in the end this overuse of emergency rooms comes back to a single factor.   This is a free service - and that is the prime motivation for most people.

It is estimated that non urgent use of emergency rooms involves about 300,000 visits a year in Australia and this costs the government at least a billion dollars.   At one stage there was a plan to create medical clinics near hospitals which offered bulk billing and operated 24/7.  Some of these were actually built, but very little changed in the volume of patients visiting the local ER for treatment.

The sticking point is the cost factor.   If a patient is directed to a GP - and even if that GP bulk bills - the most likely outcome is that a script gets written and the patient takes that to a chemist and has it filled - and there is a cost involved.   If that same patient endures a long wait at the ER and is finally treated, the medication needed comes from the hospital pharmacy - and is free !

We are faced with a dilemma.   In some countries the medical system depends entirely on the patient being able to pay the bill.   If the patient has no money - then no treatment is provided and in extreme cases this is a death sentence.   In Australia, our public hospitals are a public service - and nobody is turned away for lack of money.  The vast majority of Australians would be loath to see that abandoned.

In most respects, our present system is still the best option available.  The facilities exist at hospitals to treat  emergencies and these are the focal point of the ambulance service. Priority of treatment is determined on a triage basis, leaving those with minor presentations at the end of a very long queue.  They have the option of continuing that wait - or leaving and seeking other treatment for their ailment.

Probably the best answer to ER overload would be a digital notice board offering an estimated wait for service for those about to present to the triage nurse.   Faced with reality, many will re-evaluate whether they are prepared to undertake this amount of waiting time and many will make other arrangements.

It seems that most past efforts have been attempts to fix the unfixable !    Emergency rooms are for emergencies but we preserve the right of citizens to access free treatment - provided they are prepared to wait in direct relation to the severity of their problem.   Imposing a fee for service may shorten the queue, but it will be at the expense of denying treatment to the destitute - and that would be considered un-Australian.

It seems to be a case of enhancing that old adage:   " If it 'aint broke - don't fix it ".    The ER system is doing just fine in treating genuine emergencies.  It just needs a more efficient filter to stem the patient flow !