My Field Trip to the Emergency Room

One week ago this morning, I was on my way to the Emergency Department at a local Maryland hospital—thankfully not in the back of an ambulance and fortunately with insurance card in hand.  This was not a matter of life and death, but the ED was the correct choice and during my week-long “sabbatical” from the office, my thoughts kept returning to an article I had read sometime ago in The New York Times.

The article centered on improvements—both substantive and cosmetic—to New York City Emergency Departments.  Want a “fast-track” to separate the ill from the really, really ill?—that’ll be north of $7.5 million.  Want more space, more doctors, more beds?—at one hospital that tab approached $15 million.  New York, like many big cities around the country, knows something about pandemonium and the ED.  According to The Times, NYC EDs saw 3.6 million patients in 2005, up six percent since 2000.  The list of drivers for the increase is commonplace: rising uninsured and immigrant populations, closures and consolidations at other hospitals’ EDs, and public funding shortfalls.  These and other ED plights are perfunctorily laid out in the text of the article.

But what nagged me last week about the article wasn’t the litany of challenges facing EDs—it was the nature of several solutions noted in the text.

According to Dr. Peter Semczuk, vice president for clinical services at Montefiore Medical Center, “We want to become the Ritz-Carlton of emergency rooms.”  At Montefiore that means graham cracker snacks and on-call art therapists for children.  At Lennox Hill hospital, “putting yourself in the patient’s shoes” means individual flat screen televisions and personal telephones in the ED.

Was my medication clouding my perspective, or was something amiss here?  EDs play a complex role in a hospital’s financial machinery, often serving as sites of both profit (insured patients who are ultimately admitted to the hospital) and loss (the uninsured).

But as I reflected on my own ED experience last week, I couldn’t help but think that renovation is one thing, utter reinvention (Yes, sir; we at General Hospital realize you are having a heart attack, but we wanted to remind you of the complimentary cocktails and snacks in the ED lobby at 6PM… and provided you live that long, a full line up of just-released movies will begin showing on that plasma screen above your head at 9PM.) is quite another.

While touches of luxury may entice some paying (insured) patients to choose one ED over another (at some hospitals in some cities), I couldn’t help but recall what I saw in the waiting room at my local ED: people coughing, people resting their heads in their hands, more coughing, people in a hurry, one woman—literally—writhing in pain on the floor.  And me: also feeling a sense of urgency, also in pain.

Should I seek comfort in the prospect of a mint-topped pillow deep in the bowels of the ED?  Is that a crash cart I see before me?  Why no—it’s a mini bar.  Perhaps I should stop typing “ED,” so that Emergency Department is not mistaken for Entertainment Division.