South Florida Hospital News
Sunday September 22, 2019
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June 2008 - Volume 4 - Issue 12

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Challenges Facing South Florida Emergency Departments

Issues

Emergency departments in South Florida hospitals are faced with several issues on a daily basis. The decline in patient volumes is a reflection of poor primary care access and increasing numbers of uninsured clients, resulting in fierce competition among healthcare providers. The recent national economic decline has resulted in patients' presenting to the emergency department with a higher acuity caused by delay in seeking treatment.

Only recently, the Florida Senate announced a rate cut in its Medicaid budget, impacting the revenue of local hospitals for the sum of seven million dollars ( Sentinel May 4, 2008). Since hurricanes Katrina and Wilma, home insurance rates and declining property values have resulted in the migration of South Floridians to more northern counties, adding to the decrease in emergency departmentís visits. Hospitals are forced to compete for patient volume by providing hotel-like services such as private rooms with plasma TVís, wireless internet access, in-room refrigerators, meals on call prepared by chefs, concierge services, valet parking and so on.

Recruitment and retention of well trained personnel is critical if EDís are to provide quality patient care, safely and efficiently. Nurses are in high demand , and prospective hires are demanding more in the way of pay and benefits than ever before.

Fewer physicians in specialties such as burns, hand surgery, plastic surgery, neurology and maxillo-facial surgery are willing to take call in ED's, partly due to increasing liability exposure and poor reimbursements . Delays in ED service can sometimes be attributed to physicians trying to cover multiple hospitals, decreasing quality and efficiency of care offered to the individual. This trend has resulted in EMS diversions of these patients to hospitals where such services are readily available.

Solutions

Emergency departments need to sell there services to the general public by focusing on best practices, patient outcomes and customer service.

To be sure, the cost associated for preparing staff to face the challenges is high. However, this is not the only solution to staffing Emergency Departments, as other factors affecting retention of Ed staff can be equally important. Competitive remuneration, resources available to deliver care, educational packages, promotional opportunities, flexible work hours, availability of childcare and exercise facilities are some tools being used to attract new staff and retain the experienced, loyal staff.

How do we attract specialist services to emergency departments and provide adequate coverage? The senate is considering a reduction in liability of the physician through rehabilitation of malpractice risk management. Implementing a countrywide ED call schedule and further regionalizing this for some specialties is a suggestion of the FHA. Increasing physician coverage in the department during peak periods is advantageous. Another suggestion is to create an emergency department management group.

Initiatives to improve services include decreasing waiting room times, increasing throughput, implementing rapid discharge areas, reduction in holding and boarding, offloading of EMS in a timely manner, and collaborating with the community to identify needs and how best to service those needs.

Finally, hospitals and emergency departments need to work together with the community to build partnerships in providing quality service and care to the consumer. Through the identification of expectations and resources, bridges may be built and boundaries narrowed to help all parties be successful in meeting community needs and keeping hospitals themselves healthy.

Lisa Vieira, ED Director, Westside Regional Medical Center, can be reached at (954) 577-2433.
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