ER docs: Problem is admitted "boarders." Leavitt: That’s local.

Looks like I missed it by skipping the ACEP Fall meeting:

NEW ORLEANS – U.S. Health Secretary Michael Leavitt and emergency room doctors disagree about why the nation’s emergency rooms are overcrowded.

Many ER doctors say inpatient overcrowding – patients admitted after emergency treatment but parked in their department until rooms open up – is the major cause, and a national priority.

But Leavitt, who spoke at the American College of Emergency Physicians meeting Monday, said he believes the overcrowding is, rather, a matter of local hospital capacity and patients using the ER instead of a doctor’s office. “Emergency rooms ought to be kept for emergencies,” he said.

Inpatient overcrowding, he said, is a problem to be dealt with at the local level.

But doctors say the problem is that ER patients can’t be sent elsewhere in hospitals, causing an ER stackup that leads to inefficiencies and delays in treatment.

But Leavitt said the problem appeared spotty. “There are areas of the country with insufficient capacity. But in some areas they’re overbuilt,” Leavitt said.

This position met with disagreement:

Dr. Ramon W. Johnson, a ACEP board member from Mission Viejo, Calif., said Leavitt “dodged the question. He tried to make it seem a local issue. It clearly is a national problem.”

Dr. Todd B. Taylor, ACEP’s equivalent of speaker of the House, added, “Anybody who believes that inpatient crowding is not the problem with emergency departments just is not looking at the information.”

All emphasis added.

Yes, ER’s should be kept for emergencies.  This has been flogged to death here, but: as long as the individual patient decides what’s an emergency and what isn’t (until the end of an apparently undefinable Medical Screening Examination), the ED’s will be crammed to capacity.  More primary care offices (9-4:15 M-F, 1/2 day W or Th) aren’t going to do a heck of a lot to empty the ED.


Oh, and I want the data on those ‘overbuilt’ areas.


  1. The WSJ covered this topic in a similar manner yesterday. My favorite part was the NY ED that sends flowers to patients who had to “board” in the hallways…lol.

  2. Has Leavitt actually ever seen the inside of a hospital?

  3. Certainly not an ED.

  4. Maybe the city goverment should give a tax break to a CareNow (or another 24 hour doctor’s office) to be built by the ER. Then they would have no excuse for not having a place to go…..

  5. The ER’s are sending the message as loudly as possible that we are radically overloaded but no wants to listen. That is until the get hurt and spend a day and a half in the ED. Then somehow it becomes my fault