Hurry up and wait


A trip to the emergency room these days is not for the impatient. The ambulance may move swiftly, but once at the hospital door, there's no guarantee of a speedy reception unless death is imminent. For ailments unpleasant, alarming or not at all clear, response time is negotiable. It can stretch from hours to days. Many arrivals spend a great deal of time in idling ambulances.

Here's the truth you won't see on television dramas: Emergency rooms are being asked to do too much for too many with too little. What's more, as the population of uninsured Americans grows, emergency rooms are also coping with many patients who don't belong there but have no place else to go.

This is a national problem, described in a recent report by the National Institute of Medicine as an emergency care system at the breaking point. Contributing factors vary from community to community.

In Baltimore, though, where emergency room traffic is particularly high, back-ups could clearly be reduced if non-emergency patients - with or without insurance - turned more frequently to walk-in health clinics. Such clinics should be made easily accessible around the clock - not only to relieve the burden on emergency rooms but also to provide the preventive care that might forestall emergencies.

There are 33 public health clinics in Baltimore, and a total of 72 in Maryland. But they, too, have been overwhelmed by client increases in recent years. Their funding, much of it federal grants, has remained flat.

Other states have designated funds to reimburse clinics for services to low-income uninsured patients. In Maryland, only hospitals are compensated for treating the uninsured - another attraction of emergency rooms.

Many steps can be taken to reduce emergency room traffic, such as improving the efficiency of emergency transport and speeding the flow of patients through the screening process. Ultimately, hospital space may have to be expanded.

Before costly new facilities are built, though, Maryland's political and medical leaders must ensure that public health clinics are adequately funded so patients with minor ailments won't have to turn to emergency rooms as the only place that will - however belatedly - take them in.

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