The World Health Organization has warned that swine flu may return "with a vengeance" in the months ahead. Already facing shortages of emergency physicians, will the Deep South's ERs be ready to treat a large influx of sick patients?

 

Not really, said hospital performance expert Ron Wince, president of Guidon Performance Solutions, who has worked with hospitals and healthcare organizations across the United States to help streamline patient response times. In the Deep South, they include Surgical Care Affiliates, a Birmingham, Ala.-based company with outpatient surgical centers located throughout the region.

 

"Many ERs are woefully ill-prepared to handle a crisis situation," he said. "The volume of emergency room visits each year is being driven by the lack of affordable access to primary healthcare. And while there's a new energy around healthcare reform and health insurance coverage, and healthcare reform talks are intriguing, it'll be some time before issues such as this are addressed."

 

In the interim, hospitals can adopt some best practices to better manage patient flow and unpredictable volume. If left untreated, surges in patient traffic can lead to the "bullwhip" effect.

 

"When they're overloaded, EDs become less efficient," explained Wince. "Then to accommodate for heavier traffic flow, hospitals tend to overcorrect, which creates the bullwhip effect."

 

To avoid those situations, Wince suggests using tools that were invented in industrial companies, but now have migrated to healthcare and other service companies.

 

"Tools such as Lean and Six Sigma can help provide solutions to dealing with increasing volume and declining resources," he said.

 

According to the most recently released National Hospital Ambulatory Medical Care Survey, 227 visits are made every minute to emergency departments nationwide. However, only 3.3 percent of active doctors are emergency physicians.

 

"Some of the most current trends showing promise are found in retail healthcare," noted Wince. "Minute Clinic, NextCare Urgent Care and other retail convenience care clinics provide nurse practitioners in place of physicians with great success. While the scope of services provided is more limited, we find that some of the higher volume medical conditions that are currently being treated in EDs can be treated in this way. Another concept from the Lean toolbox is to segment complexity. Leveraging nurse practitioners in a hospital setting but with a convenience care model can work for hospitals to offload the less demanding medical conditions."

 

Nationwide, emergency physicians are moving into retirement along with the rest of America's baby boomers, exacerbating the expected emergency physician shortage problem within the next decade.

 

"This trend is prevalent in all aspects of healthcare," Wince pointed out. "Just last month, I had the same discussion with several leaders from the microbiology laboratory space and one of their primary concerns is access to qualified lab technicians and microbiologists. Microbiology is on the front lines of dealing with issues like H1N1 and HIV diagnosis. We can hardly allow the capabilities around the ability to rapidly diagnose these conditions to deteriorate. The solution in that industry is focused on innovation, efficiency and doing more with the same or fewer resources. The same will need to take place in emergency medicine."

 

The 2009 National Report Card on the State of Emergency Care, prepared by the American College of Emergency Physicians, gave the United States a C-, with individual state grades ranging from the highest, a B in Massachusetts, to the lowest, a D- in Arkansas. Even though the grade of C- is the same as that reported in the 2006 report card, the two editions are significantly different and not directly comparable.