Tuesday, January 6, 2009

Tomorrow Never Knows

I came across an interesting commentary on ED overcrowding yesterday in the current issue of the journal Academic Emergency Medicine.   Rather than focusing on the danger to patients and pressure on staff, the authors consider a different angle that I hadn't considered - the effect on medical education.  As the article makes clear, harried emergency physicians dealing with hallways full of patients do not find themselves in an ideal environment for teaching: "As we spend more time discussing diversion with charge nurses, and less time teaching students and residents, we wonder if we are doing a disservice to the doctors (and patients) of tomorrow....Could I really teach the student the subtleties of the abdominal exam on that fully clothed patient in the hallway?"  

Of course multi-tasking and prioritizing in hectic situations are core skills of emergency medicine, and no one would argue that an ER will ever be free of distraction.  Part of the difficulty in studying this problem involves establishing metrics for overcrowding and education in the first place.  But what remains clear is that continuing to push emergency departments beyond capacity will produce negative outcomes not just in the short term for those patients stuck on stretchers or out in the waiting room, but far into the future as well.

-J Fischer et al., "Overcrowding: Harming the Patients of Tomorrow?" Academic Emergency Medicine, 16(1): 56-60, January 2009.

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