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Author List:
Greiner GT (VA Puget Sound HCS)
Jesse R (Richmond VAMC)
Sales AE (VA Puget Sound HCS)
Objectives:
To assess the current state of emergency medicine across acute care medical facilities within Veterans Health Administration.
Methods:
All 135 VHA medical centers providing inpatient acute medical care completed a web-based survey in January 2004. The survey inventoried the structure, personnel resources, and functional capabilities of emergency services available in each center.
Results:
Among the 135 responding facilities, 131(97%) provide emergency services 24 hours, seven days a week, and report a mean FY03 visit volume of 12,997 (range 145-53,433). Most VHA medical centers, 112 (83%), report having an emergency room or department, while 18 (13%) report having an urgent care unit or triage. Naming convention varies from Emergency Room (43%), Urgent care (23%) and Emergency Department (14%) to Life Support Unit (5%) and Acute Evaluation Unit (6%). VHA medical centers average 7.3 emergency beds (range 0-24. Emergency units are primarily staffed by RNs (mean 11.2 FTEE, SD 6.7) and MDs (mean 4.2 FTEE, SD 3.1), though the presence of EM board certified/eligible physicians (mean 1.2 FTEE, SD 2.7) is low. There is also low utilization of mid-level providers (mean 0.83 FTEE, SD 1.42). Of note, nearly half (48%) of the VHA medical centers use outside contractors to provide emergency services at some point in their stated coverage time. Facility overcrowding was common as manifested by a mean of 29 days (range 0-299) on divert status during the first three quarters of FY03. Main reasons cited for diversion include lack of ICU beds (53%), lack of floor beds(34%), and a full emergency unit (9%).
Implications:
Urgent care or the emergency department are often the first line of contact for VHA patients, yet little is known about the overall capacity and capability of emergency services across VHA. We demonstrate wide variation across the system in facilities and resources.
Impacts:
Continued growth in the demand for emergency services coupled with rising concern for ED overcrowding and diversion necessitate careful assessment of the nature of emergency services in the VHA in order to plan for and improve delivery of patient care.
