10:25pm Friday 22 November 2019

The ER a Half-Century Later

Story Highlights:

  • Rapid growth in ER volumes in the 1950s, due to access to care challenges for patients, led to major changes in emergency departments.
  • Emergency department patients today often likely to face “deadly delays” due to hospital practices of boarding patients and downsizing staff and resources on weekends – when ED volume is the highest
  • Despite numerous advancements in care, technology and science, problems still exist  
  • Solution is to redesign the hospital staffing and care processes to be patient -centered, rather than hospital or staff-centered.

ATLANTA – Despite incredible advancements in medicine and technology, has the face of emergency medical care in both the field and at the hospital changed over the course of the last 50 years – and how much, for better or worse, has remained the same?  

In context, have more patients, and barriers to care, which a half-century ago resulted in transformation of “emergency rooms (ER)” into “emergency departments (ED)” improved any – or gotten worse – here in 2011?  A “Perspective” article co-written by an Emory University emergency medicine physician and a renowned expert in the field of emergency compares past issues with those of today in the June 16 issue of the New England Journal of Medicine.  

According to Ricardo Martinez, MD, assistant professor of emergency medicine in the Emory School of Medicine, and Arthur Kellermann, MD, MPH, vice president and director of RAND Health, much has, indeed, changed since the 1950s. However, despite remarkable scientific and technical progress, emergency rooms across the country today still grapple with many of the same challenges plaguing hospitals and caregivers 50 years ago. What’s worse is that delays in care are common, especially on nights and weekends, when hospitals downsize staff but the ED volume is highest.  

“Years ago, patient needs drove changes in the ED and hospital and physicians responded with growth of emergency medicine and newly designed emergency departments,” says Martinez. “In the face of rising patient volumes and concerns over the adequacy of emergency care available, EDs were forced to swiftly adapt to patients’ needs 50 years ago – and must do so again now in 2011. Now, overcrowding and boarding, and downsizing of hospital staff on weekends when emergency department volume is highest, are creating deadly delays.  It is time to redesign the hospital staff and care processes in order to be patient-centered, not hospital or staff-centered.”  

“Although emergency care consumes only three cents of every health care dollar and employs four percent of U.S. physicians, emergency departments handle 11 percent of all outpatient visits, 28 percent of all acute care visits, and half of all hospital admissions,” says Kellermann.  

“Hospital-based emergency care is the only treatment to which Americans have a legal right, regardless of their ability to pay, and the ED has become more than a hospital department – it provides a full snapshot of our overall health care system in America. The quickest way to assess the strength of a community’s public health, primary care, and hospital systems is to spend a few hours in the emergency department.  If public health is under-resourced, you will see more patients with vaccine-preventable illnesses, smoking-related health problems, preventable injuries, and food borne diseases. If primary care is fragmented or weak, the waiting room will be full of patients with problems that should have been prevented or treated by primary care providers.”


The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.

  1. Lance M. Skelly: (404) 686-8538

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