Improving Patient Flow in America’s Safety Net Hospitals: An Ethical Obligation to the Nation’s Underserved Populations

Abstract

Academic medical centers frequently serve as safety net hospitals, treating a large percentage of low income and uninsured patients. Emergency departments (ED) provide unscheduled care for these patients whose conditions range from non-urgent annoyances to life-threatening injuries. Most research has shown that only a fraction of these visits are truly emergencies. These visits contribute to ED overcrowding, often leading to delayed or denied admissions. A common misconception is that ED overcrowding is an ED problem. Rather, competing patient flows from ED and inpatient areas frequently converge to produce system-wide demand surges. During times of acute overcrowding, delays can frequently be attributed to lack of inpatient beds and resources, both of which are beyond the ED’s control. Multi-disciplinary collaboration and system-wide cooperation is critical for successful patient flow management. This article presents evidence that improving patient flow enhances access to care for underserved populations, leads to better patient outcomes, and improves revenue for the organization.