LAC+USC Emergency Room: Crowded Care

At 7 p.m. on a Friday night, the waiting room of LAC+USC Medical Center's emergency department is crowded and will get worse as the hours tick by. This public safety net hospital sees, on average, 450 emergency patients each day, some for ear infections, others with gunshot wounds.

Despite the crowd of waiting patients, this is a relatively quiet night, emergency department director Dr. Edward Newton tells a group of California Endowment Health Journalism Fellows as he tours them through the ED.

The nation's emergency rooms are strained with patients who can't get medical care any other way, and LAC+USC is no exception. Unlike other emergency rooms in California and nationally, this one is in no danger of closing anytime soon, but Newton said budget cuts soon will eliminate 40 ED nurses, leading to longer waits for patients.   

"We're underfunded now, but I think that's about to get worse," Newton said. There's no fat in any of these hospitals. If you don't have a bed that's generating revenue (from a patient), you send that nurse home. We may look at these as the good old days."

Although LAC+USC's emergency department sees almost exclusively uninsured patients, more and more people, many with health insurance are crowding the nation's EDs, Newton said. In addition to rising numbers of the uninsured, insured patients also come to the ED because they can get immediate access to specialists and diagnostic tests such as MRIs. An aging population and rising rates of diabetes and other chronic diseases also pack the patients in.

"We're victims of our own success," Newton said. "We're always open. People don't have to take a day off work to deal with their kids' (ear infections). We can deal with anything you develop, medical or psychiatric or toxicological. You don't see that in an urgent care facility."

One bright spot: fewer gunshot wounds: the ED's trauma center now sees two or three cases each week, compared to 16 gunshot wounds each day in the 1980s, Newton said, attributing the decline to gang truces and California's three-strikes law.

Resources

LAC+USC Emergency Department: Dr. Edward Newton's PowerPoint presentation