Busted: Student Disproves Popular Emergency Room Myth

Like the emergency room seen each week on ER, emergency departments in Canada increasingly seem overcrowded and chaotic. Emergency department overcrowding has been a pressing issue across the country for the last two decades.

The question is, why? The common belief is that primary care, or non-urgent patients—people with nagging colds, flu or aches—are causing this overcrowding.

Andre Maddison wasn’t sure what exactly was causing the problem, but he didn’t think primary care patients were at its core. The master’s student in Community Health and Epidemiology at Dalhousie UNiversity in Halifax, Nova Scotia investigated this popular misconception and by doing so, became one of two winners of the Canadian Health Services Research Foundation’s 2009 Mythbusters Award.

“The award was definitely a surprise,” says Mr. Maddison. “I was able to attend the CHSRF annual conference in Calgary and met the who's who in the Canadian Health world - for a nerdy health care student it was an exciting experience.”

“It’s a really great award and I couldn’t have accomplished this without the assistance I received from professor Yukiko Asada,” says Mr. Maddison. “She helped me a lot with the paper, even after the course was over.”

Mythbusters is a series is run by the CHSRF and is published differently than most medical publications - using plain language free of medical jargon that everyone can understand. Other myths explored in earlier issues include the myth that Canadian doctors are leaving for the U.S. in droves and that generic drugs are lower quality and less safe than brand-name drugs.

The CHSRF asked students to submit their findings as part of a national competition. Already required for his coursework, Mr. Maddison decided to submit his research. The winners were selected based on the myth they busted and their defence of it.

“I started with the view that due to a shortage of family doctors, people are going to emergency departments and overcrowding them,” explains Mr. Maddison, a native of Sarnia, Ont. “But in reality, why EDs are overcrowded wasn't known.”

While 40 to 50 per cent of cases in the ER are non-urgent patients, after extensive literature research and speaking with physicians, Mr. Maddison found that primary care patients were not overly burdensome. His research illustrated that patients in urgent need of acute-care, admitting beds, extended stay, specialists and other high demand care needs actually have a greater impact on overcrowding. “We can’t discount the affect of so many non-urgent patients, but they are certainly not the main part of the problem.”

Mr. Maddison believes it’s a system level problem, not isolated to the ED. “Emergency department overcrowding is a national problem with potentially devastating effects,” he says. “It is rooted in insufficient physical and human resources and poor integration within and between hospitals.” He went on to say that to best care for both urgent and non-urgent patients effectively, we must determine the purpose of EDs in order to best serve the patients, health care professionals, communities and the country.

During the summer, Mr. Maddison will work with the CHSRF to polish up his paper before it goes to publication. He hopes it helps people, especially policymakers, to better understand the fundamental problems of overcrowding.

At 25, Mr. Maddison is studying access to care in Nova Scotia, particularly access to colorectal cancer services in the province and will graduate next spring. An avid cyclist who travels Nova Scotia on day-long bike trips to places like Peggy’s Cove, Mr. Maddison recommends other students attempt to tackle other myths in Canadian health care. “Every student should learn to write in that manner and help give greater clarity to the health care system.”

Source: Dalhousie University

   

• wiyosaya - Jun 08, 2009
  • Rank: 3 / 5 (2)
  Too bad that BlueCross has not seen this study. They seem to be spending quite a bit of money, at least in our area, with bill boards and mailings to subscribers telling people that if you have a cold, don't go to the emergency room.
  
  Then again, BC seems to have a lot of trouble getting many things straight.
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• Nan2 - Jun 09, 2009
  • Rank: 1 / 5 (1)
  This is interesting. And yeah on BC/BS whose goal these days is cost containment by spending money. Basic and standard care in the USA is increasingly out of reach financially for far too many. Some wait until they are in a full-blown crisis before seeking care, when early intervention could have prevented prolonged and/or more expensive treatment. Never mind about what is best for the patient, that went out the door long ago.
  
  The thrust now is meta-analysis and IT spending for medical records to identify patients who are chronically ill in an attempt to save money. Too bad this wasn't applied in a patient centric way earlier, today its merely food for the MBA. Never mind too the rapid increases in plan costs for those fortunate enough to have health care coverage, patient privacy and insurers becoming providers of care to contain costs is horrifically wrong-headed and will not produce the results expected in cost savings.
  
  This research is a breath of fresh air.
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• MenaceSan - Jun 09, 2009
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  So your saying people should go to the emergency room for sniffles ? rrr. wouldnt it be better to have a primary family doctor ? Whats the point of this article ?
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