Time and Resource Constraints in the Emergency Department
Hospital emergency departments (EDs) treat individuals with acute illness and injury and manage the response to local mass casualties. They also serve a host of patients—insured and uninsured—who use the ED for nonurgent, primary care because doing so is faster, cheaper, or more convenient than scheduling an appointment at a clinic or private practice. Twenty-four-hour demand on its comprehensive treatment capability strains the ED’s resources and presents its physicians with a distinctive set of ethical quandaries that this month’s authors investigate.
The metaphor of the ED as a safety net works on many levels. It’s visual. It has heroic dimensions. Many physicians and nurses were drawn, and find great purpose, in this ideal. But does it stoke expectations that can’t be met?
James Mills Jr., MD, a founder of emergency medicine, believed he could have greater impact on medical care for the poor in his city by giving up his practice and working in the emergency room full time.