Hospitals: Boom in Emergency Rooms

The biggest boom in U.S. medicine does not involve antibiotics or even contraceptive pills; it is the fast-growing popularity of hospital emergency rooms. Across the country they are flooded with an unprecedented number of patients. Since the end of World War II, the number of emergency-room admissions has jumped 500% , although the number of accident patients — formerly the bulk of all emergency-room cases — has remained stable at about 35 million a year. The U.S. public, says Manhattan's Dr. Robert H. Kennedy, director of a John A. Hart ford Foundation study group, is rapidly turning hospital emergency departments into community medical centers.

It is easy enough to explain the startling statistics. In the days when the local G.P. owned one of the few horse-drawn buggies in town, the doctor did most of his business in the patients' of his home. In an in era the of sprawling suburbs, when patients and doctors alike travel everywhere in autos, every car is a potential ambulance, ready to rush the victim of a real accident or a simple case of bellyache to the nearest emergency room.

These days, more and more doctors can afford long weekends and longer vacations; more and more of them are unavailable for late night calls. Even the better-heeled patients soon come to see no social stigma attached to a trip to the emergency room when their own physician cannot be reached. Poorer patients who once took their non-emergency sniffles, coughs and diarrhea to daytime outpatient clinics now tend to wait for evening and treatment in an emergency room. Such a visit usually means no time off from work. Today, says Dr. Kennedy sardonically, an emergency is "anything from which the patient is suffering when he cannot reach his regular doctor."

Separate Entrances. Trouble is, most emergency rooms are not organized to handle their burgeoning business. Many of them are out of date and ill-equipped, even for treating genuine accident cases. Many are understaffed; often enough the intern on duty is a foreign-born doctor whose language difficulties become almost insurmountable for the patient or his overwrought family. And the emergency room's new popularity is likely to cram it with cases of infectious disease—which is hardly to be desired for the accident victim brought in with an open wound. It is an unhappy situation for patients, doctors and hospitals.

Instead of trying to stem the tide, Dr. Kennedy and his study colleagues concluded that the thing to do is to organize emergency care properly to produce good medicine for all concerned. A prototype of what they are looking for is the emergency pavilion opened recently by Manhattan's New York Hospital. There, change from old emergency-room procedures begins at the entrance. To keep patients with open wounds waiting on stretchers away from others with infections, there are now two emergency-room doors—one for routine cases and most adults, one for children (who have most of the fevers). Inside are separate waiting rooms. A child with a broken leg but no fever can be quickly sent to the proper room.