Understanding the Costly Impact to Clinical Settings
One example of the costly impact to both the clinician and the patient is in the emergency department. The healthcare crisis has most acutely been felt in the emergency department. Higher volumes of patients combined with more rural ED’s closing is resulting in more patients being seen in fewer ED’s.1 This overcrowding crisis, combined with the stricter 2015 CMS rating system tying hospital ratings directly to reimbursement rates is making an incalculable negative financial impact as well.
Pelvic examinations are commonly performed within the Emergency Department. The American College of Emergency Physicians (ACEP) made a policy in 2007 recommending that all emergency departments, with respect to obstetrics and gynecology, have gynecologic examination tables with the appropriate specula and emergency obstetric instruments and supplies 2
However, multiple data sources reveal that because of ED overcrowding and the necessity of special pelvic beds, there is a frequently increased delay and wait to patients who require a pelvic examination3. The Brown et al., study revealed that pelvic exams conducted within the Emergency Department (ED) are time consuming and labor intensive because typically only one to two rooms within the ED are equipped for a pelvic exam. Therefore these equipped and designated rooms require patients to wait or be moved around in order to accommodate the female patient for a pelvic exam.4
The American Hospital Association’s 2016 report records over 136 million ED visits. Of these, over 53% of these visits were by women. A conservative estimate of 4 % of these visits is for medical complaints that would include a pelvic exam for diagnosis. In addition, the number of ED visits per year is expected to increase 22% in the next decade. 5
Other clinical settings affected include the smaller urgent care clinics that are springing up in every town in part as a response to the healthcare delivery crisis. Becker reports, in 2016, there were over 7,100 urgent care clinics and 2000 retail clinics open.6 These clinics simply do not have the capacity or budgets to have the large and expensive exam tables required for gynecological exams.
Veteran’s health has not escaped this problem. The women using Veteran’s Health Administration (VHA) emergency departments have doubled over the last decade and it is anticipated to continue to rise. In 2010 there were approximately 102,000 VHA emergency department visits by women, which account for 9% of all visits (Cordasco, K.M., et. al., 2013). The women using VHA services are 45 years or less in age with high probability of presenting with gynecological or obstetrical emergencies. Cordasco et al., report women are more likely to be victims of sexual assault and will present to the VHA emergency department for medical attention; nearly one in four women who use the VHA services are sexually assaulted and are in need of a gynecologic physical exam (2013). Unfortunately women are a minority of the VHA emergency department patients and the services specific to women (pelvic exams) can be less available and harder to coordinate the proper equipment and supplies needed to perform the exam.
Another clinical area affected by the high demand for gynecological beds is the MedSpa industry. According to the American Med Spa association, there were 19,900 medical spas in 2016. The 2016 profits were placed at 3.6 billion7. Of their services, vaginal rejuvenation procedures are one of the fastest growing cosmetic procedures offered. They take less than 5 minutes at a cash cost of approximately $2,251 dollars per procedure. However, the medspas do not have specialized gyn beds which can cost thousands of dollars, and are size prohibitive in these posh environments.
As shown above, by just a few examples, the lack of appropriate pelvic exam tables affects a widespread variety of clinical settings. Every day around the world medical providers are performing pelvic exams on women. Many of the exams are being performed in a setting where pelvic exam tables are just not readily available. The settings where a pelvic exam table may not always be found include Emergency Rooms, Armed Service Medical Units, Remote & Disaster Response Agencies, Mobile Medical Facilities, Nursing Homes, Health Clinics & Urgent Care, Family Medical Practices, Ambulances & EMTs, Every floor Hospital, Women’s Shelters, Medical Missions, and Humanitarian Aid Anywhere Women’s Health is a Focus. It is difficult to calculate the impact this has on both the quality and ease of care, not to mention the huge financial costs.
However, just these few examples give an idea of the scope, affecting millions of women, healthcare workers, and business owners. In the next post in this series “Size Matters: How Portable Pelvic Exam Tables Improve Care while Saving You Money,” we will review how using smaller and innovative medical exam devices can save healthcare institutions and personnel money.
- http://www.aha.org/research/rc/stat-studies/fast-facts.shtml
- Cordasco,K.M.Zephyrin,L.C.Kessler,C.S.,Mallard, M.,Canelo,I.,Rubenstein,L.V.,Yano,E.M.(2013) An Inventory of VHA Emergency Department Resources and Processes for Caring for Women.Journal of General Internal Medicine.28,Suppli 2,pp: S583-90.DOI:10.1007/s11606-012-2327-7.
- Hamilton,R.M.,Method,M.M., Rogan,M.J.Walsh, M.,White, L., and Thomas,S. (2009). Developing a Pelvic Tilt Device for Pelvic Examinations: A Performance Improvement Project, Journal of Emergency Nursing. 35:1,40-2,Doi: 10.1016/j.jen.2007.11.001
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099609/
- http://www.beckershospitalreview.com/hospital-management-administration/25-facts-and-statistics-on-emergency-departments-in-the-us.html
- http://www.beckersasc.com/asc-quality-infection-control/5-statistics-on-urgent-care-centers-emergency-departments.html
- https://www.americanmedspa.org/