An endangered resource. Hospital emergency departments are threatened by closures and a reduction in services

Many factors threaten the hospital emergency department. Socioeconomic and healthcare trends are forcing facilities to eliminate some services. Society's failure to deal with these issues portend disaster for high-quality care and for timely access to emergency care. Hospital administrators must collaborate with emergency department managers and plan strategies to ensure the survival of this valuable resource. Hospital emergency departments will have to redefine the scope of services they provide to meet specific consumer needs. The number of older Americans is increasing rapidly. Emergency departments must understand and cater to their unique needs. Some emergency department staffs are collaborating with competitors to share resources and reduce overlapping services. The emergency department has an impact on the facility's bottom line. The emergency department can positively affect this by ensuring accurate billing, analyzing fee schedules, and requesting payment at the time service is provided. Other survival issues include developing strategies to retain staff, develop management, negotiate managed care, and reassess the department's design.