Too Many Emergency Room Visits?
Here is the argument for keeping things just as they are:
Researchers reviewed the records from almost 35,000 patient visits to emergency departments across the country. In 6 percent of cases, the patient was discharged and could have been treated in a doctor’s office.
The researchers then combed through the initial symptoms or complaints of these non-urgent cases and discovered that in nearly 90 percent of the other, more urgent cases, patients came to the emergency room with the same primary presenting symptoms, complaints like abdominal discomfort, chest pain or fever. In addition, more than 10 percent of these urgent patients ended up requiring hospital admission, surgery or intensive care.
I’m skeptical. It looks to me like only 10% of the patients really needed hospital care.
People visit the emergency room way too frequently. I had a friend that would go to the emergency room for a small fever or a papercut. Not literally but she didn’t have a primary doctor and that was her method of receiving medical care.
To me, this is a primary physician shortage more than an overuse of the emergency room.
I don’t fully understand what you mean by “keeping things just the way they are,” are you trying to be sarcastic here?
If only 10% of the people need actual care from the hospital, perhaps it is best that we have some kind of system that is flexible and mobile to cater to the 90% of the people who go to emergency rooms. I think health infortmatics and health information technology might be the best way to solve this problem.
I agree with the second Patel’s comment, I don’t know what the first Patel is talking about.
Some statistics for you:
Visiting rates: 82/100 persons on Medicaid visited the ER, 48/100 for Medicare, 48/100 for uninsured, and 21/200 for private insurance.
Payment sources: 42.8 percent of ED visits were paid for by SCHIP/Medicaid, 39.7 by private insurance, and 17.4 were uninsured.
http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf
“It looks to me like only 10% of the patients really needed hospital care.”
– Everytime I’ve been to the hospital visiting, I have seen an enormous amount of people in the waiting rooms. Always thought there was some problem.
“health infortmatics and health information technology”
I don’t know what that is. Care to expand on that?
The point that the article is making is that UNTIL a patient gets to the ER, no one, not a doctor, nurse, intake receptionist, or the patient, KNOWS whether he’s got a tummy-ache or a blowing out aneurysm.
Trying to see your family doctor when you’ve got symptoms of heart attack that could alternatively be indigestion, or of appendicitis that could also be gas, doesn’t seem quite the answer.
[I’m not talking about people with sniffles. Obviously, if you’ve but got the sniffles, you shouldn’t show up at the ER, but once you’re there, the ER can’t turn you away without confirming that it’s just sniffles. OTOH, how do you know it’s not bird flu?]
Case in point: my 70+ year old sister suffered at home all night long with difficulty breathing, discomfort, chest pressure, etc., in the belief that whatever she had, it wasn’t ER-worthy. 7:00 am ambulance ride & visit to ER revealed that she had a perforated intestine & she immediately went into surgery.
How is one to know?
“People don’t have their diagnosis stamped on their forehead.”
Pity.
I’ve heard from Emergency Room physicians that in many cases there is not a clear delineation between people who should not visit the ER and those who should. Some ER patients clearly need emergent care. Some ER patients do not. Between these two extremes are many cases that are unclear initially. Some people — in retrospect — could have been treated at the doctor’s office, but that was not easy to discern at the time.
Hindsight is 20/20.
10% of people needing hospital care does not mean that the other 90% did not need ER care. There’s not enough data here to come to any conclusions. What if it were reversed and 90% were admitted? Would that mean we still wouldn’t benefit from more primary care? What if 90% of the 90% could have had their malady treated more cheaply, and less painfully, before it became acute enough to require an ER visit?
I know who those 90% are, as a consultant physician I often take a peek at “the board” of whatever ER I’m in. I see, UTI, URI, fever, UTI, fall, cut finger, fever, fever, abd pain, SOB etc. Lot’s of primary care going on, but to the patient who feels the need to wait 4 hours for the ER to treat her UTI, it is bad enough, clearly, to warrant an ER visit. Still, if she had a relationship with a PCP, and the ability to see one, I doubt that she would be there. Some of those patients need to be in the ER to get sewn and patched up, but by no means need admission. And somewhere, hidden in there, are the admissions. The truly sick.
This issue is more complicated than just looking at which ER visits become admissions. ERs do more than triage for the hospital. THey do a lot of primary care or primary care preventable care (this should be eliminated as the ER is too expensive a place for this care), they do a lot of acute care and repair, they do triage for admission to other medical services, they do emergency resuscitation and rescue. This would suggest the only valuable use of the ER is admission triage.