I found an article the other day that discussed use of the ER for non-emergency conditions. I thought it would be a good discussion topic so here it is:

Overuse of Emergency Departments Among Insured Californians

October 2006

One of the key challenges facing emergency departments (EDs) nationwide is a marked increase in use, driven primarily by insured patients who do not have true emergencies. With the troubling trend in California of emergency room closures, it is important to examine the factors that lead to inappropriate emergency room use.

A recent Harris Interactive Inc. survey found that nearly half of recent ED patients felt their problems could have been handled by a physician’s office visit, had one been available, rather than using the ED.

CHCF commissioned Harris Interactive to conduct two sets of surveys, one of emergency room patients and one of primary care physicians and ED physicians. The patient survey found four key factors that drive increased ED use by insured patients who are not critically ill:

• Lack of access to medical care outside the ED (e.g., same-day appointments with a primary care physician, or evening and weekend appointments);
• Lack of advice on how to handle sudden medical problems;
• Lack of alternatives to the ED (e.g., nurse advice lines or urgent care clinics); and
• Positive attitudes about the ED as a site of care.

The lack of options for Medi-Cal patients, who have even more trouble with access to primary care than privately insured patients, is especially severe. The study also noted that patients with chronic conditions made more ED visits, suggesting that their primary care providers may need to improve their methods of chronic disease management.

This issue brief summarizes the key findings of the survey, recommends strategies to increase alternatives to ED use, and calls for streamlined ED processes, as well as improved communication between physicians and patients.
 
Overuse of Emergency Departments Among Insured Californians - CHCF.org  –  http://www.chcf.org/topics/hospitals/index.cfm?itemID=126089

The one good thing from this (remember, I’m an ER doc) is the last bullet - that people had positive attitudes about the ED as a site of care. They may complain about the wait they have to get the care and to complete the care, but it’s apparent that people do think that ED physicians and staff are on the cutting edge. That’s a very important point but not a good reason to use the ED.

Not only is it bad for you when the EDs are so crowded but it’s bad for everyone coming in. Fortunately the ED staff is used to getting the story quickly and barking off orders for this bed or that bed and they all get done. But this is NOT a good way to get personalized care. I hope that physicians look at this brief and say to themselves that they need to look at the services they offer. As I talk about in "Your Doctor Said What?", we have to get sick on the doctor’s schedule and I can tell you from expeirence on both sides of the fence (as a doctor and perhaps, more importantly, as a patient, that rarely occurs. The Urgent care clinics have been a great boost there but a greater review of the situation is needed.

Terrie