One-fifth of patients coming to the ED did not have conditions requiring emergency care

As a follow-up to what I wrote last week on the ER stories near Boston comes this report. Most of it we know already, but it’s nice to see some concrete data:

One-fifth of patients coming to the ED did not have conditions requiring emergency care, and another one-fifth had urgent conditions that could have been treated in a primary care setting, the report shows.

Uninsured and Medicaid patients in some communities might have to wait six months or more for an appointment with a specialist. But if they go to an ED, they get all their needs met in one place at any time.

“The convenience of the emergency department really offsets the long waits that are associated with it” . . .

The last point has resonance. The key is primary care and specialist access. When I work in ED fast-track, there is a good proportion who come in for medication refills and the like – simply because they can’t contact nor see their primary care physician.

Comments

Anonymous
As a radiologist, I am victim with the ER physicians to the phenomenon you describe, though the numbers you describe are probably an underestimate.
I agree with you that clearly a large part of the increase in ER visists is clearly the increased convenience, however, in recent years it has clearly become apparent that the ER is in a large part covering the off hours of the many primary care and specialist practices affiliated with that hospital. At worst, these physicians might by consulted by phone, however, recently it is becoming clear, that the ER is expected to manage these patients, as is, without consulting the primary or specialist physicans, who may or may not be notified later. I’ve contacted referring physicians during the day about a study done at night the evening before, and in about 50% of cases they have no idea, the patient was even in the ER, and in some cases haven’t yet been notified that the patient was admitted to the hospital.
For example, when an oncology patient has a problem, with whatever, off hours, they go to the ER. Frequently, the treating oncologist isn’t even notified. The ER, not knowing what to do for these complicated patients, many of whom are undergoing treatment at the time of presentation, generally orders a complete body CT for assessment of malignant disease. We sometimes see these studies dones days apart. Once, during working hours during the week ordered by the oncologist and a few nights later by the ER physician when the patient presents to the ER for some difficulty. While these patients are indeed sick, they don’t qualify for what we consider emergency room care. There should be someone available from their treating physicians’ practice to treat them and take care of these common problems at all hours, instead of relying on the ER, who has to reevaluate these patients from scratch. The oncologist never comes to see these patients, who should probably not be consuming the resources of the ER, but should be seen by the oncologist on call at the time of presentation.
It is interesting to note that when I now call doctors’ offices off hours for an emergency interpretation, there is almost never a service on call that will take the message and contact the doctor on call. Instead, most practices now say, “If this is an emergency, please call 911 and go to the ER”. There is no option for patients to reach their physican practices on call on off hours anymore. Thus they use the ER for all complaints.
Anonymous
Fast-tracking, in my opinion, is a big mistake. It inappropriately allocates limited resources to those who, in many cases, do not need to be in an emergency room at all.
In our attempt to increase patient thru-put, we have directed our energy to rapidly treating the wrong people. In my opinion, resources should be directed toward patients in order of their acuity. Forget “fast track” and “urgent care.” If someone who belongs in a community clinic comes to a busy ER, they should expect to have to wait until every single case more serious than theirs is treated.
Anonymous
As an oncologist, I share your view re: oncology patients have less optimal care in ER. but let’s face the truth. Oncologists make money with chemo, and not by dealing with cancer-related illnesses, just like GI doc’s do not care less once the scope out of the orifices. the money driven incentives have caused this mess.

One-fifth of patients coming to the ED did not have conditions requiring emergency care

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