By Sterling Medical Staff
On almost any given day, Emergency Room (ER) Physicians typically face overcrowding in their waiting rooms. In the early 1990s a decrease in the amount of ER use could be seen. That decline was attributed to the greater enrollment of patients into managed care plans. Several factors have reversed this trend so that many emergency departments are filled to capacity, increasing the demand for Emergency Medicine Physicians.
The reliance on Primary Care Physicians has decreased. According to the 1999 National Hospital Ambulatory Medical Care Survey (NHAMCS), a fourteen percent increase has occurred in the amount of ER utilization from the years of 1992 to 1994. This marks a rise from 89.8 million visits to 102.8 million, roughly “38 visits per 100 persons”.
The Center for Studying Health System Change cited three main reasons for increased patient demand in the ER:
- Less restrictive management practices by managed care organizations (MCOs)
- Stricter enforcement of the federal Emergency Medical Treatment and Labor Act (EMTALA)
- Increasing ED use among patients without insurance.
A large percentage of Emergency Room visits are not for true emergencies. Many patients tend to seek care from an ER for symptoms which could have easily been treated in a primary care location. In one study, nurses cataloged 37% of all Emergency Rooms as patients having a non-urgent condition (4). A similar study classified 75% of patients who walked into the Emergency Room as having a non-urgent or treatable condition in a primary care setting (1).
To reduce the number of Emergency Room visits a number of steps are being taken. Specific actions aimed at managing ER use include the following:
- Access to office appointments – Currently, many primary care practices make it nearly impossible for a patient to receive same day assistance. In order to combat this, many primary care setting are changing their scheduling protocols. Humana has started encouraging primary care providers to provide same-day assistance.
- Triage and telephone services – Many Primary Care Providers have started offering 24/7 phone consultation with medical personnel.
- Patient education – Health care plans have started distributing educational materials to primary care settings in order that patients are instructed in management of diseases.
Demand management strategies can be effective in reducing non-urgent ER visits. “Health plans, delivery systems, and physician practices can employ these strategies to meet the needs of their patient populations”.
- Billings J, Parikh N, Mijanovich T. The Commonwealth Fund, November 2000. Emergency Department Use in New York City: A Substitute for Primary Care? #433. Emergency room Use: The New York Story. #434. (3) Emergency Department Use in New York City: A Survey of Bronx Patients. #435 (4)Summary:Briefing Note: Effective Clinical Practices in Managed Care. November 2000. http://www.cmwf.org/programs/newyork/billings_e mergency_bn_433.asp
- Brewster L, Rudell L, Lesser C .Emergency Room Diversions: A Symptom of Hospitals Under Stress. Center for Studying Health System Change. Issue Brief No. 38. May 2001.http://www.hschange.org/CONTENT/312/• Coleman E, et al. Reducing emergency visits in older adults with chronic illness: a randomized, controlled trial of group visits. Effective Clinical Practice. March/April 2001;4(2):49-57.http://ecp.acponline.org
- Grossman LK, Rich LN, Johnson C. Decreasing non-urgent emergency department utilization by Medicaid children. Pediatrics. July 1998;102(1 Pt1):20-4.
- Young GP, Wagner MB, Kellermann AL, Ellis J, Bouley D. Ambulatory visits to hospital emergency departments: Patterns and reasons for use. JAMA. Aug. 14, 1996;276(6):460-5.