CDC: 1 in 5 in US visit ED each year

[Anonymous865]

Article from Healthcare Innovation Center

"One in five Americans reported visiting an emergency department at least once in the past year, according to a new report on America's health from the Centers for Disease Control and Prevention (CDC). The findings show America's increasing reliance on emergency care, according to Andy Sama, M.D., president of the American College of Emergency Physicians (ACEP). The vast majority of patients going to the ER have the symptoms of a medical emergency, and it's not possible to diagnose their conditions until medical exams and tests are complete.

There were more than 130 million emergency visits in 2010, and the vast majority of visits were for serious medical symptoms. Patients also are not able to evaluate the seriousness of their symptoms, according to the CDC, and the patient's reason for the visit did not always match the physician's diagnosis. The highest usages were among children ages 6 and younger and adults ages 75 and older.

"Emergency departments are the only part of the health care system that are always open ― all day, all night, all year," Sama said. "We know from a recent RAND report that even primary care physicians are increasingly dependent on ERs to see their patients after hours, perform complex diagnostic workups and facilitate admissions of acutely ill patients."

Other CDC findings include:

・ Those with Medicaid coverage were more likely than uninsured Americans and those with private insurance to have at least one emergency visit in the last year.

・ Injuries were the most common reason for emergency visits by adults.

・ 59 percent of emergency visits included at least one prescription when the patient was discharged.

・ Between 2000-2010, 35 percent of emergency visits included an x-ray. CT Scans or MRIs increased from 5 percent to 17 percent of visits.

The report says emergency care represents about 4 percent of the nation's health care spending.

Source: ACEP"

[mcknis]

This is interesting to read about and those of us in the ED setting know it all too well. In my neck of the woods, I wouldn't be surprised to see 1 in 5 visits each month. I am kidding, but it certainly feels like it some days!

[Anonymous865]

I'm not an ER nurse, so I found it interesting. I was surprised that "The vast majority of patients going to the ER have the symptoms of a medical emergency" From reading comments on here I thought that the majority of patients seen in the ER should not have gone to the ER. I guess the ER is like any other field. The things that stand out and that you talk about are the problems and troublemakers not the people who are using the system correctly.

On the other hand the comment that those with Medicaid were more likely to use the ER than any other group was no surprise after reading the comments on here. :)

[bell1962]

It may mean symptoms of a medical emergency that turn out not to be an emergency

severe abdominal pain...not appendix, but constipation

Chest pain...not cardiac, but GERD

etc.

the symptoms could be emergent... but turn out not to be

[Adenosine6]

That topic has been brought up in my ER and the majority of those non-emergent cases are young adults. They new generation have poor coping mechanisms for minor complaints/illnesses - and/or - mostly are impatient to wait or scheduling an Urgent Care Appt.

The main thing is the culture now is; "impatience" IMO; Facebook, Instagram, Google search - gives the younger generations instant gratitude by posting comments and receiving instant replies/satisfactions. So they want everything now...

[Keep_Calm]

That topic has been brought up in my ER and the majority of those non-emergent cases are young adults. They new generation have poor coping mechanisms for minor complaints/illnesses - and/or - mostly are impatient to wait or scheduling an Urgent Care Appt.

The main thing is the culture now is; "impatience" IMO; Facebook, Instagram, Google search - gives the younger generations instant gratitude by posting comments and receiving instant replies/satisfactions. So they want everything now...

You are so right. Instant gratification fueled by technology is finding its way into healthcare. 'I feel sick and I want to know what's wrong right now and I don't want to wait to make an appointment.' We had a mom bring her 9 month old in at 0230 the other morning for what she thought was poison ivy in his diaper area. Really? The baby was perfectly happy and not bothered by this (diaper rash...lol) at all. Smh

[TraumaSurfer]

There are many articles written about this and just some observation will give someone a clue as to who and why the ER is used. Many feel they have no place else to go and most of the time they are right. Clinics have closed or shortened their hours to 9 - 5. I remember not that long ago when you could easily find clinics open from 06 - midnight and a few 24 hours a day. Very, very few private physicians take public health insurance or walk ins without insurance. Even those of us who do have insurance might not get an appointment with their primary physician for several days or even weeks. Probably every one here has complained about trying to get into seeing their PCP or pediatrician at some time. Those on the low end of the socioeconomic scale will not have a private pediatrician to call for advice such as some of us might have had 20 - 30 years ago. If on public assistance their babies are delivered and if lucky they might be counseled about follow up clinics. Most of the time they are pushed through and out.

There are just no more Marcus Welby's left in health care who can meet the needs of the entire family. There are too many people without work. This also includes a lot of people with professional licenses who do not have a benefited jobs. It is not unusual for some of the PRN or agency RNs to pop into the ER for minor issues because of no insurance and "because they know the ER staff". They are never criticized even if their complaints are very minor but the young mother with an irritable infant from the wrong housing project is blasted.

Then you get the young college students on campus after hours when the clinic is closed. They are told by the campus EMTs to go to the ER. This is the standard advice given out throughout the US. Very few EMTs or Paramedics who can even name the clinics, the hours and services provided in some communities. If they do know of clinics very few will give out the information or will tell people to avoid the clinics because of their dislike of NPs or can all relate one horror story of a transport from that clinic. The ER is the easiest answer to give and because they know the staff there is okay.

Those dependent on mass transit for transportation are also at a disadvantage after hours since some buses will provide service to a hospital, most will not go to the clinics after hours. You might be quick to tell them to take a taxi since an RN can easily afford $30 - $50 for the fare but those on fixed incomes can not. Also, some of these patients come from neighborhoods where taxis will not go.

We also have those who complain about the same patients over and over but probably have not taken the time to put in an SW consult or follow up. Some may not have felt like taking the time to get the educational materials or a listing of clinics and hours. You will use all the excuses of not having time but still complain when you see that same person a few weeks later who still does not know of services available in the community if any after hours. Do you know what clinics are open all night? Most discharge orders will say follow up with a clinic which is usually just 9 - 5. Some also don't consider mass transit limitations when giving out the clinic appointments.

If you start trying to discourage people from using the ER you will probably only reach those who do use the system correctly. This means the elderly person who might be having symptoms of a stroke or MI might not want to be a bother. Or, the middle aged man who is already in denial of a heart attack. Or, the woman who has nondescript symptoms which could be cardiac but is now discouraged from seeking emergent attention when the symptoms start. Read the statistics in the latest articles about the mortality rate from woman, especially of poor economic status. Even EMS programs are now making a big push to discourage people from using their services but it is often only listened to by those who may truly need to be calling an ambulance. Maybe the potential ER or EMS user will wait to see if their chest pain is only gas instead of being snickered at in the triage area by the RN and Paramedics or on a forum like this.

There is no easy solution until the economic status of this country opens up the clinics which closed over the past 10 - 15 years including those for psych and more NPs/PAs are put into them and the community. Money and support for clinics in the community is always snatched up by some special interest group that is already pork heavy. And, until people do have insurance which is actually accepted by doctors, don't expect a lot of improvement.