You Came to the ED for That?

Carrie Vaughan, for HealthLeaders Media, January 9, 2009

Hospital emergency departments are full of patients who don't belong there. I'm amazed at some of the stories I hear from a friend of mine who is a nurse practitioner in an ED. For instance, the mother who showed up with her child who had lost a tooth—she wanted to make sure it wasn't going to get infected. Or the parents who brought in a child who'd had a fever for all of five hours (and hadn't given him Tylenol yet). It's not just neurotic parents, either; there are scores of people who come in for a sniffle or sore throat.

It's not news that EDs are overcrowded, plagued by long waits, and have patients lining the hallways. Unfortunately, the current economic downturn means that the uninsured ranks will likely grow, prompting even more patients to use the ED as their primary-care provider. Still, I'm not sure what senior leaders can do to prevent patients who don't even need a doctor's visit from coming to the ED. It's not like they can post a sign listing the ailments that don't warrant a trip to the emergency room.

According to recent reports, uninsured patients seeking primary-care at hospital EDs are not the main culprit behind the overcrowding issue, anyway. In an August 2008 report, the Centers for Disease Control and Prevention found that the uninsured make up 17.4% of ED visits. Patients with government-sponsored health plans and privately insured patients make up about 42% and 40% of the ED volume, respectively.

Spikes in the number of insured patients seeking treatment in the ED—especially the aging population—are the main driver behind the increase in ED visits, which has grown by 36% since 1996to about 119 million, the report says.

Senior leaders may not be able to post a sign banning patients with nonurgent conditions, but there are some steps they can take to ease overcrowding. For example, a growing number of hospitals have implemented fast-track EDs to help manage patients with nonemergent conditions in a more timely fashion. Memorial Hermann Memorial City Medical Center in Houston, TX, actually strives to give every patient a quick examination by a nurse or other health professional within five minutes of arrival and then get the patient to a physician within 30 minutes. Other health systems have policies in place to redirect patients who show up at emergency departments without emergency symptoms to local community health clinics or urgent care centers—or, at the very least, educate them about local clinics where they can seek treatment for nonurgent conditions next time.

When designing these programs, hospitals should consider ways to educate or better meet the needs of a growing elderly population that is frequenting the ED more than ever. Hospitals may also want to reevaluate their patient education materials for new parents, because the highest ED rates per population were for children under the age of 1, according to the CDC report. There are more than 900 visits per 1,000 population for children 12 months of age and younger, so essentially almost every newborn visits the ED during their first year of life.

On the other hand, if you are a cash-strapped hospital, perhaps the neurotic parent may not be such a bad thing—but only if they're insured.

Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at
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