Emergency department visits to Washington hospitals have risen more than 16 percent in two years, according to data from the state Department of Health. That's in line with a national trend since implementation of the Affordable Care Act in late 2013, which brought insurance coverage to millions of people who may have little experience using the health care system in general. Local hospitals are feeling the crush, adding nursing staff and doubling down on efforts to coordinate with primary care providers and educate patients on when, where and how to best seek medical care. But those numbers aren't going down anytime soon.