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The Demand for Emergency Care

The Demand for Emergency Care
Author Information (click to view)

James J. Augustine, MD, FACEP

Director of Clinical Operations
Emergency Medicine Physicians
Clinical Associate Professor, Department of Emergency Medicine
Wright State University
Vice President, Emergency Department
Benchmarking Alliance

James J. Augustine, MD, FACEP, has indicated to Physician’s Weekly that he has worked as a consultant for Masimo Corporation and Ferno Washing, as a paid speaker for Masimo Corporation, and is a shareholder of EMP Holdings.

Figure 1 (click to view)
Figure 2 (click to view)
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James J. Augustine, MD, FACEP (click to view)

James J. Augustine, MD, FACEP

Director of Clinical Operations
Emergency Medicine Physicians
Clinical Associate Professor, Department of Emergency Medicine
Wright State University
Vice President, Emergency Department
Benchmarking Alliance

James J. Augustine, MD, FACEP, has indicated to Physician’s Weekly that he has worked as a consultant for Masimo Corporation and Ferno Washing, as a paid speaker for Masimo Corporation, and is a shareholder of EMP Holdings.

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EDs are proving to be increasingly valuable to the country’s healthcare system, with data showing that more patients are visiting them each year. With the demand for ED resources expected to increase, policymakers and healthcare planners must prepare to meet the needs of these patients in the future.
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The CDC’s most recent National Hospital Ambulatory Medical Care Survey revealed that EDs in the United States saw more than 136 million patient visits in 2011, representing the highest number ever recorded. “It’s important to look at how EDs are being utilized on a national level,” says James J. Augustine, MD, FACEP. “By assessing ED utilization, we can document trends and set the course for what will be needed in order to continue providing high-quality care to more patients in the U.S.”

From 1992 to 2011, there was a steady growth of about 3% in the number of patients visiting EDs. Experts project that the number of emergency visits will probably reach about 140 million by the next time the CDC compiles this data. “With Americans living longer than ever before,” says Dr. Augustine, “it’s expected that they will require more medical care from EDs in the future.”

Non-Urgent Conditions: Changes in Trends

The percentage of patients who visited EDs with non-urgent medical conditions decreased from 2010 to 2011 by about 50%, according to the survey. “More patients are seeking care for non-urgent conditions from other healthcare facilities, most notably for minor injuries, illnesses, and routine medical issues,” says Dr. Augustine. “This is helping EDs devote their resources to treating those who truly need emergency care. These findings reveal some of the successes occurring in EDs throughout the country.”

The National Hospital Ambulatory Medical Care Survey found that although the highest number of ED visits was made by those between the ages of 25 and 44 (Figure 1), the highest utilization was by those over age 75 especially those that live in extended care facilities. Injuries continue to shrink as a reason for ED visits, and now account for less than 30% of all visits, with the highest rates occurring among patients aged 75 and older.  Data also showed that women had a higher ED visit rate than men and that visit rates were higher for African Americans when compared with Caucasians (Figure 2).

Reasons for ED Visits

According to the data, the most common reasons for ED visits were stomach and abdominal pain, with 11.1 million visits, followed by chest pain and fever. Medications were provided or prescribed at 80% of ED visits, with analgesics being the most common drug provided, followed by antiemetic or anti-vertigo agents. According to Dr. Augustine, more patients presented with symptoms that raise issues about a cardiac etiology. About 19% of patients had an EKG performed, and about 14% had cardiac enzyme studies performed. The use of CT was documented in about 16% of visits, with about half of those being CT scans of the head. MRI scanning increased in frequency, being performed at 0.6% of ED visits.

In 2011, blood cultures, toxicology screens, arterial blood gas tests, and blood alcohol concentration tests were orders about 3% of the time. Pregnancy testing was done in about 13% of ED visits. For patients admitted through the ED, the leading principal hospital discharge diagnosis groups were as follows:

♦  Heart disease, excluding ischemic: 969,000 cases.
♦  Chest pain: 937,000 cases.
♦  Pneumonia: 701,000 cases.
♦  Psychoses, excluding major depressive disorder: 459,000 cases.
♦  Cerebrovascular disease: 452,000 cases.

“The number of ED visits relating to mental health issues and chemical agents has risen over the past 20 years,” Dr. Augustine says. “This is an area that policymakers should address so that we can better manage these patients and attempt to reduce their need for to ED care.”

ED Wait Times & Diversion

The CDC survey found that about 60% of all patients arrived to EDs after normal business hours. The immediacy with which patients are being seen in the ED appears to have improved, according to Dr. Augustine. “The average patient presenting to an ED is seen within 29 minutes,” he says. “However, a large number of admitted patients still wait long times for inpatient beds.” Nearly two-thirds of patients waited 2 or more hours for beds in 2011.

About 33% of EDs reported going on ambulance diversion in 2011, but a positive trend was noted in that 17% of hospitals did not admit elective or scheduled surgical patients when the ED went on ambulance diversion. This finding highlights the fact that more flexibility in surgical schedules may decrease crowding. Such actions could enable hospitals to make adjustments based on inpatient bed availability for patients admitted from the ED.

ED Resources Needed

“This data demonstrates how important EDs are within the U.S. healthcare system,” says Dr. Augustine. “EDs are continuing to show that they’re essential to every community and must have adequate resources. It’s critical that policymakers and healthcare planners use this evidence and recognize the importance of giving EDs more resources in the future so that they can respond to and manage serious emergency situations when they occur.”

Readings & Resources (click to view)

CDC National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey. NHAMCS(FS)-1 (3-14). Available at: www.cdc.gov/nchs/data/ahcd/NHAMCS_2011_ed_factsheet.pdf.

Brown RT, Steinman MA. Characteristics of emergency department visits by older versus younger homeless adults in the United States. Am J Public Health. 2013 Apr 18 [Epub ahead of print].

Carlson JN, Menegazzi JJ, Callaway CW. Magnitude of national ED visits and resource utilization by the uninsured. Am J Emerg Med. 2013;31:722-726.

Srinivasan S, Mannix R, Lee LK. Epidemiology of paediatric firearm injuries in the USA, 2001-2010. Arch Dis Child. 2013 Dec 13 [Epub ahead of print].

Chakravarthy B, Tenny M, Anderson CL, Rajeev S, Istanbouli T, Lotfipour S. Analysis of mental health substance abuse-related emergency department visits from 2002 to 2008. Subst Abus. 2013;34:292-297.

Jason J. Community-acquired, non-occupational needlestick injuries treated in US emergency departments. J Public Health (Oxf). 2013;35:422-430.

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