Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Explain recent trends in emergency department utilization in the United States.
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Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwOct1. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
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This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
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This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
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Take CME(click to view)
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.