Emergency visits up 23% according to the CDC

A new report from the Centers for Disease Control and Prevention once again debunks the myth that emergency departments are crowded with non-urgent patients, a finding noted by the American College of Emergency Physicians (ACEP). 

The percentage of non-urgent patients dropped to only 7.9 percent in 2007 [from 12.1 percent in 2006].  The report also makes the excellent point that non-urgent does not imply unnecessary.  As ACEP has said repeatedly, our patients are in the ER because that’s where they need to be.

There were approximately 222 visits to U.S. emergency departments every minute in 2007 (http://bit.ly/9B5kHJ) and the number of visits increased by 23 percent between 1997 and 2007, according to the report.

Preliminary data for 2008 indicate that emergency visits will increase to a record high of more than 123 million (http://bit.ly/ak6oRx).

Babies under 12 months old had the highest visit rate at 88.5 visits per 100 infants.  The second highest visit rate was by adults age 75 and older, with 62 visits per 100 people. 

Approximately one-quarter of all visits were by patients insured by either Medicaid or the State Children’s Health Insurance Program.  The uninsured represented about 15 percent of all visits.

The report, “National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary” offers far more detail than the data brief released by the Centers for Disease Control and Prevention (CDC) in May. The U.S. Department of Health and Human Services, of which the CDC is a part, has indicated that this is the last fully detailed report of its kind to be issued about emergency department visits.

I am urging the CDC to reconsider:

“It is essential to know what is happening in our emergency departments as we implement health care reform.  This report is rich in data about who our patients are, how old they are and why they are seeking care in the ER.  From a planning perspective, this information is invaluable.  It would be a mistake for the CDC to discontinue tracking what is happening on the front lines of healthcare, the nation’s emergency departments.”

The report also notes that only 0.1 percent of patients die in the emergency department.

The report says the main issue contributing to overcrowding has been delays in moving the sickest patients to inpatient beds.  Admitted patients have often been boarded in the emergency departments or hospital hallways for hours to days, resulting in overcrowding and diversion of incoming ambulances to other hospitals.

Too Many Patients !?!

Visits to American emergency departments have reached a record high of 199.2 million in 2006, according to the “National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary”, published by the CDC (Centers for Disease Control and Prevention) this week. This is an increase of 4 million people coming to emergency departments for care since the previous report from 2005. That’s as if the entire city of Los Angeles went to the emergency department on top of the patients that were already being seen.

Over the past decade, the number of patients coming to the emergency department has increased 32%, from 90.3 million to 119.2 million. Emergency departments are now averaging 227 visits per minute. At the same time, the number of hospital emergency departments has dropped, from 4109 to 3833.

Here are some of the COMMON MYTHS:

It’s because of people being treated for “minor” complaints.

Actually, only 12.1% of the visits were characterized as patients who could wait 2 to 24 hours to be seen. (Nonurgent)

It’s because people without insurance are crowding the emergency department.

Actually, patients WITH private insurance represent the largest category of patients, 39%. Uninsured patients represented 17.4% of the patient pool.

It’s just because the population has grown.

Actually, the population-based ED utilization rate increased by 18%, from 34.2 visits per 100 persons in 2005 to 40.5 visits per 100 persons in 2006.

Here are some HARD TRUTHS:

There aren’t enough beds in the hospitals.

People wait hours and days in the ED after they have been admitted because there is no hospital room available for them. This is called boarding.

There aren’t enough nurses to take care of patients.

According to a report released by the American Hospital Association in July 2007, U.S. hospitals need approximately 116,000 RNs to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%.

There aren’t enough doctors.

Eleven (11) percent of all ambulatory medical care visits in the U.S. occur in the emergency department, and yet emergency physicians represent only 3.3% of active physicians.

As the population ages and as the economic situation worsens, these problems are unlikely to be corrected without purposeful, thoughtful change in the healthcare system.