Report: ED visits are on the rise
July 1, 2002
Report: ED visits are on the rise
Does your emergency department (ED) seem like it’s busier than ever? That may very well be the case, according to a report by the Atlanta-based Centers for Disease Control and Prevention (CDC). The study says that ED visits have increased by 14% (from 95 million in 1997 to 108 million in 2000.) During the same period, the number of EDs decreased by 2%, from 4,005 to 3,934.1
The increased burden placed on EDs across the country demonstrates the need for ever greater operational efficiencies by the entire health care system, not just the ED, argues Nancy Bonalumi, RN, MS, CEN, director of emergency services for Pinnacle Health Hospitals in Harrisburg, PA.
She points out that primary care services must be available, to keep patients from relying on the ED as their source for routine health care services. Additionally, improved management of chronic health problems such as asthma, congestive heart failure, and respiratory ailments will prevent acute exacerbation resulting in ED visits, says Bonalumi. "The health care system has been overburdened for many years, of which ED overcrowding and diversion of ambulances are only symptoms," says Bonalumi. "EDs alone did not create this problem, nor can they solve this problem alone."
These troubling statistics underscore the need to identify new ways to improve patient flow and cut delays, says Brent King, MD, FACEP, FAAEM, FAAP, associate professor of pediatrics and emergency medicine at the University of Texas Houston Medical School and chief of the emergency medicine service at Memorial Hermann Hospital, also in Houston. "However, in doing so, we need to recognize that we are treating the symptom and not the disease," he says. "We shouldn’t let these efforts, necessary as they are, distract us from working on the underlying problems of a broken health care system."
King recommends the following:
• Show the study to colleagues. King says that the CDC study can serve as a wake-up call for other departments and administrators. "There is a lot of mythology surrounding the reasons for overcrowding, and too little science," he says.
• Use protocol-driven observation units. Observation units can deliver efficient care and avoid hospitalizations, says King. "This helps to keep in-house beds free to decompress the ED," he adds.
• Move hold patients from the ED to the floors. King recommends "sharing the wealth" with the rest of the hospital. "I think we should remind our colleagues that other parts of the hospital have hallways, too," he says. He argues that admitted patients can wait in the upstairs hallways just as well as they can wait in the ED hallway.
• Find solutions that work for your individual ED. King notes that some solutions may work in some regions and not so well in others. "For example, there is a notion that a large part of the problem is people with minor illnesses and injuries who use the ED like a clinic," he says. "I hear that all the time." If that is true, King concludes the obvious answer is to increase the capacities of urgent centers and fast tracks. However, he points to a recent study that examined trends in California EDs over a 10-year period.2 "These authors found that nonurgent visits actually decreased by 8% during the study period," says King. "This data would suggest that, for California at least, more fast-track capacity isn’t the answer."
If time and resources are available, King recommends tracking increased visits in your own ED. "There are clearly local and regional variations for this problem. The solutions that work in Houston may not work in Boston," he says. "Likewise what works for the big city’ ED may not be best for the smaller city."
References
1. Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2000 Emergency Department Summary, 2002.
2. Lambe S, Washington DL, Fink A, et al. Trends in the use and capacity of California’s emergency departments, 1990-1999. Ann Emerg Med. 2002; 39:389-396.
Sources/Resource
For more information about the report on emergency department visits, contact:
• Nancy Bonalumi, RN, MS, CEN, Emergency Services, Pinnacle Health Hospitals, 111 S. Front St., Harrisburg, PA 17101. Telephone: (717) 782-3275. Fax: (717) 782-5716. E-mail: [email protected].
• Brent R. King, MD, FACEP, FAAEM, FAAP, Chief, Emergency Medicine Service, Memorial Hermann Hospital, 6431 Fannin, Houston, TX 77030. Telephone: (713) 500-7863. E-mail: Brent. [email protected].
The Centers for Disease Control and Prevention study, National Hospital Ambulatory Medical Care Survey: 2000 Emergency Department Summary, can be accessed at the National Center for Health Statistics web site (www.cdc.gov/nchs/products/pubs/pubd/ad/321-330/321-330.htm).
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