Emergency rooms could get more crowded, survey says

Amy Higgins

A March 2011 poll conducted by the American College of Emergency Physicians (ACEP) showed that emergency room visits are on the rise. More than 80 percent of the 1,768 emergency physicians who responded to the poll said their emergency departments have seen an increase in emergency visits, and more than 90 percent said they anticipate increases over the next year.

The two prevailing reasons these doctors predict more emergency visits are the increase in patients without health coverage (28 percent of responses) and the growing elderly population (23 percent of responses). However, 97 percent said they treat patients on a daily basis who were referred to them by primary care doctors. An ACEP news release on the poll's findings points out that this finding goes against a widely held assumption that people are choosing to go to the emergency department instead of seeking primary care.

What's the frequency?

According to a July 2009 Robert Wood Johnson Foundation (RWJF) report on emergency department use, only about 6 percent of patients treated at emergency departments in 2003 were uninsured. The bulk of patients had private insurance, Medicaid, Children's Health Insurance Program (CHIP) coverage or Medicare that same year. So why are people opting for emergency room care rather than visiting a primary care doctor?

The most frequent emergency department users in 2006 were infants, people age 75 and over, nursing home residents, the homeless, African-Americans, and people with Medicaid or CHIP coverage, according to the RWJF report. The reasons these groups are frequenting the ER include:

  • Chronic illnesses, limited medical capabilities in nursing homes, reimbursement incentives and poor communication between patients and medical providers are some of the main reasons nursing home residents opt for emergency care, RWJF found.
  • Ninety-seven percent of ACEP poll respondents said they treated Medicaid patients on a daily basis because these patients could not find doctors who would accept their Medicaid coverage.
  • Primary doctors' business hours prevent many sick patients from receiving care at their offices. According to ACEP, two-thirds of emergency room visits occur outside business hours, when sick patients have nowhere else to turn.
  • When it comes down to it, low income and poor health are the chief motivators for emergency department visits, RWJF found.

Restructuring the future

There are consequences when emergency departments are overcrowded. Overcrowding can result in longer waiting times for care and patients leaving the emergency department without being seen, the RWJF report points out. Many times, ambulance drivers must reroute to the next available hospital because of emergency department overcrowding. Even if they are not asked to reroute, medical providers might be hesitant to take on new patients if the emergency department is overcrowded, RWJF found.

Other consequences of overcrowding include:

  • Scarcity of hospital beds for patients admitted through the emergency department.
  • Failure to provide needed antibiotics and other needed medications in time.
  • More patient deaths.
  • Not enough staff to perform treatments.

When federal health care reform's insurance mandate goes into effect in 2014, all Americans will be required to get health insurance. Massachusetts law already requires its residents to do so. Yet more insurance may not ease the growing number of emergency room visits because health insurance does not guarantee access to care, according to ACEP. And if health care reform leads to primary doctors getting reimbursed at lower rates, the problem could push more people into the ER.

"Emergency physicians command the resources of a hospital to provide the best care for patients," ACEP President Dr. Sandra Schneider says in a statement. "But we must be prepared for increasing numbers of patients, not fewer, especially given our growing elderly population."