“The percentage of non-urgent patients dropped to only 7.9 percent in 2007 [from 12.1 percent in 2006],” said Dr. Angela Gardner, president of ACEP, a national medical specialty society representing emergency medicine. “The report also makes the excellent point that non-urgent does not imply unnecessary. As we have 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 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. The report, “National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary” offers far more detail than the data brief released by the 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.
Gardner is urging the CDC to reconsider. “It is essential to know what is happening in our emergency departments as we implement health care reform,” said Gardener. “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.”
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.
“Most doctors’ offices are open for around 45 hours a week, as opposed to the 168 hours a week emergency departments are open,” said Gardner. “That nearly two-thirds of emergency patients came to the ER between 5 p.m. and 8 a.m. during the week or on weekends highlights the unpredictable nature of health emergencies. When you are the one who has a sick child, the last thing you want is a ‘closed’ sign or after-hours message.”
The report also notes that only 0.1 percent of patients die in the emergency department.
“We do an excellent job of stabilizing and treating our patients, but the persistent problems of overcrowding, ambulance diversion and boarding admitted patients in the ER are not going away,” said Gardner. “We know from the Massachusetts experience that visits will continue to rise with health care reform. We also know that as Baby Boomers age, a tsunami of patients in need of emergency care is just around the corner. We need help and we need it now.”
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.
ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.