As ‘Emergency’ Doors Close More Seek Care

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Emergency Medicine

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By Nancy Walsh, Staff Writer, MedPage Today

Published: May 30, 2013

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania

Action Points

  • Approximately 20% of adults in the U.S. sought care in the emergency department (ED) at least once in 2011, a CDC report found.
  • Although the percentage of Americans visiting the ED each year was stable, the total number of visits to emergency departments increased between 1995 and 2010, while at the same time the supply of EDs declined.

One in five adults in the U.S. sought emergency department treatment at least once during 2011, according to an annual report from the CDC.

“Although the percentage of Americans visiting the emergency department each year is stable, the total number of visits to emergency departments increased 34% between 1995 and 2010 (from 97 million to 130 million visits),” stated the agency in Health, United States, 2012.

“At the same time, the supply of emergency departments has declined by about 11% to 3,700 emergency departments in 2010,” the report noted.

The results have been problems such as crowding, delays in treatment, patient dissatisfaction, and worse outcomes.

To explore the details and ramifications of emergency department (ED) use nationwide, CDC included a special feature on this topic in its yearly report on Americans’ health, addressing issues such as which patients tend to rely on the ED for healthcare and why, the treatments they receive there, and the costs involved.

The researchers found that 27% of visits to the ED were among adults 75 and up, and 24% were children younger than 6. A total of 7% of patients had two or more ED visits.

Having Medicaid insurance was associated with ED use in 2011, when 24% of children with public insurance were treated in the ED at least once. In comparison, 15% of children covered by private insurance and 14% of uninsured children were seen in the ED at least once.

Among adults, 38% of Medicaid recipients used the ED at least once, as did 16% of those who had private insurance and 21% of those who had no insurance.

“Persons with Medicaid may be sicker than the rest of the population and may find it more difficult to locate other sources of care, and these factors may be reflected in higher emergency department use among adults and children with Medicaid coverage,” the report suggested.

The most common reasons for the ED visit by children were symptoms related to colds, in 27%, followed by injuries in 21%.

For adults, injuries were the most frequent reason, reported by 14%, while abdominal pain was reported by 9% and chest pain by 7%.

The most common types of injuries related to falls, which were the reason for ED visits in:

  • 10% of children
  • 6% of adults 18 to 64
  • 13% of adults 65 and older

Other types of injuries resulted from being hit by another person and motor vehicle accidents.

Another trend was an increase in the time spent waiting to see a physician, according to the report. In 1998 to 2000, the mean time was 45 minutes, but a decade later this had risen to 55 minutes.

The longest wait times in 2008 to 2010 were for adults ages 18 to 64 (58 minutes), women (57 minutes), and blacks (68 minutes), as well as for patients living in large metropolitan centers (67 minutes).

No change was seen between 2000 and 2010 in the frequency of x-ray use during ED visits, which remained at 35%, but the use of more sophisticated imaging such as CT and MRI tripled, from 5% to 17%.

Older patients underwent imaging studies more often, with 55% of those ages 65 and older having x-rays and 29% having more advanced imaging studies.

Most patients seen in the ED in 2009 to 2010 (81%) were discharged with instructions to seek follow-up care, but 16% were admitted to the hospital, and 2% left the ED without being seen. Fewer than 1% died during the visit.

Older patients were more likely to be admitted, with 42% of those 65 and older being hospitalized compared with only 5% of children.

Among patients who weren’t admitted, 59% were discharged with at least one drug prescription. “Across all medical care settings, the appropriate use of two of the most commonly used classes of drugs (narcotics and antibiotics) is of concern,” the report stated.

For narcotics, the difficulty for clinicians is in balancing the need for pain control with cautions about drug-seeking by unfamiliar patients in a hectic environment, while inappropriate antibiotic prescribing can worsen the ever-growing problem of resistance.

Narcotic prescriptions were most often given to adults ages 18 to 64 (25%), while antibiotics were most often prescribed for children under 18 (21%).

The final section of the special ED feature dealt with the rising expenditures, including facility and physician fees.

“Between 2000 and 2010, the mean expense for emergency department visits that did not result in a hospital admission increased 77%, from $546 (in 2010 dollars) to $969,” the authors noted.

While per-visit costs remained unchanged for children, adults 18 to 64 saw an increase from $539 to $1,097, and for those 65 and older the cost per visit rose from $720 to $1,062.

The full report also included data on a variety of other healthcare issues. For instance, it noted that life expectancy increased for men by 2.1 years between 2000 and 2010, and by 1.7 years for women.

During that decade, the age-adjusted rate of death from heart disease fell by 30%, while the mortality rate from cancer fell by 13%.

And between 2009 and 2010, the birth rate among teen girls decreased by 10% to 34.2 per 1,000, “a record low for the United States.”

The authors are employees of the CDC.

Primary source: Department of Health and Human Services, CDC
Source reference:
CDC “Health, United States, 2012” DHHS Publication no. 2013-1232.

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