From ACEP (press release):
The nation’s emergency departments saw more than 136 million patient visits in 2011, the highest number ever recorded, compared with 129.8 million in 2010, according to new data released by the Centers for Disease Control and Prevention (CDC). The percentage of patients with nonurgent medical conditions dropped by half — an overwhelming 96 percent were triaged as needing medical treatment within 2 hours, up from 92 percent in 2010.
“The growth in patient demand aligns with what emergency physicians have been seeing and predicting: demand is going to increase,” said Michael Gerardi, MD, FACEP, president of the American College of Emergency Physicians (ACEP). “Given that our nation’s population is aging, and emergency departments have a critical role as the front line of responding to disasters and infectious disease outbreaks in America, such as what we saw with Ebola, we need to prepare for increased numbers of patients.”
Experts project that emergency visits are likely to be around 140 million currently, given the 10-year trend of increasing visits at about 2.9 percent per year and factoring in a modest 1-percent growth for 2013.
Dr. Gerardi said that despite the growing need for emergency care, most hospitals had not expanded their emergency departments as of 2011, nor had they made plans to expand in the subsequent 2 years.
“Emergency departments are essential to every community and must have adequate resources,” said Dr. Gerardi. “They continue to be under severe stress and face soaring demands, despite the efficiency of caring for more than 136 million of the sickest patients each year using only 4 percent of the nation’s health care dollar. This report is more evidence that we are going to need more resources, not less, in the future.”
In addition, Dr. Gerardi said a study just released by the Colorado Hospital Association confirmed that emergency visits are up significantly in Medicaid expansion states. The study found Medicaid expansion states saw a 5.6 percent increase in Medicaid emergency visits compared with the same period last year. Emergency departments in non-expansion states saw a 1.8 percent increase, possibly the study authors speculated, because people who were previously eligible for Medicaid were getting coverage and using emergency care more.
According to the CDC report, more than half (60 percent) of patients arrived after normal business hours (after 5 pm on weekdays). One-third of visits were for patients under age 15 or over age 65. Injuries accounted for nearly 30 percent (29.5 percent) of all visits. The highest injury rates were among those aged 75 and older.
“The report also finds that there are large numbers of admitted patients who wait long times for inpatient beds,” said Dr. Gerardi. “Nearly two-thirds of patients waited 2 or more hours for beds in 2011, and nearly three-quarters of hospitals continued to board patients, even when the emergency department was critically overloaded. Hospitals must move admitted patients out of the emergency department faster to make room for the increasing number of people coming.”
According to the CDC, one-third (33 percent) of emergency departments reported going on ambulance diversion in 2011, and in a positive development, 17 percent of hospitals did not admit elective or scheduled surgical patients when the emergency department went on ambulance diversion. However, more than half of hospitals continued to admit elective or scheduled surgeries even when the ER was on diversion. The lack of flexibility in surgical schedules has been shown to contribute to emergency department crowding, as it limits availability of inpatient beds for patients admitted from the ER.
Even though these newly-released figures from the CDC pre-date the implementation of the Affordable Care Act (ACA), there is already evidence that emergency visits are on the rise now. Nearly half of emergency physicians responding to an ACEP poll in April reported a rise in emergency visits since January 1 when expanded coverage under the ACA began to take effect. Nearly 90 percent expected emergency visits to increase over the next three years, and more than three-fourths (77 percent) said their ERs are not adequately prepared for significant increases.
“Emergency departments occupy a unique place within the American health care system,” said Dr. Gerardi. “We see and treat anyone who needs us, regardless of their ability to pay, and we do so every hour of every day. To our patients, the emergency department is the right place to be at the right time.”
ACEP is the 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.
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