Hospitals Expand Emergency Rooms As Patient Visits Rise

Despite concerns from insurers over costs, a "growing number" of Americans use hospital emergency rooms for "everyday medical treatment," the Philadelphia Inquirer reports. While care at emergency rooms is "expensive and fragmented," patients are utilizing emergency rooms because primary care physicians are "scheduled ... to the hilt" and "overwhelmed" with patients. However, while visits to emergency rooms rose 7% between 1997 and 1999 over the past few years, it is "too early" to predict a long term trend. The Inquirer reports that a "backlash" against managed care, as well as medical TV shows that raise "anxiety levels" and improve the public's image of ER doctors, may have contributed to the increase in emergency room use. Even though some primary care physicians "go out of their way" to accommodate sick patients, some "won't wait even a few hours." Therefore, experts say emergency rooms are changing from a "last recourse" to a place for "24-hour access care" for "all sorts" of problems. To treat the increasing number of patients without "traditional emergencies" such as gunshot wounds or car accidents, many hospitals have expanded their emergency rooms by offering "fast track" care by hiring additional physicians' assistants and nurse practioners. Michael Carius, president-elect of the American College of Emergency Physicians, said, "You can either try to change demand, or you can try to meet demand." While emergency rooms have not seen an increase in uninsured patients, there has been a "jump" in chronically ill patients seeking care. The Inquirer reports this is due in part to medical progress, as people are living longer. In addition, doctors are "prone" to refer "hard to diagnose" cases to the emergency room.

Efficient Care, All Day, Every Day
Some doctors think it is cheaper to "centralize" after hours care at the emergency room, rather than keeping primary care offices open nights and weekends. Uwe Reinhardt, a Princeton University health economist, said, "Using the emergency room for routine procedures is actually quite efficient." Emergency rooms also offer care at "any time," so patients do not need to miss work. In addition, hospital administrators are beginning to view emergency rooms as a point of contact with patients, as 40% to 60% of inpatients come through the emergency room. Ted Christopher, director of emergency medicine at Thomas Jefferson University Hospital, said, "It's kind of like a field of dreams. If you build it, they will come. I think hospitals have realized the ER is the gateway to the hospital" (Burling, Philadelphia Inquirer, 3/16).