Emergency Department Visits Increased by More Than 32% From 1996 to 2006, CDC Report Finds

The number of emergency department visits in the U.S. increased by 36% to 119 million in 2006 from 90 million in 1996, according to a CDC report on hospital use released on Wednesday, the AP/Miami Herald reports (Stobbe, AP/Miami Herald, 8/6). At the same time, the number of EDs nationwide declined from about 4,000 to about 3,800, contributing to an increase in ED treatment wait times (Bavley, Kansas City Star, 8/6). The findings are based on data from the 2006 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (CDC release, 8/6).

According to the report, average ED wait time increased to about 56 minutes in 2006, compared with 38 minutes in 1997 (Fahy, Pittsburgh Post-Gazette, 8/7). However, the average ED wait time could be misleading because urban EDs with waits longer than an hour boost the average, according to Catharine Burt of the National Center for Health Statistics at CDC (Hellmich, USA Today, 8/7). The report's lead author, Stephen Pitts of CDC, said that half of ED users had wait times of 31 minutes or less (AP/Miami Herald, 8/6).

ED Overcrowding
Several factors contribute to overcrowding in the nation's EDs, according to the San Francisco Chronicle. Pitts said that it is getting more difficult for U.S. residents to schedule primary care appointments, which contributes to the rise in ED use. He said this trend applies to Medicare and Medicaid beneficiaries in particular (Colliver, San Francisco Chronicle, 8/7). The report found that 82 of every 100 Medicaid beneficiaries used ED care in 2006, compared to 21 of every 100 people with private insurance (Reichard, CQ HealthBeat, 8/6).

Pitts said a limited number of inpatient beds also is contributing to ED overcrowding as patients wait in the ED to be admitted (AP/Miami Herald, 8/6). As hospitals have reduced bed capacity, the "major solution over the past 10 years has been to allow these patients to sit in the hallways in the ER," Pitts said. More than half of hospital admissions in 2006 were through EDs, a 38% increase since 1996, the report found.

According to the report, although the number of uninsured U.S. residents increased by more than five million since 1996 to about 47 million, the growing uninsured population did not account for higher ED use. The report also found that the overall growth in population did not account for the trend (San Francisco Chronicle, 8/7). According to the report, about 40% of ED patients had private insurance; about 25% received health coverage through state programs; about 17% were Medicare beneficiaries; and about 17% were uninsured (AP/Miami Herald, 8/6).

Other ED Findings
The report also found that:

• About 13% of ED visits led to a hospital admission;
  
  
• Infants had the highest use of EDs of any age group;
  
  
• People older than 75 were the second-highest users of ED care (San Francisco Chronicle, 8/7); and
  
  
• ED or hospital outpatient department visits accounted for 38% of care used by blacks, compared with 17% for whites (CQ HealthBeat, 8/6).

Overall Hospital Use
The report also examined other types of ambulatory care visits in hospital outpatient departments and physicians offices. Overall ambulatory care increased by 26% to 1.1 billion visits in 2006 compared with a decade earlier, despite just an 11% growth in population, according to USA Today (USA Today, 8/7).

The report is available online (.pdf).

NBC's "Nightly News" on Wednesday reported on how EDs have become a source of primary care for an increasing number of U.S. residents. The segment includes comments from Ricardo Martinez of the American College of Emergency Physicians and Mark Spektor of Maimonides Medical Center (Bazell, "Nightly News," NBC, 8/6).