MHA Press Room

Study: Fewer ED patients seeing physician within recommended time

One in four emergency department patients in 2006 waited longer than recommended to be evaluated by a physician, up from one in five in 1997, according to a study in the Nov. 9 Archives of Internal Medicine. Researchers from Yale-New Haven Hospital and Yale University School of Medicine analyzed data from the National Hospital Ambulatory and Medical Care Survey to examine the percentage of patients seen by a physician within the time recommended at triage, when ED patients are prioritized on arrival based on the seriousness of their condition.

The percentage of emergent (highest priority) patients who saw a physician within the recommended 14 minutes declined to 48% in 2006 from 59% in 1997. Rising wait times are likely due to a variety of factors, including growing ED use and declining access to primary care, the authors say. They call for comparative research into the most effective methods of reducing ED crowding.

EDs Can't Sustain Care in Current Economic Environment

A recent federal report casts more concern that hospital emergency rooms are having increasing difficulty treating all comers, especially because federal payments and the uninsured don't pay their full cost of care. "There is a growing concern that EDs will not be able to sustain care for all persons in the current economic environment," according to the report, entitled Payers of Emergency Department Care, 2006, that was published by the U.S. Agency for Healthcare Research and Quality.

"Between 1993 and 2003, there was a 23% increase in ED visits and a closure of 425 hospital EDs. In addition, a recent Institute of Medicine report notes that EDs have become increasingly overcrowded, overburdened, and underfunded. Yet little is known about who is paying for ED care, what the charges are for the care, and how to potentially relieve this pressure," the report said.

AHRQ: Kids’ sports injuries commonly treated in ED

Sports-related injuries account for more than one-fifth of children’s injuries treated in the emergency department, according to a new report by the Agency for Healthcare Research and Quality. Only 1.3% of the visits result in hospital admission.

ED visits for sports-related injuries are higher in rural than urban areas, and three times higher for boys than girls. The findings are based on 2006 data from the agency’s Healthcare Cost and Utilization Project.

Report: ED crowding mainly due to lack of inpatient beds

Lack of access to inpatient beds is the main reason for continued hospital emergency department crowding, according to a report released June 1 by the Government Accountability Office. The GAO found that the average wait time to see a physician in the ED – one measure of crowding – increased from 46 minutes in 2003 to 56 minutes in 2006, while the percentage of visits in which wait time exceeded recommended time frames for patients with immediate (less than 1 minute) and emergent (within 1 to 14 minutes) acuity levels increased from 37.5% in 2003 for both to 73.9% and 50.4% respectively in 2006.

“Emergency rooms are a critical component of our nation’s health care safety net,” said Sen. Max Baucus (D-MT), who requested the report. He called the findings “unacceptable” and reiterated the need for comprehensive health care reform.

Large EDs Bear Brunt of Crowding

Large, metropolitan emergency departments that serve more than 50,000 patients each year represent just 17.7% of all emergency departments in the nation, but they accounted for 44% of all ED visits in 2007, a new Centers for Disease Control and Prevention survey shows.

The new report, Estimates of Emergency Department Capacity: United States 2007, suggests that small EDs with annual visit volume less than 20,000 patients may not be experiencing the same levels of crowding.

Patients visit EDs more often, wait longer

The number of visits to physician offices and hospital outpatient and emergency departments (ED) rose by 26% between 1996 and 2006, according to new statistics released by the Centers for Disease Control and Prevention ( CDC) this week.

The CDC data also revealed that the average waiting time in the ED is nearly 56 minutes, up from 38 minutes a decade ago. Other findings include:

The ED served as the route of admission to hospital inpatient services for roughly 50% of non-obstetric hospital patients in 2006, up from 36% in 1996.

Patients with Medicaid use the ED more frequently than patients with private insurance – 82 per 100 persons for Medicaid versus 21 per 100 for private insurance.

Most ED visits occurred after business hours (defined as 8 a.m. to 5 p.m. on weekdays), when 63% of adults and 73% of children younger than age 15 arrived.

For more information, click here.

Study: Hospitals seek alternatives to ED for non-urgent patients

Many safety-net hospitals are attempting to help non-urgent patients in their emergency departments establish “medical homes” for preventive and primary care, according to a study released May 7 by the Center for Studying Health System Change.

Some are adding primary care capacity and working with hospital specialty care clinics to treat more patients needing follow-up care, the authors said. Others are helping patients with non-urgent conditions identify other providers and schedule appointments.

However, the amount of primary care available through clinics and health centers varies by community, and overall demand for care typically exceeds supply, the authors said. Also, adding staff and health information technology to redirect patients to outpatient settings strains safety-net providers’ limited funds, they said.

The study looked at public and not-for-profit hospitals that serve large proportions of low-income, uninsured and Medicaid patients in 12 nationally representative communities.

[ via AHA News Now ]

Report looks at reasons for adult ED visits

Pneumonia was the top reason adults were admitted to the hospital from the emergency department in 2005, according to a new report from the Agency for Healthcare Research and Quality. The report presents data on adult ED visits in 23 states from the Healthcare Cost and Utilization Project.

About 19% of ED visits in those states resulted in hospital admission. Other leading reasons for admission from the ED were congestive heart failure, chest pain, heart attack and chronic obstructive pulmonary disease.

The poorest communities had nearly twice the rate of ED visits as the wealthiest communities. A future report will focus on pediatric ED visits.

Trend: Hospital EDs continue to face strain

Evidence continues to mount up that emergency departments are facing an overcrowding crisis. According to a new report published this week in the Annals of Emergency Medicine, ED visits by people aged 65 and older are a particular problem, with visits by such patients increasing 26 percent between 1993 and 2003. These older patients are generally sicker, and often need scarce inpatient beds, but that can pose a problem as well.

To find out more about the problem, read this Kaiser Daily Health Policy Report item.

Docs note rise in emergency department crowding

In a survey of nearly 1,500 practicing emergency physicians, more than 80% said crowded conditions in their emergency departments had increased either slightly (40.2%) or significantly (42.4%) in the past year, according to a recent poll from the American College of Emergency Physicians. In the study, conducted from Aug. 28 to Sept. 19, nearly 67% of respondents cited “not enough staffing and/or resources” as their leading concern about patient care.

Other top concerns included decreased throughput in the emergency department because of boarding patients (65.4%) and long wait times (65.3%). Also, 40.4% of physicians said their emergency-care environment has overcrowding and that access to specialty physicians and similar practice issues is a concern, but not yet a crisis.

Of those who responded, 703, or about 47%, said they had experienced a patient suffering as a result of crowded emergency rooms, while 200 said they had experienced a patient death for this reason at some point.

The survey was released at the 25,000-member association’s annual scientific assembly being held in Seattle this week.

[ via Jessica Zigmond, Modern Healthcare's Daily Dose ]