DECATUR, Ga. — The time it takes to get treated at emergency rooms in the United States is on the rise, but hospitals are trying new methods to reduce the wait.
One tactic that's working: Some hospitals are redirecting people with less-urgent conditions to other health-care providers. But that practice comes with its own problems, some doctors say.
Annual emergency department visits increased almost 31 percent, from 94.9 million to 124 million, from 1997 to 2008. Median wait times for treatment during that period rose from 22 minutes to 33, according to a University of California at San Francisco study.
About 14 percent to 27 percent of all emergency room visits could take place at urgent-care centers or retail clinics, according to another study, published in September in Health Affairs.
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"It's perfectly rational to go to the emergency room for comparatively minor conditions if you can't access care elsewhere, if the primary-care physician can't get you in, or you can't get off work for the day," said Robin M. Weinick, lead researcher and a senior social scientist at RAND Corp.
Of course, beyond the inconvenience of a long wait time, treatment delays can be deadly. Consider the highly publicized 2006 case of a woman who came to an ER in Waukegan, Ill., with chest pains. She went into cardiac arrest after waiting two hours. Two Australian studies have suggested that overcrowding at emergency rooms might be associated with higher mortality rates.
In Milwaukee County, Wis., 48 percent of the 363,377 emergency department visits last year were non-emergencies, said Dr. Paul Coogan, emergency department medical director at Aurora Sinai Medical Center in Milwaukee.
"There's a lot of non-urgent, non-emergent use of ERs because, let's face it, we're pretty quick, open 24/7, board-certified in emergency medicine, and because of (federal) law, we have to see everybody who shows up," he said.
Since starting a program in mid-2006 that matches non-urgent patients with alternative providers, Aurora-Sinai has reduced its annual ER visits by about 23 percent, Coogan said. That percentage might have been higher if another nearby hospital had not closed, funneling more emergency patients into Aurora-Sinai, he said.
During the past 15 years, the number of emergency departments around the nation has declined by 10 percent, Coogan said.
To meet federal legal guidelines, all arriving patients at Aurora-Sinai's emergency department are seen and triaged by a physician, nurse practitioner or physician assistant, he said. If a patient is found to have a non-emergency, he is educated about the appropriate use of the emergency room to reduce unnecessary future visits and then sent to a scheduler to make a follow-up appointment with an appropriate primary-care provider.
"We don't just kick the patient out," Coogan said. "We make sure they have an appointment with a primary-care doctor in hand, and that's whether they have insurance or not."
You might assume that uninsured people are the greatest ER users for non-emergencies because of their lack of access to doctors, but it's Medicaid recipients who show up the most — at a rate five times higher than adults with private insurance in 2007, according to the UCSF study.
Last year's federal health-reform law not only will insure more people but will increase Medicaid ranks by about 16 million by 2014.
Some doctors acknowledge that some ER visits might be unnecessary, but they worry about discouraging people from coming to the emergency room. Many studies supporting redirection, such as the one by RAND Corp., are based on final diagnoses — not the symptoms people present with to the ER, said Dr. Joseph A. Duncan, medical director of the emergency department at Northwestern Medical Center in St. Albans, Vt.
"People don't come in saying I have muscle strain in the chest; they say they have chest pain," Duncan said. "We encourage people to come to the emergency room with chest pain. If you have a severe headache, how do you know if it's a migraine, an intracranial bleed or a stroke?"
His advice is to call your doctor and come to the ER when you are in doubt about whether your symptoms are serious, especially if the complaint is chest pain, a head injury, a possible serious fracture or other injury.
If you are concerned about ER wait times, some hospitals are marketing their shorter wait times by posting them online and even on billboards. ER wait times also will be reported on the U.S. Department of Health and Human Service's Hospital Compare Web site starting in 2012. Go to Hospitalcompare.hhs.gov/hospital-search.aspx?AspxAutoDetectCookieSupport=1.