33% of ER cases weren't emergencies

No immediate treatment was needed, study finds

February 22, 2003|By M. William Salganik | M. William Salganik,SUN STAFF

A third of emergency room visits in Maryland are for health problems that didn't need immediate treatment or could have been dealt with in a doctor's office, according to a study presented yesterday to the Maryland Health Care Commission.

"Most likely, they did not require an emergency department visit for appropriate care," said Penny Mohr, a senior research director of the Project Hope Center for Health Affairs and one of the authors of the report.

The study is a follow-up to a task force report, released last year, which found emergency room visits in Maryland approaching 2 million a year - up 31 percent from 1990.

Ben Steffen, deputy director of the commission, said both last year's task force report and the Project Hope follow-up stemmed from concerns about overuse of emergency rooms, ambulance diversions when ERs are overcrowded and the cost of hospital emergency department expansion projects.

There's been a flurry of construction for new and enlarged emergency departments - 25 since 1997, at a capital cost of $126 million, according to the commission.

Many of the newer ERs include separate areas to provide quick treatment for less serious conditions, separating the sore throat patients from those with life-threatening conditions.

State regulators have set five different rates of charges for emergency departments. Charges for the highest level, "comprehensive," are 16 times greater than for the lowest, "brief" treatment.

The Project Hope study, conducted by Mohr and her colleague Claudia L. Schur, used data from the hospitals to look at how many ER cases could have been treated elsewhere.

Since it was based on the hospital records rather than interviews with patients, it reached no conclusions about why patients choose to come to emergency rooms.

The study did, however, look at who was coming to emergency rooms most often.

For each 100 uninsured people, there were, on average 81 emergency room visits per year - compared with just 22 ER visits for each 100 people with private insurance.

About half of the visits by children under 6 and nearly 40 percent of those by patients ages 18 to 34 were for reasons that didn't require emergency room care, the study found.

Nancy Fiedler, senior vice president of the Maryland Hospital Association, said hospitals are increasingly reporting that most emergency-room patients are seriously ill, so she thought that the proportion of those considered not to need emergency-room care might be too high.

Beyond that, she said, the findings on who is using ERs most are consistent with what hospitals are reporting.

Although hospitals are not entirely sure why emergency-room use has surged, she continued, they believe that factors contributing to the trend include the closing of free-standing urgent-care centers and a shortening of physician office hours.

She also noted that regulations require emergency departments to treat all comers, while many doctors don't want to treat uninsured patients.

The Project Hope study also looked at hospital "red alerts" and "yellow alerts," in which ambulances are diverted from overcrowded emergency rooms. Four large Baltimore hospitals - Johns Hopkins, Johns Hopkins Bayview, University of Maryland Medical Center and Sinai - accounted for 25 percent of the alert hours, Schur told the commission.

Although there have been concerns about "cascading alerts" - diversions from one hospital causing crowding at another, leading to more diversions - Mohr said the data showed that 82 percent of all alerts involved only one hospital turning away patients.

The study was based on data from 2001. Steffen, of the state health commission, said earlier data didn't contain enough information, but the agency hoped to track trends over time.

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